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Tufts Medicare Preferred HMO Value Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Tufts Medicare Preferred HMO Value 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 Value Rx (HMO) in 2026, please refer to our full plan details page.
Tufts Medicare Preferred HMO Value 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 Value 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 Value 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 Value Rx (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $188.00. 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 Value Rx (HMO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generics, you pay no copay at preferred pharmacies or through standard mail order, while standard pharmacies charge a $14 copay for a one-month supply. Tier 2 generics cost a low $4 copay for a one-month supply at preferred pharmacies and standard mail order, compared to a $19 copay at standard pharmacies. Brand-name and specialty medications are subject to coinsurance rather than flat copays under this plan. You will pay 20% coinsurance for Tier 3 preferred brands, 40% coinsurance for Tier 4 non-preferred drugs, and 33% coinsurance for Tier 5 specialty drugs. Additionally, Tier 6 vaccines are fully covered with no copay at both preferred and standard pharmacies.
Additional Benefits
The Tufts Medicare Preferred HMO Value Rx (HMO) plan offers comprehensive coverage for essential medical services with low copays and no coinsurance for most primary care. Primary care visits require a $10 copay, specialist visits are $25, and inpatient hospital stays have a $200 daily copay for the first five days with no copay thereafter. Emergency care is covered worldwide with a $125 copay, which is waived if admitted within one day, and urgent care is available for a $30 copay. In addition to medical care, the plan provides preventive services and home health care with no copay or coinsurance. Dental services are covered up to a $1,000 annual maximum, eyewear is covered up to $150, and routine hearing exams require a $25 copay. Skilled nursing facility stays are also covered with no coinsurance, featuring a $20 daily copay for the first 20 days and no copay for days 45 through 100.
Inpatient Hospital See details
Tufts Medicare Preferred HMO Value Rx (HMO) partially covers inpatient hospital stays with no coinsurance, requiring a $200 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute hospital days are covered, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Tufts Medicare Preferred HMO Value Rx (HMO) covers outpatient services with no coinsurance, featuring a $0 to $150 copay for outpatient hospital services and a $150 copay per stay for observation services. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $20 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the Tufts Medicare Preferred HMO Value Rx (HMO) plan with no copay and no coinsurance.
Ambulance and Transportation Services See details
Tufts Medicare Preferred HMO Value Rx (HMO) covers ground and air ambulance services with a $225 copay and no coinsurance, requiring prior authorization. Unlimited one-way transportation to plan-approved health-related locations is also covered with no copay or coinsurance, though transportation to any other health-related locations is not covered.
Emergency Services See details
Tufts Medicare Preferred HMO Value Rx (HMO) covers emergency services with a $125 copay (waived if admitted to the hospital within one day) and urgently needed services with a $30 copay, both with no coinsurance and no plan-level deductible. Worldwide emergency services are also covered with no coinsurance, featuring copays of $125 for emergency care, $30 for urgent care, and $225 for emergency transportation.
Primary Care See details
Tufts Medicare Preferred HMO Value Rx (HMO) covers primary care visits for a $10 copay, specialist visits for a $25 copay, and therapy services for a $20 copay, all with no coinsurance. Mental health, psychiatric, and telehealth services are covered with no coinsurance and copays ranging from no copay up to $150. Podiatry services and routine chiropractic care are not covered.
Preventive Services See details
Tufts Medicare Preferred HMO Value Rx (HMO) covers preventive services, including annual physical exams and kidney disease education with no copay and no coinsurance, and an EKG following a welcome visit for a $10 copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance for fitness, weight management, and alternative therapies, while home and bathroom safety devices require a 10% coinsurance and no copay. Sub-services such as personal emergency response systems, post-discharge medication reconciliation, readmission prevention, adult day health, home-based palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access, and counseling are not covered.
Hearing Services See details
Hearing services are covered by Tufts Medicare Preferred HMO Value Rx (HMO), including annual routine exams and fitting evaluations for a $25 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $250 to $1,150 for up to two devices per year, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Tufts Medicare Preferred HMO Value Rx (HMO), as other eye exam services are not covered. Covered eye exams require a $15 to $25 copay and no coinsurance, while eyewear is covered with no copay, no coinsurance, and no deductible up to a $150 annual maximum.
Dental Services See details
Dental services are partially covered by Tufts Medicare Preferred HMO Value Rx (HMO) up to a $1,000 annual maximum, with a $25 copay and no coinsurance for Medicare-covered dental. Other covered services, such as cleanings, exams, and fillings, require no copay and coinsurance ranging from 0% to 50%. Fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are partially covered by Tufts Medicare Preferred HMO Value Rx (HMO) with no copay and no coinsurance, although prior authorization and step therapy are required. Medicare Part B insulin drugs are covered under this benefit, but Medicare Part B chemotherapy, radiation, and other Part B drugs are not covered.
Dialysis Services See details
Dialysis Services are covered under the Tufts Medicare Preferred HMO Value Rx (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Tufts Medicare Preferred HMO Value Rx (HMO) partially covers medical equipment with no copays, requiring a 10% coinsurance for durable medical equipment (DME) and prosthetics, and 0% to 10% coinsurance for medical supplies. Diabetic equipment is 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 Value Rx (HMO) with no coinsurance, though prior authorization is required. Lab services have no copay, outpatient X-rays require a $10 copay, diagnostic tests range from a $10 to $30 copay, and diagnostic radiological services have a minimum $100 copay, while therapeutic radiological services are not covered.
Home Health Services See details
Home health services are covered by the Tufts Medicare Preferred HMO Value Rx (HMO) plan with no copay and no coinsurance. Both prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Tufts Medicare Preferred HMO Value Rx (HMO) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, requiring prior authorization and a referral. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Tufts Medicare Preferred HMO Value Rx (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1-20, a $120 daily copay for days 21-44, and no copay for days 45-100. Prior authorization is required, a prior three-day hospital stay is not, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services under the Tufts Medicare Preferred HMO Value Rx (HMO) are partially covered, offering unlimited acupuncture treatments with no copay and no coinsurance. Over-the-counter (OTC) items and meal benefits are not covered.
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