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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 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 $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 $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
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, there is no copay at preferred pharmacies or through standard mail order, while Tier 2 generics cost a low $4 copay for a one-month supply. Standard pharmacies are also available but come with higher copays of $14 for Tier 1 and $19 for Tier 2 drugs. Brand-name and specialty medications are subject to coinsurance, with Tier 3 preferred brands costing 20% and Tier 4 non-preferred drugs costing 40% across all pharmacy networks. Tier 5 specialty drugs require a 33% coinsurance for a one-month supply, whereas 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 coverage for core medical services, featuring no copay for annual physicals and a $10 copay for primary care doctor visits. Specialists require a $40 copay, while inpatient hospital stays incur a $275 daily copay for the first five days and no copay for days six through 90. Emergency care is covered with a $125 copay, which is waived if you are admitted within one day, and urgent care visits require a $45 copay. For supplemental care, the plan provides routine hearing exams with no copay and up to a $150 annual allowance for eyewear with no copay. Dental services are covered up to a $1,000 annual limit, featuring no copay and 0% to 50% coinsurance for most covered dental procedures. Additionally, home health care and diabetic equipment are covered with no copay, while durable medical equipment carries a 20% coinsurance.
Inpatient Hospital See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers inpatient hospital services 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 upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers outpatient services with no coinsurance, featuring copays of $0 to $270 for outpatient hospital services and $270 per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $25 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by Tufts Medicare Preferred HMO Basic Rx (HMO) with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Tufts Medicare Preferred HMO Basic Rx (HMO), featuring a $325 copay and no coinsurance for ground and air ambulance services. 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
Tufts Medicare Preferred HMO Basic Rx (HMO) covers emergency services with a $125 copay (waived if admitted to the hospital within one day) and urgently needed services with a $45 copay, both featuring no coinsurance. Worldwide emergency, urgent, and emergency transportation services are also covered with no coinsurance and copays of $125, $45, and $325, respectively.
Primary Care See details
Primary Care benefits under the Tufts Medicare Preferred HMO Basic Rx (HMO) are partially covered with no coinsurance, featuring a $10 copay for primary care visits, a $40 copay for specialists, and a $30 copay for physical, occupational, and speech therapies. Telehealth and mental health services are also covered with copays starting at no copay, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers preventive services with no copay and no coinsurance for annual physicals, though an EKG requires a $20 copay and home safety devices require 20% coinsurance. The benefit is partially covered because PERS, post-discharge medication reconciliation, readmission prevention, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access, and counseling are not covered.
Hearing Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered hearing exams require a $40 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $250 to $1,150, though OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Tufts Medicare Preferred HMO Basic Rx (HMO), offering one annual routine eye exam with a $15 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $150 annual maximum for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) partially covers dental services up to a $1,000 annual limit, with Medicare-covered dental requiring a $40 copay and no coinsurance, and other covered dental services requiring no copay and 0% to 50% coinsurance. Sub-services not covered under this plan include other diagnostic dental services, fluoride treatment, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers Home Infusion bundled Services, including Part D home infusion drugs, with no copay and no coinsurance. Under this benefit, Medicare Part B chemotherapy and other drugs require a 0% to 20% coinsurance and no copay, while Part B insulin drugs carry a $35 copay and no coinsurance.
Dialysis Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers durable medical equipment and prosthetics with no copay and 20% coinsurance, while medical supplies have no copay and 0% to 20% coinsurance. Diabetic equipment is covered with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services have no copay and outpatient X-rays have a $10 copay, while diagnostic tests, therapeutic radiology, and diagnostic radiology require copays ranging from $10 to a minimum of $100.
Home Health Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, although prior authorization and referrals are required. In practice, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and allowing admission without a prior three-day hospital stay. Under this plan, there is a $20 copay for days 1 to 20, a $160 copay for days 21 to 44, and no copay for days 45 to 100, though additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) partially covers other services, offering 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.
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