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Tufts Medicare Preferred HMO Prime Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Tufts Medicare Preferred HMO Prime Rx (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Tufts Medicare Preferred HMO Prime Rx (HMO) in 2026, please refer to our full plan details page.
Tufts Medicare Preferred HMO Prime Rx (HMO) is a HMO plan offered by Point32Health, Inc. available for enrollment in 2025 to people living in Most of Massachusetts. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Tufts Medicare Preferred HMO Prime Rx (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Tufts Medicare Preferred HMO Prime Rx (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Tufts Medicare Preferred HMO Prime Rx (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $193.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3850.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Tufts Medicare Preferred HMO Prime Rx (HMO) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, you will pay a copay of $4 for a one-month supply at standard pharmacies and standard mail order. Tier 2 generic drugs have an $8 copay for a one-month supply, while Tier 6 vaccines are available with no copay. For brand-name and specialty medications, costs are determined by coinsurance. Tier 3 preferred brand drugs require a 20% coinsurance, Tier 4 non-preferred drugs require a 40% coinsurance, and Tier 5 specialty drugs require a 33% coinsurance for a one-month supply. Standard mail-order options are available for these tiers, offering convenient delivery options for your prescriptions.
Additional Benefits
The Tufts Medicare Preferred HMO Prime Rx (HMO) plan offers robust medical coverage with predictable out-of-pocket costs, including no copay for preventive services, home health care, and partial hospitalization. Inpatient hospital stays require a $300 copay per stay with no coinsurance, while outpatient hospital services range from no copay up to a $100 copay. Primary care visits carry a $10 copay, specialists require a $15 copay, and emergency room visits have a $110 copay which is waived if you are admitted. For supplemental care, the plan covers annual routine eye and hearing exams for a $15 copay, alongside a $150 annual eyewear allowance and prescription hearing aid coverage with copays from $250 to $1,150. Skilled nursing facility stays require daily copays for the first 44 days but have no copay for days 45 through 100. Additionally, diagnostic lab tests, outpatient X-rays, and plan-approved transportation are available with no copay, while durable medical equipment requires a 10% coinsurance and no copay.
Inpatient Hospital See details
Tufts Medicare Preferred HMO Prime Rx (HMO) covers inpatient acute and psychiatric hospital stays with a $300 copay per stay and no coinsurance. While unlimited additional days are covered for acute care, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Tufts Medicare Preferred HMO Prime Rx (HMO) with no coinsurance, featuring a $0 to $100 copay for outpatient hospital services and a $100 copay per stay for observation services. Additionally, there is no copay or coinsurance for ambulatory surgical center and blood services, while outpatient substance abuse sessions require a $10 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the Tufts Medicare Preferred HMO Prime Rx (HMO) plan with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Tufts Medicare Preferred HMO Prime Rx (HMO), with ground and air ambulance requiring a $175 copay and no coinsurance. Transportation services are partially covered, offering unlimited one-way rides to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) covers emergency services with a $110 copay, which is waived if admitted to the hospital within one day, and urgently needed services with a $30 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $110, $30, and $175, respectively.
Primary Care See details
Tufts Medicare Preferred HMO Prime Rx (HMO) offers partially covered primary care benefits with no coinsurance, featuring a $10 copay for PCP visits and a $15 copay for specialist, therapy, and chiropractic services. Mental health and telehealth services range from no copay up to a $100 copay with no coinsurance, while routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) covers core preventive services, such as annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering services like fitness benefits and alternative therapies with no copay, while home safety modifications require a 10% coinsurance, and personal emergency response systems and in-home support are not covered.
Hearing Services See details
Hearing services are partially covered by Tufts Medicare Preferred HMO Prime Rx (HMO), offering one routine exam and fitting annually for a $15 copay and no coinsurance. Up to two prescription hearing aids are covered per year with a copay ranging from $250 to $1,150 and no coinsurance, while OTC hearing aids as well as inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) offers partially covered vision services, featuring one annual routine eye exam with a $15 copay, no coinsurance, and a required referral, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $150 annual maximum for contacts, eyeglasses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Tufts Medicare Preferred HMO Prime Rx (HMO), which provides Medicare-covered dental services for a $15 copay and no coinsurance. Other dental services, including oral exams, cleanings, x-rays, fluoride, restorative services, endodontics, periodontics, and orthodontics, are not covered.
Home Infusion bundled Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) partially covers Home Infusion bundled Services with no copay and no coinsurance, though prior authorization is required. Under this benefit, insulin is covered with no copay and no coinsurance, while Medicare Part B chemotherapy/radiation drugs and other Part B drugs are not covered.
Dialysis Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Tufts Medicare Preferred HMO Prime Rx (HMO) covers medical equipment with no copays, though prior authorization is required and coinsurance ranges from 0% to 10%. Durable medical equipment and prosthetics require a 10% coinsurance, while diabetic equipment is partially covered with no coinsurance, excluding diabetic supplies and therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) partially covers diagnostic and radiological services, with lab services and outpatient X-rays offered at no copay or coinsurance. Diagnostic procedures and tests carry a copay of $0 to $30 with no coinsurance, diagnostic radiological services require both a copay and a minimum 20% coinsurance, and therapeutic radiological services are not covered.
Home Health Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Tufts Medicare Preferred HMO Prime Rx (HMO) plan. This includes no coverage for standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Tufts Medicare Preferred HMO Prime Rx (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. Patients pay a $20 daily copay for days 1 to 20, an $80 daily copay for days 21 to 44, and no copay for days 45 to 100, though additional days beyond the standard 100 days are not covered.
Other Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) partially covers Other Services, providing unlimited acupuncture treatments with no copay and no coinsurance. Over-the-counter (OTC) items, meal benefits, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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