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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 $83.00. 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 will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $4 copay at preferred pharmacies and a $19 copay at standard pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. The plan's monthly premium is $51.90, but may be reduced to $28.40 if you qualify for the low-income subsidy.
Additional Benefits
The Tufts Medicare Preferred HMO Value Rx (HMO) plan provides comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. This plan also offers additional benefits like preventive services, hearing and vision care, and dental services, with specific copays, coinsurance, and annual maximums for certain services. Emergency, ambulance, and transportation services are covered, while some services like cardiac rehabilitation and certain home health services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, there is a $200 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, there is a $200 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, while non-Medicare-covered stays and upgrades are not covered. Additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
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, including both individual and group sessions, have a copay of $20, while outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan. There is no copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and air ambulance services have a $225 copay, with no coinsurance. Transportation services to a plan-approved health-related location are covered, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Tufts Medicare Preferred HMO Value Rx (HMO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $30 copay, and there is no coinsurance for either. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $30 copay, and Worldwide Emergency Transportation has a $225 copay.
Primary Care See details
The "Tufts Medicare Preferred HMO Value Rx (HMO)" plan covers primary care physician services with a $10 copay. Chiropractic services are partially covered, with a $15 copay for Medicare-covered services, but routine care is not covered.
Preventive Services See details
The Tufts Medicare Preferred HMO Value Rx (HMO) plan covers preventive services including annual physical exams, health education, and kidney disease education services. Other covered services include wigs for chemotherapy-related hair loss, weight management programs, alternative therapies, therapeutic massage, nutritional/dietary benefits, fitness benefits, and home and bathroom safety devices, some of which have a coinsurance. Additional preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are covered, but some have a copay. Personal emergency response systems, post-discharge in-home medication reconciliation, re-admission prevention, counseling services, 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 adult day health services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $25 copay, and fitting/evaluation for hearing aids, both covered once per year. Prescription hearing aids (all types) are covered with a copay between $250 and $1150 for 2 visits per year, but prescription hearing aids for the 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 coverage for eye exams, with a copay of $15-$25, and eyewear, including contact lenses, eyeglass lenses and frames, and upgrades. Eyewear has a combined maximum plan benefit coverage of $150 per year. Routine eye exams have a $15 copay for 1 visit every year.
Dental Services See details
Dental services are covered, with a $1,000 maximum benefit per year. Medicare dental services require a $25 copay, and other dental services include oral exams with 0-50% coinsurance, dental X-rays with 0-50% coinsurance, and up to two cleanings per year. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered. Restorative services, adjunctive general services, oral and maxillofacial surgery and periodontics are covered with 50% coinsurance. Endodontics, Prosthodontics (removable and fixed) are optional supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Tufts Medicare Preferred HMO Value Rx (HMO) plan, including Medicare Part B Insulin Drugs, but Medicare Part B Chemotherapy/Radiation Drugs are not covered. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Tufts Medicare Preferred HMO Value Rx (HMO) plan. The coinsurance for dialysis services is between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include 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 - Non-Medicare benefit, Prosthetic Devices and Medical Supplies are covered with a 10% coinsurance and no copay. 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 by the Tufts Medicare Preferred HMO Value Rx (HMO) plan. 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. 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. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization, with a $20 copay for days 1-20, a $120 copay for days 21-44, and no copay for days 45-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The "Tufts Medicare Preferred HMO Value Rx (HMO)" plan covers acupuncture with no copay, a meal benefit for chronic illness, and "Other 1" services with 10% coinsurance for medical stockings and sleeves. However, over-the-counter items, Dual Eligible SNPs, 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, and Self-Directed Personal Assistance Services are not covered.
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