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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 $37.00. 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. In 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. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. However, this plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Tufts Medicare Preferred HMO Basic Rx (HMO) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a $275 copay for the first 5 days, then no copay for the rest. Outpatient services have copays that vary depending on the service. Emergency services have copays between $45 and $125. Primary care visits cost between $10 and $40, with some mental health services also having copays. Preventive services, including exams and health education, have no copay. Hearing services include hearing exams and hearing aids with copays, while vision services cover eye exams and eyewear with copays. Dental services include a $40 copay for Medicare dental services, with coinsurance for other services. The plan also covers ambulance, home health, and skilled nursing facility services with copays or coinsurance, as well as certain therapies and medical equipment.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $275 copay for days 1-5 and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will pay a $275 copay for days 1-5 and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $270, observation services have a $270 copay, ambulatory surgical center services have no copay, and both individual and group outpatient substance abuse sessions have a $25 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the plan. There is no information about the cost of this service, so the copay and coinsurance are not available.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services, with a $325 copay per service. Transportation Services to a plan-approved health-related location are also covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage have a copay of $125, $45, $125, and $45, respectively, with no coinsurance. Worldwide Emergency Transportation has a copay of $325 with no coinsurance.
Primary Care See details
Primary Care services include a $10 copay for Primary Care Physician Services, a $15 copay for Chiropractic Services, a $30 copay for Occupational Therapy Services, a $40 copay for Physician Specialist Services, and a $0-$25 copay for Individual and Group Sessions for Mental Health Specialty Services. Additionally, there is a $10-$40 copay for Other Health Care Professional services, a $0-$25 copay for Individual and Group Sessions for Psychiatric Services, and a $30 copay for Physical Therapy and Speech-Language Pathology Services. Additional Telehealth benefits have a copay of $0-$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 wigs for hair loss related to chemotherapy, with no copay or coinsurance. Additional preventive services include a coinsurance for home and bathroom safety devices and modifications. Other services like personal emergency response systems, post-discharge in-home medication reconciliation, re-admission prevention, and home-based palliative care 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 covered, with a copay between $250 and $1150, while OTC hearing aids are not covered, and prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay of $15-$40, as well as routine eye exams with a copay of $15. Eyewear is covered, with a combined maximum benefit of $150 every year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Upgrades are also covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $40 copay. Other Dental Services include Oral Exams with a 0% to 50% coinsurance, Dental X-Rays with a 0% to 50% coinsurance, Prophylaxis (Cleaning), and Orthodontic Services; however, Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. Additionally, Restorative Services, Adjunctive General Services, Periodontics, and Oral and Maxillofacial Surgery have a 50% coinsurance. Endodontics, Prosthodontics (removable and fixed) are offered as an optional, supplemental benefit.
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 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 this benefit.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with a 0-20% coinsurance. However, 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 $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 Additional Hours of Care and Personal Care Services are not covered. This benefit requires both authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are covered. 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. 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. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture, meal benefits, and medical stockings and sleeves. Acupuncture is covered with no copay or coinsurance, and meal benefits are provided for a chronic illness. Medical stockings and sleeves require prior authorization and have a 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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