A non-government entity
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 $166.00. 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:
Sign up for Tufts Medicare Preferred HMO Value Rx (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Tufts Medicare Preferred HMO Value Rx (HMO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. Beneficiaries pay no copay for Tier 1 preferred generic drugs at preferred pharmacies or through standard mail order, while standard pharmacies charge a $14 copay for a one-month supply. Tier 2 generic drugs cost as little as a $4 copay for a one-month supply at preferred pharmacies, and Tier 6 vaccines are available with no copay at both preferred and standard pharmacies. For higher-tier medications, cost-sharing transitions from flat copays to coinsurance. Tier 3 preferred brand drugs require a 20% coinsurance, and Tier 4 non-preferred drugs carry a 40% coinsurance across preferred, standard, and mail-order pharmacies. Tier 5 specialty drugs are covered with a 33% coinsurance for a one-month supply.
Additional Benefits
The Tufts Medicare Preferred HMO Value Rx (HMO) plan offers comprehensive medical coverage featuring affordable out-of-pocket costs, including no coinsurance for inpatient hospital stays, outpatient services, and primary care. Members pay a $10 copay for primary care visits, a $25 copay for specialists, and no copay for most preventive services. Emergency room visits require a $125 copay, which is waived if admitted, while inpatient hospital stays have a $200 daily copay for the first five days and no copay thereafter. This plan also provides valuable supplemental benefits, such as dental and vision care with no copay for eyewear up to a $150 annual limit and covered dental services up to a $1,000 yearly maximum. Routine hearing exams require a $25 copay, while durable medical equipment features no copay and a 10% coinsurance. Additionally, members can access unlimited acupuncture treatments and home health services with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital care is covered by Tufts Medicare Preferred HMO Value Rx (HMO) with no coinsurance, requiring a $200 daily copay for days 1 through 5 and no copay for days 6 through 90 per stay. While unlimited additional days are covered for acute care, additional psychiatric days, hospital upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Tufts Medicare Preferred HMO Value Rx (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay and no coinsurance. Outpatient hospital services require a $0 to $150 copay, observation services have a $150 copay per stay, and outpatient substance abuse sessions carry a $20 copay, all with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Tufts Medicare Preferred HMO Value Rx (HMO) 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, though prior authorization is required. Transportation services are partially covered, providing unlimited one-way rides to plan-approved locations with no copay or coinsurance, but transportation to any health-related location is not covered.
Emergency Services See details
Tufts Medicare Preferred HMO Value Rx (HMO) covers emergency services with a $125 copay, which is waived if admitted to the hospital within one day, and urgently needed services with a $30 copay, both featuring no coinsurance and no deductible. Worldwide emergency services, urgent care, and emergency transportation are also covered with no coinsurance and copays of $125, $30, and $225 respectively.
Primary Care See details
Tufts Medicare Preferred HMO Value Rx (HMO) covers primary care visits for a $10 copay and specialist visits for a $25 copay, both with no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance (routine chiropractic care is not covered), podiatry is not covered, and other services like mental health and therapies require no coinsurance and copays ranging from no copay up to $150.
Preventive Services See details
Preventive Services are partially covered by Tufts Medicare Preferred HMO Value Rx (HMO), with most covered benefits, including annual physical exams and kidney disease education, requiring no copay and no coinsurance. While services like fitness programs and weight management are covered, some benefits require a cost-share, such as a 10% coinsurance for home and bathroom safety devices and a $10 copay for an EKG following a welcome visit. Sub-services not covered include personal emergency response systems, post-discharge medication reconciliation, re-admission prevention, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
Tufts Medicare Preferred HMO Value Rx (HMO) covers hearing services, offering routine hearing exams and fitting evaluations for a $25 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay between $250 and $1,150, but OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by the Tufts Medicare Preferred HMO Value Rx (HMO), which excludes other eye exam services. Covered eye exams require a referral and carry a $15.00 to $25.00 copay with no coinsurance, while eyewear is provided with no copay, no coinsurance, and a $150 annual maximum benefit.
Dental Services See details
Dental services are partially covered by Tufts Medicare Preferred HMO Value Rx (HMO), featuring a $25 copay and no coinsurance for Medicare-covered dental, and no copay with 0% to 50% coinsurance for other dental services up to a $1,000 annual maximum. Fluoride treatments, implant services, orthodontics, maxillofacial prosthetics, other diagnostic dental, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are partially covered by the Tufts Medicare Preferred HMO Value Rx (HMO) plan with no copay and no coinsurance, though prior authorization and step therapy are required. While insulin is covered with no copay and no coinsurance, Medicare Part B chemotherapy, radiation, and other Part B drugs are not covered.
Dialysis Services See details
Dialysis services are covered by Tufts Medicare Preferred HMO Value Rx (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Tufts Medicare Preferred HMO Value Rx (HMO) covers durable medical equipment and prosthetic devices with no copay and 10% coinsurance, and medical supplies with no copay and 0% to 10% coinsurance. For diabetic equipment, some services are covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Tufts Medicare Preferred HMO Value Rx (HMO) partially covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Members pay no copay for lab services, a $10 copay for outpatient X-rays, a $10 to $30 copay for diagnostic procedures, and a minimum $100 copay for diagnostic radiological services, while therapeutic radiological services are not covered.
Home Health Services See details
Tufts Medicare Preferred HMO Value Rx (HMO) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to receive these covered services.
Cardiac Rehabilitation Services See details
Tufts Medicare Preferred HMO Value Rx (HMO) features Cardiac Rehabilitation Services where some services are covered with no copay and no coinsurance, subject to prior authorization and referral requirements. 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 and no prior three-day hospital stay requirement, though prior authorization is required. Covered days 1 through 20 require a $20 daily copay, days 21 through 44 require a $120 daily copay, and days 45 through 100 have no copay, while additional days beyond the 100-day Medicare-covered limit are not covered.
Other Services See details
Tufts Medicare Preferred HMO Value 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved