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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 $47.00. 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 no drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, you pay no copay at preferred pharmacies or standard mail order, compared to a $14 copay for a one-month supply at standard pharmacies. Tier 2 generic medications cost a low $4 copay for a one-month supply at preferred pharmacies, and Tier 6 vaccines are available with no copay at both preferred and standard locations. Brand-name and specialty medications on this plan require coinsurance instead of flat copays. You will pay a 20% coinsurance for Tier 3 preferred brand drugs and a 40% coinsurance for Tier 4 non-preferred drugs at preferred, standard, and standard mail-order pharmacies. Tier 5 specialty drugs are subject to a 33% coinsurance for a one-month supply.
Additional Benefits
The Tufts Medicare Preferred HMO Basic Rx (HMO) plan offers comprehensive coverage with predictable out-of-pocket costs, featuring a $10 copay for primary care visits, a $40 copay for specialists, and no coinsurance for doctor services. For hospital care, members pay a $275 daily copay for the first five days of an inpatient stay and no copay for days six through ninety. Outpatient procedures, laboratory services, and emergency care are also covered with fixed copays and no coinsurance. Additionally, the plan provides valuable supplemental benefits, including no copay for home health care, routine hearing exams, and unlimited transportation to approved medical locations. Dental and vision benefits are also included, offering up to $1,000 annually for dental care and a $150 allowance for eyewear with no copay. While certain items like durable medical equipment and dialysis require a 20% coinsurance, many preventive services are fully covered with no copay.
Inpatient Hospital See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers inpatient hospital stays with no coinsurance, requiring a $275 daily copay for days 1 to 5 and no copay for days 6 to 90. While unlimited additional days are covered for acute care, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers outpatient services with no coinsurance, including no copays for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $270, observation services require a $270 copay per stay, and outpatient substance abuse sessions carry a $25 copay.
Partial Hospitalization See details
Partial hospitalization is covered by the Tufts Medicare Preferred HMO Basic Rx (HMO) plan with no copay and no coinsurance.
Ambulance and Transportation Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers ambulance services with a $325 copay and no coinsurance for both ground and air transport, which requires prior authorization. Transportation services are partially covered, offering unlimited one-way trips to plan-approved health-related locations with no copay and no coinsurance, though transportation to any other health-related locations is not covered.
Emergency Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers emergency services with a $125 copay and no coinsurance, which is waived if you are admitted to the hospital within one day. Urgently needed services require a $45 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $125, $45, and $325 respectively.
Primary Care See details
Primary care benefits under Tufts Medicare Preferred HMO Basic Rx (HMO) are partially covered, as routine chiropractic and podiatry services are not covered. Covered services require no coinsurance, with copays of $10 for primary care providers, $40 for specialists, $30 for physical and occupational therapy, and $0 to $25 for mental health sessions.
Preventive Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) partially covers preventive services, offering annual physical exams and kidney disease education with no copay and no coinsurance, while EKGs after welcome visits require a $20 copay and home safety modifications require a 20% coinsurance. Supplemental health and fitness benefits are included, but services such as personal emergency response systems, post-discharge medication reconciliation, readmission prevention, adult day health, home-based palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access technologies, and counseling are not covered.
Hearing Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers Medicare-covered hearing exams for a $40 copay, alongside routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $250 to $1150 and no coinsurance, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Tufts Medicare Preferred HMO Basic Rx (HMO), featuring a $15 copay and no coinsurance for one routine annual eye exam with a referral, though 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, and upgrades.
Dental Services See details
Dental services are partially covered by Tufts Medicare Preferred HMO Basic Rx (HMO) up to a $1,000 annual limit, featuring a $40 copay and no coinsurance for Medicare-covered dental, and no copay with 0% to 50% coinsurance for other covered preventive and comprehensive dental care. Fluoride treatment, other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics 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, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance.
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) covers medical equipment with no copay, though prior authorization is required. Durable medical equipment and prosthetic devices require a 20% coinsurance (ranging from no coinsurance to 20% coinsurance for medical supplies), and while some diabetic equipment is covered with no coinsurance, 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. There is no copay for lab services, a $10 copay for outpatient X-rays, a $10 to $45 copay for diagnostic procedures, and minimum copays of $60 for therapeutic radiology and $100 for diagnostic radiology.
Home Health Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers Home Health Services with no copay and no coinsurance. A referral and prior authorization are required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Tufts Medicare Preferred HMO Basic Rx (HMO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all 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 prior authorization but no prior three-day inpatient hospital stay. Patients pay 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. Additional days beyond the standard 100 Medicare-covered days 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. Over-the-counter (OTC) items, meal benefits, and other additional services are not covered under this plan.
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