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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 $93.00. 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 drug coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or standard mail order. Tier 2 generic drugs are also highly affordable, costing a low $4 copay for a one-month supply at preferred pharmacies and standard mail order. Higher-tier medications transition to coinsurance, with Tier 3 preferred brands requiring 20% coinsurance and Tier 4 non-preferred drugs requiring 40% coinsurance. Tier 5 specialty drugs carry a 33% coinsurance for a one-month supply at preferred, standard, and mail-order pharmacies. 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 affordable coverage with no coinsurance for many key medical services, including primary care doctor visits for a $10 copay and specialist visits for a $25 copay. Inpatient hospital stays require a $200 daily copay for the first five days and no copay for days six through 90, while emergency room visits carry a $125 copay that is waived if you are admitted. Outpatient services, home health care, and cardiac rehabilitation are also highly accessible, with many of these services requiring no copay and no coinsurance. For supplemental care, this plan features unlimited plan-approved transportation and routine preventive services with no copay or coinsurance. Vision exams require a $15 copay alongside a $150 annual allowance for eyewear, while dental services are covered up to a $1,000 annual limit with no copay for cleanings and exams. Additionally, routine hearing exams are available for a $25 copay, and prescription hearing aids are covered with copays ranging from $250 to $1,150 per device.
Inpatient Hospital See details
Tufts Medicare Preferred HMO Value Rx (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $200 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional days are covered for acute care, but additional psychiatric days, room 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 no copays for ambulatory surgical center and blood services. Outpatient hospital services require a $0 to $150 copay, observation services carry a $150 copay per stay, and outpatient substance abuse sessions have a $20 copay.
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 ambulance services with a $225 copay and no coinsurance for ground and air transport. Transportation services are partially covered, offering unlimited rides to plan-approved health-related 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 with no coinsurance. 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 physician services with a $10 copay and specialist visits with a $25 copay, both featuring no coinsurance. While therapy, mental health, and telehealth services are also covered with no coinsurance and varying copays, podiatry and routine chiropractic care are not covered.
Preventive Services See details
Tufts Medicare Preferred HMO Value Rx (HMO) covers preventive services, including annual physicals and kidney education, with no copay and no coinsurance, though an EKG following a welcome visit requires a $10 copay and home safety devices require a 10% coinsurance. This benefit is partially covered because personal emergency response systems, adult day health, home-based palliative care, caregiver support, in-home support, telemonitoring, and counseling services are not covered.
Hearing Services See details
Tufts Medicare Preferred HMO Value Rx (HMO) covers hearing services, including one annual routine exam and fitting evaluation 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, while 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), featuring one routine eye exam per year with a $15.00 copay, no coinsurance, and a referral requirement, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, up to a $150.00 annual maximum for contacts, frames, lenses, and upgrades.
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 Medicare-covered dental requiring a $25 copay and no coinsurance. Other covered services like cleanings, exams, and fillings have no copay and 0% to 50% coinsurance, though fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Tufts Medicare Preferred HMO Value Rx (HMO) provides partial coverage for home infusion bundled services with no copay and no coinsurance, although prior authorization and step therapy are required. While Medicare Part B insulin and Part D home infusion drugs are covered, Medicare Part B chemotherapy, radiation, and other Part B drugs are not covered under this benefit.
Dialysis Services See details
Tufts Medicare Preferred HMO Value Rx (HMO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Tufts Medicare Preferred HMO Value Rx (HMO) with no copays, featuring a 10% coinsurance for durable medical equipment and prosthetics, and 0% to 10% coinsurance for medical supplies. While diabetic equipment is covered with no copay or coinsurance, 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, as therapeutic radiological services are not covered. Covered services require prior authorization and include lab services with no copay, outpatient X-rays for a $10 copay, diagnostic tests for a $10 to $30 copay, and diagnostic radiological services with a minimum $100 copay.
Home Health Services See details
Home health services are covered under the Tufts Medicare Preferred HMO Value Rx (HMO) plan with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Tufts Medicare Preferred HMO Value Rx (HMO) with no copay and no coinsurance, though prior authorization and a referral 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
Tufts Medicare Preferred HMO Value Rx (HMO) covers skilled nursing facility services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. 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, though days beyond the 100-day Medicare 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.
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