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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 $48.00. 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 used. For example, preferred generic drugs have a $4 copay at preferred pharmacies, while standard generic drugs have 23% coinsurance at both preferred and 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. If you qualify for the low-income subsidy (LIS), your monthly premium could be reduced. Be sure to check the plan's formulary for specific drug coverage details.
Additional Benefits
The Tufts Medicare Preferred HMO Basic Rx (HMO) plan offers a variety of benefits, including inpatient and outpatient hospital services, with varying copays. Emergency, urgent, and ambulance services are covered, along with primary care, mental health, and specialist visits, each with its own copay structure. Preventive services, hearing, vision, and dental services are also included, with specific copays or coinsurance applying to certain services. Additional benefits encompass home health services, medical equipment, and diagnostic services, each with its own cost-sharing. The plan also covers partial hospitalization, skilled nursing facility stays, and dialysis, with specific copays or coinsurance. Other covered services include acupuncture, meal benefits, and medical stockings and sleeves.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a copay of $275 for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, but 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 also not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $270, observation services with a $270 copay, and ambulatory surgical center services with no copay. This plan also covers outpatient substance abuse individual and group sessions with a copay between $25 and $25, as well as outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Tufts Medicare Preferred HMO Basic Rx (HMO) plan. There is no cost-sharing for this benefit.
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 a plan-approved health-related location are covered, with no copay or coinsurance.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Tufts Medicare Preferred HMO Basic Rx (HMO). Emergency Services have a $125 copay, and Urgently Needed Services have a $45 copay, while Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $325 copay.
Primary Care See details
Primary Care Physician Services have a $10 copay, and Chiropractic Services have a $15 copay, but routine care is not covered. Other Chiropractic Services also have a $15 copay for one visit per year. Occupational Therapy Services have a $30 copay, while Physician Specialist Services have a $40 copay. 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. Other Health Care Professional services have a copay between $10 and $40. Additional Telehealth Benefits have a copay between $0 and $270, and Opioid Treatment Program Services have a $25 copay.
Preventive Services See details
The Tufts Medicare Preferred HMO Basic Rx (HMO) plan covers preventive services, including annual physical exams, health education, and in-home safety assessments. Additional preventive services include a coinsurance for home and bathroom safety devices. Other services like Personal Emergency Response Systems, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include coverage for 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, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, with a copay between $250 and $1150 for all other types. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay of $15-$40, and eyewear with a combined maximum benefit of $150 every year. Routine eye exams have a $15 copay for one visit every year.
Dental Services See details
Dental Services are covered under the Tufts Medicare Preferred HMO Basic Rx (HMO) plan. Medicare Dental Services have a $40 copay, and other dental services, including oral exams, x-rays, and cleanings, are covered with varying coinsurance amounts. Fluoride treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Tufts Medicare Preferred HMO Basic Rx (HMO) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered by the Tufts Medicare Preferred HMO Basic Rx (HMO) plan, including Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with a coinsurance between 0% and 20%. Some services are covered, but 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 under the Tufts Medicare Preferred HMO Basic Rx (HMO) plan. Diagnostic Procedures/Tests have a copay between $10 and $45, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $250, Therapeutic Radiological Services have a copay of at least $60, 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 require prior authorization and a referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are technically covered, but none of the sub-services are covered, including cardiac rehabilitation services, intensive cardiac rehabilitation services, pulmonary rehabilitation services, and SET for PAD services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-20, the copay is $20, for days 21-44, the copay is $160, and for days 45-100, there is no copay.
Other Services See details
Other Services includes acupuncture, meal benefits, and medical stockings and sleeves. Acupuncture is covered with no copay or coinsurance, the meal benefit is covered, and medical stockings and sleeves are covered with 20% coinsurance. 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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