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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 $156.00. 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 an enhanced alternative drug benefit. The plan has no deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $4 copay at preferred pharmacies and $19 at standard pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Tufts Medicare Preferred HMO Value Rx (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $200 copay for the first five days, with no copay thereafter, while outpatient services have copays ranging from $0 to $150. Emergency services have a $125 copay, and primary care visits cost $10. This plan includes coverage for preventive services, such as routine hearing and vision exams, with copays ranging from $15 to $25. Dental services are covered up to a $1,000 annual maximum, and the plan also covers home health services with no copay. Additional benefits include ambulance services, dialysis services with 20% coinsurance, and medical equipment with 10% coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization. For Inpatient Hospital-Acute, the copay is $200 for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, the copay is $200 for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $150, and observation services with a $150 copay. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services, including individual and group sessions, have a $20 copay. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Tufts Medicare Preferred HMO Value Rx (HMO) plan. There is no copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Tufts Medicare Preferred HMO Value Rx (HMO). Ground and Air Ambulance Services have a $225 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 Value Rx (HMO) plan. Emergency Services has a $125 copay, and Urgently Needed Services has a $30 copay, with no coinsurance for either. Worldwide Emergency Services has a $125 copay for Worldwide Emergency Coverage, a $30 copay for Worldwide Urgent Coverage, and a $225 copay for Worldwide Emergency Transportation, with no coinsurance for any.
Primary Care See details
Primary Care Physician Services are covered with a $10 copay, while Chiropractic Services are covered with a $15 copay, but Routine Chiropractic Care is not covered. Occupational Therapy Services have a $20 copay, and Physician Specialist Services have a $25 copay. Mental Health Specialty Services have a copay between $0 and $20, with Individual and Group Sessions both covered. Other Health Care Professional visits have a copay between $10 and $25. Psychiatric Services have a copay between $0 and $20, with Individual and Group Sessions both covered. Physical Therapy and Speech-Language Pathology Services have a $20 copay. Additional Telehealth Benefits have a copay between $0 and $150, and Opioid Treatment Program Services have a $25 copay.
Preventive Services See details
The Tufts Medicare Preferred HMO Value Rx (HMO) plan covers preventive services including annual physical exams, health education, and wigs for hair loss related to chemotherapy. The plan also covers Medical Nutrition Therapy with 3 additional sessions. Other services like Personal Emergency Response Systems, 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. Other preventive services such as EKG following Welcome Visit have a $10 copay, while home and bathroom safety devices and modifications have a 10% coinsurance.
Hearing Services See details
Hearing Services include routine hearing exams with a $25 copay, and fitting/evaluation for hearing aids, each covered once per year. Prescription hearing aids are covered, with a copay between $250 and $1150, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay of $15-$25, routine eye exams with a $15 copay, and eyewear with a combined maximum benefit of $150 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental services are covered, with a maximum plan benefit of $1,000 per year. Medicare dental services require a $25 copay and a doctor's referral, while 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, and restorative services, adjunctive general services, periodontics, and oral and maxillofacial surgery have 50% coinsurance. Endodontics, prosthodontics (removable and fixed) are offered as supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Insulin and 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 20% coinsurance for this benefit.
Medical Equipment See details
Medical equipment includes Durable Medical Equipment (DME) with a 10% coinsurance and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies has a 10% coinsurance and no copay for Medicare-covered Prosthetic Devices and Medical Supplies, and Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $10 and $30, while Lab Services have no copay. Diagnostic Radiological Services have a $100 copay, and Outpatient X-Ray Services have a $10 copay, but 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 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. For days 1-20, the copay is $20, for days 21-44 the copay is $120, and for days 45-100 there is no copay.
Other Services See details
The "Other Services" benefit covers acupuncture, meal benefits for chronic illnesses, and medical stockings and sleeves. Acupuncture has no copay or coinsurance, and the plan covers an unlimited number of treatments. Medical stockings and sleeves have a 10% coinsurance. The plan does not cover 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, 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, or Self-Directed Personal Assistance Services.
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