A non-government entity
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 2026, 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 2026.
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 $68.00. 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:
Sign up for Tufts Medicare Preferred HMO Basic Rx (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Tufts Medicare Preferred HMO Basic Rx (HMO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately with no upfront costs. For Tier 1 preferred generics, you will pay no copay at preferred pharmacies or through standard mail order, while standard pharmacies charge a $14 copay for a one-month supply. Tier 2 generic medications are also highly affordable, costing a $4 copay for a one-month supply at preferred pharmacies and standard mail order. Higher-tier prescription drugs transition to coinsurance, with Tier 3 preferred brands requiring a 20% coinsurance and Tier 4 non-preferred drugs requiring a 40% coinsurance across all pharmacy types. Tier 5 specialty drugs carry a 33% coinsurance for a one-month supply at preferred, standard, or standard 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 Basic Rx (HMO) plan offers comprehensive healthcare coverage with predictable copayments and no coinsurance for many core services. Doctor visits require a $10 copay for primary care and $40 for specialists, while inpatient hospital stays have a $275 daily copay for the first five days and no copay thereafter. Additionally, emergency room visits carry a $125 copay, and most routine preventive services are available with no copay. Specialty benefits include a $1,000 annual dental allowance, a $15 copay for routine eye exams with a $150 eyewear credit, and routine hearing exams with no copay. While durable medical equipment and dialysis services require a 20% coinsurance, some benefits like cardiac rehabilitation and over-the-counter items are not covered under this plan.
Inpatient Hospital See details
Inpatient hospital care is covered by Tufts Medicare Preferred HMO Basic Rx (HMO) with no coinsurance, requiring a $275 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered because while unlimited additional days are provided for acute stays, additional psychiatric days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient services are covered by Tufts Medicare Preferred HMO Basic Rx (HMO) with no coinsurance, featuring copays of $0 to $270 for outpatient hospital services, $270 per stay for observation services, and $25 for substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Tufts Medicare Preferred HMO Basic Rx (HMO) with no copay and no coinsurance.
Ambulance and Transportation Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers ground and air ambulance services with a $325 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 or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Tufts Medicare Preferred HMO Basic 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 $45 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $125, $45, and $325 respectively.
Primary Care See details
Tufts Medicare Preferred HMO Basic Rx (HMO) partially covers primary care benefits with no coinsurance, featuring a $10 copay for primary care visits, a $40 copay for specialists, and a $30 copay for physical and occupational therapy. While mental health services range from no copay to a $25 copay, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by Tufts Medicare Preferred HMO Basic Rx (HMO), with no copay and no coinsurance for most services like annual physical exams and kidney disease education. While some options like personal emergency response systems, adult day health, and home-based palliative care are not covered, other benefits may require costs, such as a $20 copay for EKGs and a 20% coinsurance for home safety devices.
Hearing Services See details
Hearing services are partially covered by Tufts Medicare Preferred HMO Basic Rx (HMO) with no deductible and no coinsurance. Medicare-covered exams require a $40 copay, while annual routine exams and fitting evaluations have no copay. Prescription hearing aids carry a copay of $250 to $1,150, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) partially covers vision services, offering one annual routine eye exam with a $15 copay, no coinsurance, and no deductible, though other eye exam services are not covered. Eyewear is also covered with no copay, no coinsurance, and no deductible up to a $150 yearly maximum.
Dental Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) offers partially covered dental services with an annual maximum plan benefit of $1,000. Medicare-covered dental services require a $40 copay and no coinsurance, while other covered services have no copay and 0% to 50% coinsurance; however, fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers Home Infusion bundled Services with no copay and no coinsurance, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Tufts Medicare Preferred HMO Basic Rx (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Tufts Medicare Preferred HMO Basic Rx (HMO) partially covers medical equipment, with no coverage for diabetic supplies and therapeutic shoes or inserts. Covered durable medical equipment and prosthetic devices require no copay and 20% coinsurance, medical supplies have no copay and 0% to 20% coinsurance, and diabetic equipment is available with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Tufts Medicare Preferred HMO Basic Rx (HMO) with no coinsurance, subject to prior authorization. Lab services have no copay, diagnostic tests require a $10 to $45 copay, outpatient X-rays cost $10, and diagnostic and therapeutic radiological services carry minimum copays of $100 and $60, respectively.
Home Health Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization and a referral are required for coverage.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Tufts Medicare Preferred HMO Basic Rx (HMO) plan. All related sub-services, including pulmonary, intensive cardiac, and SET for PAD services, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 to 20, a $160 daily copay for days 21 to 44, and no copay for days 45 to 100. Prior authorization is required and a prior three-day hospital stay is not needed, though additional days beyond the standard 100 days are not covered.
Other Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) partially covers other services, providing unlimited acupuncture treatments with no copay and no coinsurance. Supplemental benefits such as over-the-counter (OTC) items and meal benefits are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved