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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:
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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) offers comprehensive medical coverage featuring no copays or coinsurance for many preventive services, home health visits, and cardiac rehabilitation. For inpatient hospital stays, members pay a $300 copay per stay with no coinsurance, while primary care visits require a $10 copay and specialist visits require a $15 copay. Emergency services are covered with a $110 copay, which is waived if admitted within one day, and urgent care has a $30 copay. Routine vision and hearing exams are available for a $15 copay, plus the plan provides up to a $150 annual allowance for eyewear with no copay. While preventive dental is not covered, Medicare-covered dental services require a $15 copay, and durable medical equipment is covered with a 10% coinsurance and no copay. Skilled nursing facility stays feature a $20 daily copay for the first 20 days, an $80 daily copay for days 21 through 44, and no copay for days 45 through 100.
Inpatient Hospital See details
Tufts Medicare Preferred HMO Prime No Rx (HMO) covers inpatient hospital services with a $300 copay per stay and no coinsurance for both acute and psychiatric admissions. This benefit is partially covered, as room upgrades, non-Medicare-covered stays, and additional psychiatric days are excluded.
Outpatient Services See details
Tufts Medicare Preferred HMO Prime No Rx (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services have a copay ranging from $0 to $100, observation services require a $100 copay per stay, and outpatient substance abuse sessions have a $10 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Tufts Medicare Preferred HMO Prime No Rx (HMO) with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Tufts Medicare Preferred HMO Prime No Rx (HMO), featuring a $175 copay and no coinsurance for prior-authorized ground and air ambulance services. Transportation services are partially covered, providing unlimited one-way trips to plan-approved health-related locations with no copay and no coinsurance, though transportation to any 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, with the copay waived if you are admitted to the hospital within one day. Urgently needed services require a $30 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $30 to $175.
Primary Care See details
Tufts Medicare Preferred HMO Prime No Rx (HMO) covers primary care visits for a $10 copay and specialist visits, physical therapy, and occupational therapy for a $15 copay, all with no coinsurance. Mental health services range from no copay to a $10 copay with no coinsurance, though 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 screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered, featuring no copay for fitness and weight programs and a 10% coinsurance for home safety devices. However, personal emergency response systems, post-discharge medication reconciliation, readmission prevention, adult day health, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, remote technologies, counseling, and extra smoking cessation sessions are not covered.
Hearing Services See details
Hearing services are covered by Tufts Medicare Preferred HMO Prime No Rx (HMO), which offers routine exams and fitting evaluations for a $15 copay and no coinsurance. Up to two prescription hearing aids are covered per year with a copay ranging from $250 to $1150 and no coinsurance, though OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Tufts Medicare Preferred HMO Prime No Rx (HMO) covers vision services, offering one routine annual eye exam with a $15 copay, no coinsurance, and a required referral, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $150 annual maximum allowance.
Dental Services See details
Tufts Medicare Preferred HMO Prime No Rx (HMO) partially covers dental services, offering coverage only for Medicare-covered dental services with a $15 copay and no coinsurance, subject to prior authorization and referral requirements. Preventive and comprehensive dental services, including cleanings, exams, x-rays, restorative treatments, and orthodontics, are not covered.
Home Infusion bundled Services See details
Tufts Medicare Preferred HMO Prime No Rx (HMO) partially covers home infusion bundled services with no copay and no coinsurance, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs are covered with no copay or coinsurance, while chemotherapy, radiation, and other Medicare 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, though prior authorization is required. Durable medical equipment and prosthetics carry a 10% coinsurance, medical supplies have a 0% to 10% coinsurance, and diabetic equipment is partially covered with no coinsurance as diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services under Tufts Medicare Preferred HMO Prime No Rx (HMO) are partially covered, as therapeutic radiological services are not covered. Covered diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $30 copay for procedures, while outpatient X-rays require no copay and diagnostic radiological services require both a copay and a minimum 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, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Tufts Medicare Preferred HMO Prime No Rx (HMO) with no copay and no coinsurance, though prior authorization and referrals are required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Tufts Medicare Preferred HMO Prime No Rx (HMO) with no coinsurance, featuring a $20 daily copay for days 1 through 20, an $80 daily copay for days 21 through 44, and no copay for days 45 through 100. Prior authorization is required and a prior three-day hospital stay is not needed, but additional days beyond the standard 100 days are not covered.
Other Services See details
Tufts Medicare Preferred HMO Prime No 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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