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Tufts Medicare Preferred HMO Value No Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Tufts Medicare Preferred HMO Value No 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 No Rx (HMO) in 2026, please refer to our full plan details page.
Tufts Medicare Preferred HMO Value No 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 No Rx (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Tufts Medicare Preferred HMO Value No 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 No Rx (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by Tufts Medicare Preferred HMO Value No Rx (HMO).
Additional Benefits
The Tufts Medicare Preferred HMO Value No Rx (HMO) plan offers comprehensive coverage with predictable copayments and no coinsurance for many core medical services. Inpatient hospital stays require a daily copay of $200 for the first five days and no copay thereafter, while primary care visits have a $10 copay and specialist visits cost $25. Additionally, emergency room visits require a $125 copay, which is waived if admitted, and urgent care visits feature a $30 copay. For routine wellness, members benefit from no copay on many preventive services, home health care, and unlimited acupuncture. Routine vision exams require a $15 copay alongside a $150 annual allowance for eyewear, while covered dental services feature no copay and up to 50% coinsurance up to a $1,000 annual limit. Hearing exams are available with a $25 copay, and prescription hearing aids are covered with copayments ranging from $250 to $1,150.
Inpatient Hospital See details
Inpatient hospital care is covered by Tufts Medicare Preferred HMO Value No Rx (HMO) with no coinsurance and a $200 daily copay for days 1 through 5, and no copay for days 6 through 90. The benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under the Tufts Medicare Preferred HMO Value No Rx (HMO) are covered with no coinsurance, featuring a $0 to $150 copay for outpatient hospital services and a $150 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $20 copay.
Partial Hospitalization See details
The Tufts Medicare Preferred HMO Value No Rx (HMO) plan fully covers partial hospitalization services. Under this plan, members will pay no copay and no coinsurance for covered partial hospitalization care.
Ambulance and Transportation Services See details
Tufts Medicare Preferred HMO Value No Rx (HMO) covers ground and air ambulance services with a $225 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered, offering unlimited one-way rides to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Tufts Medicare Preferred HMO Value No Rx (HMO) with a $125 copay and no coinsurance, which is waived if you are admitted to the hospital within one day. Urgently needed services require a $30 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $30 to $225.
Primary Care See details
Primary care benefits are partially covered by Tufts Medicare Preferred HMO Value No Rx (HMO), offering a $10 copay for primary care visits and a $25 copay for specialists with no coinsurance. While physical therapy, mental health, and telehealth are covered with low copays and no coinsurance, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Tufts Medicare Preferred HMO Value No Rx (HMO) preventive services are partially covered, with major benefits like annual physicals and kidney disease education offered at no copay and no coinsurance. While some services require a cost, such as a $10 copay for post-welcome visit EKGs and 10% coinsurance for home safety devices, others like personal emergency response systems, adult day health, in-home support, telemonitoring, and counseling are not covered.
Hearing Services See details
Hearing Services are partially covered by Tufts Medicare Preferred HMO Value No Rx (HMO), which offers one routine hearing exam and fitting annually for a $25 copay and no coinsurance. Up to two prescription hearing aids are covered per year with copayments between $250 and $1,150 and no coinsurance, though OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Tufts Medicare Preferred HMO Value No Rx (HMO), as other eye exam services are not covered. Routine eye exams require a $15 copay and no coinsurance with no deductible, while eyewear is covered with no copay, no coinsurance, and no deductible up to a $150 annual maximum.
Dental Services See details
Dental services are partially covered by Tufts Medicare Preferred HMO Value No Rx (HMO), offering Medicare-covered dental care for a $25 copay and no coinsurance. Other covered preventive and comprehensive services feature no copay and 0% to 50% coinsurance up to a $1,000 annual limit, while fluoride, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are partially covered under the Tufts Medicare Preferred HMO Value No Rx (HMO) with no copay and no coinsurance, subject to prior authorization and step therapy. Under this benefit, Medicare Part B insulin drugs are covered with no copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs are not covered.
Dialysis Services See details
Tufts Medicare Preferred HMO Value No Rx (HMO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Tufts Medicare Preferred HMO Value No Rx (HMO) covers durable medical equipment and prosthetics with no copay, 0% to 10% coinsurance, and prior authorization requirements. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Tufts Medicare Preferred HMO Value No Rx (HMO) with no coinsurance, though prior authorization is required. Lab services have no copay, outpatient X-rays have a $10 copay, diagnostic procedures and tests have a $10 to $30 copay, and diagnostic radiological services require a minimum $100 copay. Therapeutic radiological services are not covered under this benefit.
Home Health Services See details
Home Health Services are covered under the Tufts Medicare Preferred HMO Value No Rx (HMO) with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Tufts Medicare Preferred HMO Value No Rx (HMO) plan with no copay and no coinsurance. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Tufts Medicare Preferred HMO Value No Rx (HMO) with no coinsurance and do not require a prior three-day hospital stay. Patients will pay a daily copay of $20 for days 1 to 20, $120 for days 21 to 44, and no copay for days 45 to 100, with prior authorization required.
Other Services See details
Other services are partially covered under Tufts Medicare Preferred HMO Value No Rx (HMO), which features unlimited acupuncture with no copay and no coinsurance. Over-the-counter (OTC) items and meal benefits are not covered under this plan.
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