A non-government entity
Tufts Medicare Preferred HMO Value Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Tufts Medicare Preferred HMO Value 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 Value Rx (HMO) in 2025, please refer to our full plan details page.
Tufts Medicare Preferred HMO Value 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 Value 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 Value 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 Value Rx (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $163.00. 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:
Sign up for Tufts Medicare Preferred HMO Value Rx (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Tufts Medicare Preferred HMO Value Rx (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will 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 and a $19 copay at standard pharmacies. After your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. This plan may reduce your premium if you qualify for the low-income subsidy.
Additional Benefits
The Tufts Medicare Preferred HMO Value Rx (HMO) plan offers coverage for a wide range of services. This plan includes inpatient hospital stays with a $200 copay for days 1-5, and no copay for days 6-90. Outpatient services have a copay between $0 and $150, and primary care visits have a $10 copay. The plan also covers preventive services with no copay, along with hearing, vision, and dental services, with varying copays and coinsurance. Emergency services have a $125 copay. Other benefits include ambulance, home health, and skilled nursing facility services, as well as medical equipment and diagnostic services, with associated cost-sharing.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $200 copay for days 1-5, and no copay for days 6-90; Inpatient Hospital Psychiatric has the same cost sharing.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Tufts Medicare Preferred HMO Value Rx (HMO) plan. Outpatient Hospital Services have a copay between $0 and $150, while Observation Services have a $150 copay. Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Substance Abuse Services have a $20 copay for both individual and group sessions. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial hospitalization is covered with this plan.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a $225 copay. Transportation Services to a plan-approved health-related location are covered, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Tufts Medicare Preferred HMO Value Rx (HMO) plan with a $125 copay, and no coinsurance. Urgently Needed Services have a $30 copay and no coinsurance, while Worldwide Emergency Coverage has a $125 copay and no coinsurance. Worldwide Urgent Coverage has a $30 copay with no coinsurance, and Worldwide Emergency Transportation has a $225 copay and no coinsurance.
Primary Care See details
The Tufts Medicare Preferred HMO Value Rx (HMO) plan covers primary care physician services with a $10 copay, chiropractic services with a $15 copay, occupational therapy services with a $20 copay, and physician specialist services with a $25 copay. Mental health services have a copay between $0 and $20, other health care professional services have a copay between $10 and $25, psychiatric services have a copay between $0 and $20, physical therapy and speech-language pathology services have a $20 copay, additional telehealth benefits have a copay between $0 and $150, and opioid treatment program services have a $25 copay. Podiatry services are not covered.
Preventive Services See details
The Tufts Medicare Preferred HMO Value Rx (HMO) plan covers preventive services, including an annual physical exam, with no copay or coinsurance. Additional preventive services may have a coinsurance, and other services like Medicare-covered glaucoma screening have a copay.
Hearing Services See details
Hearing exams are covered with a $25 copay, including routine hearing exams and fitting/evaluation for hearing aids, each limited to one visit per year. Prescription hearing aids are covered with a copay between $250 and $1150 for all types of prescription hearing aids, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $15-$25, and routine eye exams with a copay of $15. Eyewear is covered with a combined maximum benefit of $150 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $25 copay, along with other dental services with a $1,000 annual maximum. Oral exams have a 0-50% coinsurance, dental x-rays have a 0-50% coinsurance, and prophylaxis (cleaning) is covered. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Restorative services, adjunctive general services, periodontics, and oral and maxillofacial surgery have a 50% coinsurance, and endodontics, prosthodontics (removable and fixed), and orthodontics are optional supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Tufts Medicare Preferred HMO Value Rx (HMO) plan, with prior authorization required. This includes coverage for Medicare Part B Insulin Drugs, but does not cover Medicare Part B Chemotherapy/Radiation Drugs.
Dialysis Services See details
Dialysis Services are covered by the Tufts Medicare Preferred HMO Value Rx (HMO) plan. The coinsurance for dialysis services is between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 10% coinsurance and no copay, Prosthetics/Medical Supplies with 10% coinsurance and no copay, and Diabetic Equipment. Durable Medical Equipment for use outside the home and Diabetic Supplies and Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a copay between $10 and $30, and Lab Services with no copay. Diagnostic Radiological Services have a $100 copay, while Therapeutic Radiological Services are not covered, 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 Value 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 covered by the Tufts Medicare Preferred HMO Value Rx (HMO) plan, but none of the sub-services are covered. Prior authorization and a doctor's referral are required for coverage.
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 $120, and for days 45-100 there is no copay.
Other Services See details
The Tufts Medicare Preferred HMO Value Rx (HMO) plan covers acupuncture with no copay, and also includes a meal benefit for chronic illnesses. Other services like over-the-counter items and medical stockings and sleeves are covered, with a 10% coinsurance for the latter. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and several other services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved