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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 2025, 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 2025.
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 $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:
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 a range of benefits with varying cost-sharing. Inpatient hospital stays have a $300 copay per admission, while outpatient services can have copays between $0 and $100. Emergency services and ambulance services are covered with copays, and transportation to health-related locations is available with no copay. This plan includes coverage for primary care visits with a $10 copay, along with vision, hearing, and dental services with copays. Preventive services are covered, and home health services have no copay. Additionally, the plan provides coverage for medical equipment and diagnostic services.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both with a $300 copay per admission or stay, and an out-of-pocket maximum of $900.00. Additional Days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay of $0-$100, observation services with a $100 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $10 copay for individual and group sessions, and outpatient blood services. Prior authorization and a doctor referral are required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered by the plan.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with all ambulance services requiring prior authorization. Ground and air ambulance services have a $125 copay, while transportation services to a plan-approved health-related location are covered with no copay or coinsurance.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Tufts Medicare Preferred HMO Prime No Rx (HMO) plan. Emergency Services have a $110 copay, 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.
Primary Care See details
The Tufts Medicare Preferred HMO Prime No Rx (HMO) plan covers primary care physician services with a $10 copay. Chiropractic services are covered with a $15 copay, but routine chiropractic care is not covered. Occupational therapy, specialist, and physical therapy services have a $15 copay, while mental health and psychiatric individual and group sessions have $0-$10 copays. Other health care professionals have copays between $10-$20. Additional telehealth benefits have copays between $0-$100, and Opioid Treatment Program Services have a $15 copay.
Preventive Services See details
Preventive Services are covered, including services not usually covered by Medicare plans; however, Personal Emergency Response System (PERS), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, and Counseling Services are not covered. Home and Bathroom Safety Devices and Modifications have a 10% coinsurance, and wigs for chemotherapy have a $500 maximum benefit per year.
Hearing Services See details
Hearing Services are covered, including hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a $15 copay, and routine hearing exams and fitting/evaluation for hearing aids are each covered once per year. Prescription hearing aids (all types) are covered with a copay between $250 and $1150. However, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
Vision services include coverage for eye exams with a $15 copay, routine eye exams with a $15 copay, contact lenses, eyeglasses (lenses and frames), eyeglass lenses and eyeglass frames. Eyewear has a combined maximum benefit of $150 every year, and upgrades are covered.
Dental Services See details
Dental Services are partially covered under the Tufts Medicare Preferred HMO Prime No Rx (HMO) plan, with a $15 copay for Medicare Dental Services. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Tufts Medicare Preferred HMO Prime No Rx (HMO) plan, with prior authorization required. Medicare Part B Insulin Drugs are covered. Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis services are covered under the Tufts Medicare Preferred HMO Prime No Rx (HMO) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered by Tufts Medicare Preferred HMO Prime No Rx (HMO), with no copay. Durable Medical Equipment (DME) has a 10% coinsurance, but DME for use outside the home is not covered. Prosthetic devices have a 10% coinsurance, and medical supplies have a 0% to 10% coinsurance. Diabetic equipment is covered, but diabetic supplies and therapeutic shoes/inserts are not.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with a copay, and diagnostic procedures/tests with a copay between $0 and $30. Lab services have no copay, while diagnostic radiological services have a coinsurance of at most 20%, and therapeutic radiological services are not covered. Outpatient X-Ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Tufts Medicare Preferred HMO Prime No Rx (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires both authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but this plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor's referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization, with a copay of $20 for days 1-20, $80 for days 21-44, and no copay for days 45-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture, which is covered, and "Other 1" which covers medical stockings and sleeves with a 10% coinsurance, but does not cover over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, 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. The plan also offers a meal benefit for a chronic illness.
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