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Tufts Medicare Preferred HMO Basic Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Tufts Medicare Preferred HMO Basic 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 Basic Rx (HMO) in 2025, please refer to our full plan details page.
Tufts Medicare Preferred HMO Basic 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 Basic 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 Basic 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 Basic Rx (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $58.00. 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 Basic Rx (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $4 copay at preferred pharmacies and $19 copay at standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. This plan also offers a Part D premium reduction if you qualify for the low-income subsidy.
Additional Benefits
The Tufts Medicare Preferred HMO Basic Rx (HMO) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays. You'll have a copay for emergency services, primary care, and specialist visits, with no copay for many preventive services. The plan also covers hearing, vision, and dental services, with annual maximums and copays applying to some services. Additional benefits include ambulance services, home health, and skilled nursing facility care. The plan also covers medical equipment, diagnostic services, and some other services like acupuncture and meal benefits. However, certain services like podiatry, personal emergency response systems, and certain dental and vision services may not be covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For days 1-5 of an Inpatient Hospital-Acute or Inpatient Hospital Psychiatric stay, the copay is $275, and there is no copay for days 6-90; additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services with a copay between $0 and $270, and observation services with a $270 copay. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services, including individual and group sessions, have a copay of $25. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered under the Tufts Medicare Preferred HMO Basic Rx (HMO) plan.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $325 copay for both ground and air ambulance services. Transportation Services to plan-approved health-related locations are also covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Tufts Medicare Preferred HMO Basic Rx (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Transportation has a $325 copay; all have no coinsurance. Worldwide Urgent Coverage has a $45 copay and no coinsurance.
Primary Care See details
Primary Care Physician Services have a $10 copay, Chiropractic Services have a $15 copay, and Occupational Therapy Services have a $30 copay. Physician Specialist Services have a $40 copay, and Mental Health and Psychiatric Individual and Group Sessions have a copay between $0 and $25. Physical Therapy and Speech-Language Pathology Services have a $30 copay, and Opioid Treatment Program Services have a $25 copay. Additional Telehealth Benefits have a copay between $0 and $270. Podiatry Services are not covered.
Preventive Services See details
The Tufts Medicare Preferred HMO Basic Rx (HMO) plan covers preventive services, including annual physical exams, with no copay. Other preventive services include a $20 copay for EKG following a Welcome Visit, and home and bathroom safety devices and modifications with 20% coinsurance. Some services, such as Personal Emergency Response System (PERS), are not covered.
Hearing Services See details
Hearing services include hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with all types covered with a copay between $250 and $1150, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams, routine eye exams, and eyewear. Eye exams have a copay between $15 and $40, while routine eye exams have a $15 copay. Eyewear is covered with a combined maximum benefit of $150 per year.
Dental Services See details
Dental Services are covered, with a $1,000 maximum benefit per year. Medicare Dental Services require prior authorization and a doctor referral, with a $40 copay. Other Dental Services cover oral exams with a 0% - 50% coinsurance, dental x-rays with a 0% - 50% coinsurance, and prophylaxis (cleaning) with no coinsurance. Fluoride Treatment is not covered. Orthodontic Services are covered under Diagnostic and Preventive Dental. Restorative Services, Adjunctive General Services, Periodontics, and Oral and Maxillofacial Surgery are covered with a 50% coinsurance. Endodontics, Prosthodontics (removable and fixed), Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Tufts Medicare Preferred HMO Basic Rx (HMO) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Tufts Medicare Preferred HMO Basic Rx (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by this plan. For DME, you will pay 20% coinsurance, while Prosthetic Devices have a 20% coinsurance, and Medical Supplies have 0-20% coinsurance; 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, including all diagnostic services and radiological services, are covered. Diagnostic Procedures/Tests have a copay between $10 and $45, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $100 and $250, Therapeutic Radiological Services have a $60 copay, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Tufts Medicare Preferred HMO Basic Rx (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are technically covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, with prior authorization required. For days 1-20, there is a $20 copay; for days 21-44, there is a $160 copay; and for days 45-100, there is no copay.
Other Services See details
Other services include acupuncture, meal benefits, and medical stockings and sleeves. Acupuncture is covered, while meal benefits are provided for chronic illnesses and Other 1 has a 20% coinsurance for medical stockings and sleeves; however, 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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