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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 2026, 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 2026.
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 $203.00. 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 Prime Rx (HMO) plan features no drug deductible, allowing your prescription coverage to begin immediately. Under this plan, Tier 1 preferred generic drugs at standard pharmacies require a low $4 copay for a one-month supply, while Tier 2 generic drugs cost an $8 copay. Furthermore, Tier 6 vaccines are covered with no copay for all supply durations at standard pharmacies. For higher-tier medications, cost sharing transitions to a percentage of the drug cost. Tier 3 preferred brand drugs carry a 20% coinsurance, and Tier 4 non-preferred drugs require a 40% coinsurance for standard retail and mail-order fills. Specialty tier drugs under Tier 5 are covered with a 33% coinsurance for a one-month supply.
Additional Benefits
The Tufts Medicare Preferred HMO Prime Rx (HMO) plan offers robust coverage with predictable out-of-pocket costs, featuring a $300 copay per admission for inpatient hospital stays and no coinsurance. Primary care visits require a $10 copay, while specialist visits and routine eye or hearing exams have a $15 copay. Emergency room visits carry a $110 copay, which is waived if you are admitted, and urgently needed care requires a $30 copay. Many essential services under this plan feature no copay and no coinsurance, including preventive care, annual physicals, routine home health services, and unlimited acupuncture. For other medical needs, durable medical equipment requires a 10% coinsurance with no copay, while dialysis services require a 20% coinsurance. Although dental benefits are limited to Medicare-covered services for a $15 copay, the plan provides up to $150 annually for eyewear with no copay or deductible.
Inpatient Hospital See details
Tufts Medicare Preferred HMO Prime Rx (HMO) covers inpatient acute and psychiatric hospital stays with a $300 copay per admission and no coinsurance. The benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Tufts Medicare Preferred HMO Prime Rx (HMO) with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a $0 to $100 copay, observation services have a $100 copay per stay, and outpatient substance abuse sessions carry a $10 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Tufts Medicare Preferred HMO Prime Rx (HMO) with no copay and no coinsurance.
Ambulance and Transportation Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) covers ambulance and transportation services, though transportation is only partially covered because trips to any health-related location are excluded. Ground and air ambulance services require prior authorization and have a $175 copay with no coinsurance, while unlimited one-way rides to plan-approved locations are available with no copay and no coinsurance.
Emergency Services See details
Emergency services under the Tufts Medicare Preferred HMO Prime Rx (HMO) plan are covered with a $110 copay and no coinsurance, and the copay is waived if you are admitted to the hospital within one day. Urgently needed services have a $30 copay and no coinsurance, while worldwide emergency, urgent, and emergency transportation services are covered with no coinsurance and copays of $110, $30, and $175 respectively.
Primary Care See details
Primary care is partially covered by Tufts Medicare Preferred HMO Prime Rx (HMO) with no coinsurance, featuring a $10 copay for primary care visits and a $15 copay for specialists, though podiatry services and routine chiropractic care are not covered.
Preventive Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay for services like fitness and weight management, although a 10% coinsurance applies to home and bathroom safety devices, and several services like PERS and adult day health are not covered.
Hearing Services See details
Hearing services are covered by Tufts Medicare Preferred HMO Prime Rx (HMO), featuring a $15 copay and no coinsurance for annual routine hearing exams and fitting evaluations. Prescription hearing aids are partially covered with copays ranging from $250 to $1,150 and no coinsurance for up to two aids per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered under the Tufts Medicare Preferred HMO Prime Rx (HMO) plan, as other eye exam services are not covered. Routine eye exams require a referral and have a $15 copay and no coinsurance, while eyewear is covered with no copay or coinsurance up to a $150 annual limit, with no deductibles applying to these services.
Dental Services See details
Dental services are partially covered under the Tufts Medicare Preferred HMO Prime Rx (HMO) plan, which only covers Medicare-covered dental services for a $15 copay and no coinsurance. Preventive and comprehensive dental services, including oral exams, cleanings, X-rays, and restorative procedures, are not covered.
Home Infusion bundled Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) partially covers Home Infusion bundled Services with no copay and no coinsurance, though prior authorization is required. While insulin is covered with no copay and no coinsurance, Medicare Part B chemotherapy, radiation, and other Part B drugs are not covered.
Dialysis Services See details
Dialysis Services are covered under the Tufts Medicare Preferred HMO Prime Rx (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Tufts Medicare Preferred HMO Prime Rx (HMO) partially covers medical equipment with no copays, though prior authorization is required. Durable medical equipment and prosthetics carry a 10% coinsurance, medical supplies have a 0% to 10% coinsurance, and diabetic equipment has no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) partially covers diagnostic and radiological services, as therapeutic radiological services are not covered. Lab services and outpatient X-rays have no copay and no coinsurance, while diagnostic procedures and tests have a $0 to $30 copay and no coinsurance. Diagnostic radiological services require both a copay and a minimum 20% coinsurance, and prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Tufts Medicare Preferred HMO Prime Rx (HMO) with no copay and no coinsurance, requiring prior authorization and a referral. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Tufts Medicare Preferred HMO Prime Rx (HMO) with no coinsurance, requiring a $20 daily copay for days 1 through 20, an $80 daily copay for days 21 through 44, and no copay for days 45 through 100. Prior authorization is required, a three-day prior hospital stay is not needed, and additional days beyond the standard 100 days are not covered.
Other Services See details
Tufts Medicare Preferred HMO Prime Rx (HMO) partially covers other services, providing unlimited acupuncture treatments with no copay and no coinsurance. Over-the-counter (OTC) items and meal benefits are not covered under this plan.
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