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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 2025, 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 2025.
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 $178.00. 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 $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:
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Drug Coverage
The Tufts Medicare Preferred HMO Value Rx (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $4 copay at preferred pharmacies and a $19 copay at standard pharmacies, while specialty tier drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, your monthly premium will be reduced.
Additional Benefits
The Tufts Medicare Preferred HMO Value Rx (HMO) plan offers a range of additional benefits to help cover your healthcare needs. This plan includes coverage for inpatient hospital stays with a copay, outpatient services, and ambulance services. You'll also have access to primary care, hearing, vision, and dental services, each with its own copay or coinsurance structure. Preventive services, home health services, and several other services are covered, often with no copay. The plan also offers some coverage for medical equipment, dialysis, and diagnostic services. However, it's important to note that certain services like Cardiac Rehabilitation, some hearing aids, and specific dental procedures are not covered.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you'll pay a $200 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay between $0 and $150, observation services with a $150 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services are covered with a $20 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Tufts Medicare Preferred HMO Value Rx (HMO) plan. Ground and air ambulance services have a copay of $225, while transportation services to a plan-approved health-related location are covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay, and Urgently Needed Services have a $30 copay, while Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $30 copay, and Worldwide Emergency Transportation has a $225 copay; all services have no coinsurance.
Primary Care See details
Primary Care Physician Services have a $10 copay, Chiropractic Services have a $15 copay, Occupational Therapy Services have a $20 copay, Physician Specialist Services have a $25 copay, and Physical Therapy and Speech-Language Pathology Services have a $20 copay. Mental Health and Psychiatric Individual and Group Sessions have a copay between $0 and $20, Other Health Care Professional services have a copay between $10 and $25, Additional Telehealth Benefits have a copay between $0 and $150, and Opioid Treatment Program Services have a $25 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The "Tufts Medicare Preferred HMO Value Rx (HMO)" plan covers preventive services, including an annual physical exam and additional preventive services, with no coinsurance. Additional services covered include Health Education, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Nutritional/Dietary Benefit, Fitness Benefit, Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, and Other Preventive Services; however, services such as Personal Emergency Response System (PERS), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, and several others are not covered. Glaucoma Screening has a copay, while an EKG following a Welcome Visit also has a copay.
Hearing Services See details
Hearing Services include hearing exams with a $25 copay, with coverage for routine hearing exams and fitting/evaluation for hearing aids, each limited to one visit per year. Prescription Hearing Aids are covered with a copay between $250 and $1150, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $15-$25 and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum plan benefit coverage amount of $150 per year.
Dental Services See details
The Tufts Medicare Preferred HMO Value Rx (HMO) plan covers dental services, with a $25 copay for Medicare dental services. Other dental services include oral exams with 0-50% coinsurance, dental x-rays with 0-50% coinsurance, and prophylaxis (cleaning). Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Endodontics, prosthodontics (removable & fixed) are offered as optional supplemental benefits. Restorative services, adjunctive general services, oral and maxillofacial surgery, and periodontics are covered with 50% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Tufts Medicare Preferred HMO Value Rx (HMO) plan, with prior authorization required. Medicare Part B Insulin Drugs are covered, while Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered by the Tufts Medicare Preferred HMO Value Rx (HMO) plan. You will pay a coinsurance between 20% and 20% for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 10% coinsurance and no copay, Prosthetic Devices with a 10% coinsurance and no copay, and Medical Supplies with 0-10% coinsurance and no copay; however, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures/tests with a copay between $10 and $30, and lab services with no copay. Diagnostic Radiological Services have a copay of at least $100, and Outpatient X-Ray Services have a $10 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, but require prior authorization and a referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Tufts Medicare Preferred HMO Value Rx (HMO) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. You will pay a $20 copay for days 1-20, a $120 copay for days 21-44, and no copay for days 45-100.
Other Services See details
Other Services include coverage for acupuncture, meal benefits, and medical stockings and sleeves. Acupuncture is covered with no copay and no coinsurance, while meal benefits are provided for chronic illnesses. Medical stockings and sleeves have a 10% coinsurance and require prior authorization. Over-the-counter (OTC) items, 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, 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 are not covered.
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