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Tufts Medicare Preferred HMO Prime Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Tufts Medicare Preferred HMO Prime 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 Prime Rx (HMO) in 2025, please refer to our full plan details page.
Tufts Medicare Preferred HMO Prime Rx (HMO) is a HMO plan offered by Point32Health, Inc. available for enrollment in 2025 to people living in Worcester County. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Tufts Medicare Preferred HMO Prime 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 Prime 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 Prime Rx (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $193.00. 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 Prime 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, you will pay $8.00 copay for preferred generic drugs at a standard pharmacy, and 23% coinsurance for standard generic drugs at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. However, if you qualify for the low-income subsidy (LIS), your monthly premium will be $19.60.
Additional Benefits
The Tufts Medicare Preferred HMO Prime Rx (HMO) plan offers a range of benefits, including inpatient hospital stays with a $300 copay per stay, outpatient services with copays varying from $0 to $100, and ambulance services with a $125 copay. Emergency services have a $110 copay, and primary care physician visits cost $10. This plan also covers preventive services, hearing, vision, dental, home health, and cardiac rehabilitation services. Hearing exams have a $15 copay, and vision services include eye exams with a $15 copay. The plan covers dental services with a $15 copay for Medicare dental services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $300 copay per stay with a service-specific out-of-pocket maximum of $900. Additional days and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services for the Tufts Medicare Preferred HMO Prime Rx (HMO) plan include coverage for all outpatient hospital services, with a copay between $0 and $100, and observation services with a $100 copay. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services have a $10 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan. There is no additional information provided about the cost of services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Tufts Medicare Preferred HMO Prime Rx (HMO) plan. All ambulance services have no coinsurance, but a $125 copay applies to both ground and air ambulance services. Transportation services to plan-approved health-related locations are covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay, Urgently Needed Services have a $30 copay, Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $30 copay, and Worldwide Emergency Transportation has a $125 copay.
Primary Care See details
Primary Care services include coverage for primary care physician services with a $10 copay, chiropractic services with a $15 copay, occupational therapy with a $15 copay, physician specialist services with a $15 copay, mental health specialty services with a $0-$10 copay, other health care professional services with a $10-$20 copay, psychiatric services with a $0-$10 copay, physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits with a $0-$100 copay, and opioid treatment program services with a $15 copay. Podiatry services are not covered.
Preventive Services See details
The Tufts Medicare Preferred HMO Prime Rx (HMO) plan covers a variety of preventive services, including annual physical exams, health education, in-home safety assessments, medical nutrition therapy, wigs for hair loss related to chemotherapy (up to $500 per year), weight management programs (up to $150 per year), alternative therapies, therapeutic massage, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices and modifications (10% coinsurance), kidney disease education, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Personal Emergency Response System (PERS), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Counseling Services, 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 Adult Day Health Services are not covered.
Hearing Services See details
Hearing Services includes hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids, but not OTC hearing aids. Hearing exams have a $15 copay, and routine hearing exams and fitting/evaluation for hearing aids are limited to one visit per year. Prescription hearing aids have a copay between $250 and $1150, and are limited to two per year, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams with a $15 copay, and eyewear with a combined maximum plan benefit coverage of $150 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services are covered under the Tufts Medicare Preferred HMO Prime Rx (HMO) plan with a $15 copay for Medicare Dental Services, but Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), Oral and Maxillofacial Surgery, and Orthodontics are not covered. Prior authorization and a doctor referral are required for Medicare Dental Services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Tufts Medicare Preferred HMO Prime Rx (HMO) plan, including Medicare Part B Insulin Drugs. Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered under the Tufts Medicare Preferred HMO Prime Rx (HMO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Tufts Medicare Preferred HMO Prime Rx (HMO) plan. Durable Medical Equipment (DME) has no copay and a 10% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit has no copay and coinsurance applies. Prosthetic Devices have a 10% coinsurance. Medical Supplies have a coinsurance between 0% and 10%. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services and outpatient X-Ray services with a copay of $0. Diagnostic Procedures/Tests have a copay between $0 and $30, and Lab Services have no copay. Diagnostic Radiological Services have a coinsurance of 20%, while Therapeutic Radiological Services are not covered.
Home Health Services See details
Home Health Services are covered by the Tufts Medicare Preferred HMO Prime Rx (HMO) plan with no copay and no coinsurance, though authorization and a referral are required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. 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, there is a $20 copay, for days 21-44, there is an $80 copay, and for days 45-100, there is no copay. Additional days beyond Medicare-covered for SNF 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 and no coinsurance, and meal benefits for a chronic illness are covered. Medical stockings and sleeves require prior authorization and have a 10% coinsurance. Other services such as Over-the-Counter (OTC) 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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