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Tufts Medicare Preferred HMO Prime No Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Tufts Medicare Preferred HMO Prime No 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 No Rx (HMO) in 2026, please refer to our full plan details page.
Tufts Medicare Preferred HMO Prime No 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 No Rx (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Tufts Medicare Preferred HMO Prime No 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 No Rx (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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:
Sign up for Tufts Medicare Preferred HMO Prime No Rx (HMO)
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Drug Coverage
Prescription drugs are not covered by Tufts Medicare Preferred HMO Prime No Rx (HMO).
Additional Benefits
The Tufts Medicare Preferred HMO Prime No Rx (HMO) plan offers comprehensive medical coverage, featuring a ten-dollar copay for primary care physician visits and a fifteen-dollar copay for specialists. Inpatient hospital stays require a three-hundred-dollar copay per stay with no coinsurance, while outpatient services are available with no coinsurance and copays ranging from no copay up to one hundred dollars. Emergency room visits incur a one-hundred-and-ten-dollar copay, which is waived upon admission, while preventive care and home health services require no copay. Routine vision and hearing exams are covered with a fifteen-dollar copay, and members receive a one-hundred-and-fifty-dollar annual eyewear allowance with no copay. Although routine dental services are not covered, the plan offers acupuncture and approved transportation with no copay. Durable medical equipment is covered with no copay and a ten percent coinsurance, helping keep your healthcare costs predictable.
Inpatient Hospital See details
Tufts Medicare Preferred HMO Prime No Rx (HMO) covers inpatient acute and psychiatric hospital stays with a $300 copay per stay and no coinsurance, with prior authorization required for acute care. This benefit is partially covered because hospital upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Tufts Medicare Preferred HMO Prime No Rx (HMO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay. Outpatient hospital services require a $0 to $100 copay, observation services have a $100 copay per stay, and outpatient substance abuse sessions incur a $10 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Tufts Medicare Preferred HMO Prime No Rx (HMO) plan with no copay and no coinsurance.
Ambulance and Transportation Services See details
Tufts Medicare Preferred HMO Prime No Rx (HMO) covers ground and air ambulance services with a $175 copay, no coinsurance, and prior authorization required. Transportation services are partially covered, providing unlimited one-way rides to plan-approved locations with no copay and no coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
Tufts Medicare Preferred HMO Prime No Rx (HMO) covers emergency services with a $110 copay and no coinsurance, which is waived if you are admitted to the hospital within one day, and urgently needed services with a $30 copay and 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 No Rx (HMO) provides partially covered primary care benefits with no coinsurance, featuring a $10 copay for primary care physician visits and a $15 copay for specialists, chiropractic evaluations, and physical therapy. While mental health and psychiatric services range from no copay to a $10 copay, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Tufts Medicare Preferred HMO Prime No 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, offering fitness benefits and nutrition therapy with no copay, though home and bathroom safety devices require a 10% coinsurance and certain services like personal emergency response systems, adult day health, and caregiver support are not covered.
Hearing Services See details
Hearing services are partially covered by Tufts Medicare Preferred HMO Prime No Rx (HMO), featuring a $15 copay and no coinsurance for annual routine hearing exams and fitting evaluations. Prescription hearing aids are covered with no coinsurance and copays ranging from $250 to $1,150 for up to two devices per year, but OTC hearing aids and inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Vision services are partially covered by Tufts Medicare Preferred HMO Prime No Rx (HMO) because other eye exam services are not covered. Covered benefits include one routine eye exam per year for a $15 copay and no coinsurance, as well as eyewear with no copay or coinsurance up to a $150 annual maximum.
Dental Services See details
Tufts Medicare Preferred HMO Prime No Rx (HMO) partially covers dental services, offering Medicare-covered dental care for a $15 copay and no coinsurance, which requires prior authorization and a referral. Routine preventive care, diagnostic services, restorative treatments, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are partially covered by Tufts Medicare Preferred HMO Prime No Rx (HMO) with no copay and no coinsurance, although prior authorization is required. Under this benefit, Medicare Part B insulin drugs are covered with no copay and no coinsurance, while Medicare Part B chemotherapy or radiation drugs and other Part B drugs are not covered.
Dialysis Services See details
Dialysis Services are covered by Tufts Medicare Preferred HMO Prime No Rx (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Tufts Medicare Preferred HMO Prime No Rx (HMO) covers medical equipment with no copays, featuring a 10% coinsurance for durable medical equipment and prosthetic devices, and no coinsurance to 10% coinsurance for medical supplies. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Tufts Medicare Preferred HMO Prime No Rx (HMO), as therapeutic radiological services are not covered. Diagnostic services require prior authorization but have no coinsurance, featuring no copay for lab services and a $0 to $30 copay for tests. Outpatient X-rays have no copay, while diagnostic radiological services require prior authorization, a copay, and a 20% coinsurance.
Home Health Services See details
Tufts Medicare Preferred HMO Prime No 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
Tufts Medicare Preferred HMO Prime No Rx (HMO) offers Cardiac Rehabilitation Services with no copay and no coinsurance, but in practice, some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Tufts Medicare Preferred HMO Prime No Rx (HMO) covers skilled nursing facility services with no coinsurance, requiring a $20 copay for days 1 to 20, an $80 copay for days 21 to 44, and no copay for days 45 to 100. Prior authorization is required, no prior 3-day hospital stay is needed, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other Services are partially covered under the Tufts Medicare Preferred HMO Prime No Rx (HMO), featuring unlimited acupuncture treatments with no copay and no coinsurance. However, over-the-counter (OTC) items and meal benefits are not covered under this plan.
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