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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 2025, 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 2025.
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 $106.00. 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 $3650.00 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 has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay different amounts depending on the drug tier and whether you use a preferred or standard pharmacy. For example, you will pay an $8 copay for preferred generic drugs at a standard pharmacy. For standard generic drugs, you will pay 23% coinsurance, and 50% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for Part D covered drugs.
Additional Benefits
The Tufts Medicare Preferred HMO Prime Rx (HMO) plan offers comprehensive coverage, including inpatient hospital stays with a $300 copay per admission, outpatient services with varying copays, and ambulance services for a $125 copay. Emergency services have a $110 copay, and primary care visits have a $10 copay, while preventive services, home health, and lab services are available with no copay. The plan also includes coverage for hearing and vision services, with copays for exams and benefits for eyewear. Dental services are covered with a $15 copay for Medicare dental services. Additionally, the plan offers benefits for dialysis, medical equipment, and diagnostic services with varying cost-sharing, as well as skilled nursing facility services with copays that vary based on the length of stay.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, each with a $300 copay per admission or stay and a service-specific out-of-pocket maximum of $900. Additional Days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a copay of $0-$100, Observation Services have a copay of $100, Ambulatory Surgical Center Services have no copay, and both Individual and Group Sessions for Outpatient Substance Abuse have a copay of $10.
Partial Hospitalization See details
Partial Hospitalization is covered by the plan. There is no information about the cost of the service.
Ambulance and Transportation Services See details
The Tufts Medicare Preferred HMO Prime Rx (HMO) plan covers ambulance and transportation services, with a $125 copay for both ground and air ambulance services; there is no coinsurance. Transportation services to a plan-approved health-related location are covered, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered by the Tufts Medicare Preferred HMO Prime Rx (HMO) plan, with a $110 copay, and Urgently Needed Services have a $30 copay. Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $30 copay, and Worldwide Emergency Transportation has a $125 copay. There is no coinsurance for any of these services.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with a $10 copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $15 copay, Physician Specialist Services with a $15 copay, Mental Health Specialty Services with a $0-$10 copay, Other Health Care Professional with a $10-$20 copay, Psychiatric Services with a $0-$10 copay, Physical Therapy and Speech-Language Pathology Services with a $15 copay, Additional Telehealth Benefits with a $0-$100 copay, and Opioid Treatment Program Services with a $15 copay. Podiatry Services are not covered.
Preventive Services See details
The Tufts Medicare Preferred HMO Prime Rx (HMO) plan covers preventive services, including annual physical exams, with no copay. Additional preventive services are covered, but may have coinsurance for some services.
Hearing Services See details
Hearing services include hearing exams with a $15 copay, routine hearing exams, and fitting/evaluation for hearing aids. Prescription hearing aids are partially covered, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $15 copay, and eyewear with a combined maximum plan benefit of $150 per year. Eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, contact lenses, and upgrades are also covered.
Dental Services See details
Dental Services are covered under the Tufts Medicare Preferred HMO Prime Rx (HMO) plan, with a $15 copay for Medicare Dental Services, but Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics, Oral and Maxillofacial Surgery, and Orthodontics are not covered. Prior authorization and a doctor referral are required for Medicare Dental Services.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, are covered under the Tufts Medicare Preferred HMO Prime Rx (HMO) plan, but Medicare Part B Chemotherapy/Radiation Drugs are not covered. Prior authorization is required for Home Infusion bundled Services, and the plan offers step therapy, stepping from Part B to Part D.
Dialysis Services See details
Dialysis Services are covered under the Tufts Medicare Preferred HMO Prime Rx (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Tufts Medicare Preferred HMO Prime Rx (HMO) plan, with Durable Medical Equipment (DME) subject to a 10% coinsurance and no copay, and Prosthetics/Medical Supplies subject to a 10% coinsurance and no copay. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with the plan requiring prior authorization. Diagnostic Procedures/Tests have a copay between $0 and $30, while Lab Services have no copay. Diagnostic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have no copay. Therapeutic Radiological Services are not covered.
Home Health Services See details
Home Health Services are covered by the Tufts Medicare Preferred HMO Prime Rx (HMO) plan, with no copay or coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the sub-services are covered, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is a $20 copay; days 21-44 have an $80 copay; and days 45-100 have no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for acupuncture with no copay or coinsurance, a meal benefit, and "Other 1" services with a 10% coinsurance. Over-the-counter items, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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