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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 2025, 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 2025.
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 $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
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 a range of benefits. Inpatient hospital stays have a copay of $200 for days 1-5, and no copay for days 6-90, while outpatient services have copays ranging from $0 to $150. Emergency, urgent, and ambulance services are covered with varying copays. The plan also includes coverage for primary care services with a $10 copay, along with vision, hearing, and dental services. Vision benefits include eye exams and eyewear, while hearing services cover routine exams and hearing aids. Dental includes both preventative and restorative services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-5, there is a $200 copay, and for days 6-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stay and Upgrades for Inpatient Hospital-Acute are not covered. 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, while outpatient substance abuse services have a $20 copay for both individual and group sessions, and outpatient blood services are covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Tufts Medicare Preferred HMO Value No Rx (HMO) plan.
Ambulance and Transportation Services See details
The Tufts Medicare Preferred HMO Value No Rx (HMO) plan covers ambulance services with a $225 copay for both ground and air ambulance services. Transportation services to plan-approved health-related locations 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 No Rx (HMO) plan. Emergency Services has a $125 copay, and no coinsurance. Urgently Needed Services has a $30 copay, and no coinsurance. Worldwide Emergency Coverage has a $125 copay, and no coinsurance; Worldwide Urgent Coverage has a $30 copay, and no coinsurance; Worldwide Emergency Transportation has a $225 copay, and no coinsurance.
Primary Care See details
The Tufts Medicare Preferred HMO Value No Rx (HMO) plan covers primary care physician services with a $10 copay, chiropractic services with a $15 copay, occupational therapy services with a $20 copay, and physician specialist services with a $25 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have varying copays, while physical therapy and speech-language pathology services have a $20 copay, and other health care professional services have copays between $10 and $25. Additional telehealth benefits range from no copay to a $150 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services are covered, including Medicare-covered zero-dollar services, annual physical exams, kidney disease education services, and other preventive services. Additional services like glaucoma screenings, and EKG following a Welcome Visit have a copay of $10, and home and bathroom safety devices have 10% coinsurance. 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, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, and remote access technologies are not covered.
Hearing Services See details
Hearing services include routine hearing exams with a $25 copay, and fitting/evaluation for hearing aids, each with a limit of one visit per year. Prescription hearing aids are covered with a copay between $250 and $1150, but prescription hearing aids - 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, 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 include coverage for Medicare dental services with a $25 copay, and other dental services with an annual maximum of $1,000. Oral exams are covered with a coinsurance of 0% - 50%, and dental X-rays are covered with a coinsurance of 0% - 50%. Prophylaxis (cleaning) is also covered. Fluoride treatment is not covered. Restorative services, adjunctive general services, periodontics, and oral and maxillofacial surgery are covered with a 50% coinsurance. Endodontics, prosthodontics (removable and fixed), and orthodontics are offered as optional supplemental benefits, and implants and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Tufts Medicare Preferred HMO Value No Rx (HMO) plan, with prior authorization required. Insulin, including Medicare Part B Insulin Drugs, is covered. However, Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered by the Tufts Medicare Preferred HMO Value No Rx (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 10% coinsurance and no copay, Prosthetic Devices with 10% coinsurance and no copay, and Medical Supplies with 0-10% coinsurance and no copay. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $10 and $30, and Lab Services have no copay. Diagnostic Radiological Services have a $100 copay, while Therapeutic Radiological Services are not covered. Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Tufts Medicare Preferred HMO Value No 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 No Rx (HMO) plan. Specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is a $20 copay; for days 21-44, the copay is $120; and for days 45-100, there is no copay.
Other Services See details
The "Tufts Medicare Preferred HMO Value No Rx (HMO)" plan covers acupuncture with no copay or coinsurance, meal benefits for chronic illness, and other services with a 10% coinsurance for medical stockings and sleeves. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, 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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