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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 $116.00. 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 coverage begins immediately. For Tier 1 preferred generic drugs, standard pharmacy copays are $4 for a 1-month supply and $12 for a 3-month supply, while Tier 2 generic drugs cost $8 for 1-month and $24 for 3-month supplies. Additionally, Tier 6 vaccines are covered with no copay at standard pharmacies. Brand-name and specialty medications are covered under coinsurance, with Tier 3 preferred brands requiring a 20% coinsurance and Tier 4 non-preferred drugs requiring 40% coinsurance. Tier 5 specialty drugs carry a 33% coinsurance for a 1-month supply through standard pharmacies and mail order. You can also save on generic medications by utilizing standard mail-order services, which offer a 3-month supply of Tier 1 drugs for an $8 copay and Tier 2 drugs for a $16 copay.
Additional Benefits
The Tufts Medicare Preferred HMO Prime Rx (HMO) plan offers affordable access to essential medical care, featuring a low $10 copay for primary care visits, a $15 copay for specialists, and no copay for annual physical exams. Emergency room visits require a $110 copay, which is waived if you are admitted, while inpatient hospital stays incur a $300 copay per stay with no coinsurance. Outpatient hospital services are also cost-effective, ranging from no copay to a $100 copay, with no coinsurance. For specialized care, the plan provides routine hearing and vision exams for a $15 copay, alongside a $150 annual eyewear allowance and prescription hearing aid coverage. Skilled nursing facility stays feature no coinsurance, with daily copays of $20 for days 1 to 20 and $80 for days 21 to 44. Additionally, members benefit from no copay on home health care, unlimited acupuncture, and approved transportation services.
Inpatient Hospital See details
Tufts Medicare Preferred HMO Prime Rx (HMO) partially covers inpatient hospital services with a $300 copay per stay and no coinsurance for both acute and psychiatric admissions. Unlimited additional days are covered for acute care, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $100 copay and observation services with a $100 copay per stay. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse services have a $10 copay and no coinsurance.
Partial Hospitalization See details
Tufts Medicare Preferred HMO Prime Rx (HMO) covers partial hospitalization services 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), featuring a $175 copay and no coinsurance for both ground and air ambulance services. Unlimited one-way transportation to plan-approved health-related locations is available with no copay or coinsurance, though transportation to any other 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 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
Primary care benefits under the Tufts Medicare Preferred HMO Prime Rx (HMO) are partially covered, featuring no coinsurance for all services, a $10 copay for primary care visits, and a $15 copay for specialists and physical therapy. Routine chiropractic care and podiatry services are not covered under this plan.
Preventive Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay, though home and bathroom safety devices require 10% coinsurance, and sub-services such as PERS, adult day health, home-based palliative care, in-home support, caregiver support, counseling, telemonitoring, remote access, post-discharge medication reconciliation, readmission prevention, enhanced disease management, and additional smoking cessation are not covered.
Hearing Services See details
Hearing services are partially covered by Tufts Medicare Preferred HMO Prime Rx (HMO), offering annual routine exams with a $15 copay, no coinsurance, and no deductible. Prescription hearing aids are covered with no coinsurance and copays ranging from $250 to $1,150, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered under the Tufts Medicare Preferred HMO Prime Rx (HMO), offering one routine annual eye exam with a $15 copay and no coinsurance (referral required), while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing up to a $150 annual maximum benefit for contacts, frames, lenses, and upgrades.
Dental Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) partially covers dental services, offering coverage only for Medicare-covered dental services with a $15.00 copay and no coinsurance. Non-Medicare dental services, including preventive care like cleanings and exams, and comprehensive services like restorative work 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 and step therapy are required. While Part D home infusion drugs and Part B insulin are covered with no copay or coinsurance, Medicare Part B chemotherapy, radiation, and other Part B drugs are not covered.
Dialysis Services See details
Dialysis Services are covered by Tufts Medicare Preferred HMO Prime Rx (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Tufts Medicare Preferred HMO Prime Rx (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and coinsurance ranging from 0% to 10%, with prior authorization required. Diabetic equipment is partially covered with no copay or coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) partially covers diagnostic and radiological services, with therapeutic radiological services excluded from coverage. Diagnostic services require prior authorization and have no coinsurance, featuring no copay for lab services and a $0 to $30 copay for tests, while covered radiological services require prior authorization and include outpatient X-rays with no copay and diagnostic radiological services with a minimum 20% coinsurance and a copay.
Home Health Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) does not cover Cardiac Rehabilitation Services, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Tufts Medicare Preferred HMO Prime Rx (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior 3-day hospital stay required, though prior authorization is necessary. Patients pay a daily copay of $20 for days 1-20, $80 for days 21-44, and no copay for days 45-100, with additional days beyond the 100-day benefit period not covered.
Other Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) partially covers Other Services, offering unlimited acupuncture treatments with no copay and no coinsurance. Over-the-counter (OTC) items and meal benefits are not covered under this plan.
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