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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 2026, 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 2026.
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 $173.00. 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 Value Rx (HMO) plan features a $0 drug deductible, meaning your coverage starts immediately with no upfront deductible costs. For Tier 1 preferred generics and Tier 6 vaccines, you will enjoy no copay when using preferred pharmacies or standard mail order options. Tier 2 generic drugs are also highly affordable, costing a low $4 copay for a one-month supply at preferred pharmacies or standard mail order, compared to $19 at standard pharmacies. Higher-tier prescriptions on this plan transition to coinsurance percentages instead of flat copays. Tier 3 preferred brands require a 20% coinsurance, while Tier 4 non-preferred drugs have a 40% coinsurance across all pharmacy types. Specialty drugs in Tier 5 carry a 33% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Tufts Medicare Preferred HMO Value Rx (HMO) plan offers affordable medical care with no coinsurance for many key services, including a low $10 copay for primary care visits and a $25 copay for specialists. Inpatient hospital stays require a $200 daily copay for the first five days with no copay for days six through 90, while emergency room visits carry a $125 copay. Outpatient hospital services are also highly accessible, ranging from no copay up to a $150 copay with no coinsurance. This plan also features valuable extra benefits, including routine vision exams for a $15 copay and up to a $150 annual eyewear allowance with no copay. Dental care is covered with a $25 copay for Medicare-approved services and up to a $1,000 annual limit with 0% to 50% coinsurance for other covered dental services. Additionally, members benefit from unlimited transportation to approved health-related locations and home health services with no copay.
Inpatient Hospital See details
Tufts Medicare Preferred HMO Value Rx (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $200 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional days are covered for acute stays, but additional psychiatric days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Tufts Medicare Preferred HMO Value Rx (HMO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay. Outpatient hospital services carry a $0 to $150 copay, observation services require a $150 copay per stay, and outpatient substance abuse sessions have a $20 copay, all with no coinsurance.
Partial Hospitalization See details
Tufts Medicare Preferred HMO Value Rx (HMO) covers partial hospitalization services with no copay and no coinsurance.
Ambulance and Transportation Services See details
Tufts Medicare Preferred HMO Value Rx (HMO) covers ambulance services with a $225 copay and no coinsurance for both ground and air transport, which requires prior authorization. The plan also provides unlimited one-way transportation to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Tufts Medicare Preferred HMO Value Rx (HMO) covers emergency services with a $125 copay and no coinsurance, with the copay waived if you are admitted to the hospital within one day. Urgently needed services require a $30 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $30 to $225.
Primary Care See details
Tufts Medicare Preferred HMO Value Rx (HMO) covers primary care visits for a $10 copay and specialist visits for a $25 copay, both with no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, though routine chiropractic care is not covered, and podiatry services are entirely uncovered. Therapy, mental health, and telehealth services are also covered with no coinsurance and copays ranging from no copay up to $150.
Preventive Services See details
Preventive services under the Tufts Medicare Preferred HMO Value Rx (HMO) are partially covered, with annual physical exams and kidney disease education available with no copay and no coinsurance. However, several sub-services are not covered, including PERS, post-discharge medication reconciliation, re-admission prevention, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, and counseling. Bathroom safety devices require a 10% coinsurance, while an EKG following a welcome visit has a $10 copay.
Hearing Services See details
Hearing Services are partially covered by Tufts Medicare Preferred HMO Value Rx (HMO), offering annual routine exams and fittings for a $25 copay and no coinsurance, and prescription hearing aids with no coinsurance and copays ranging from $250 to $1,150. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by Tufts Medicare Preferred HMO Value Rx (HMO), featuring a $15 copay and no coinsurance for one routine eye exam per year, while other eye exam services are not covered. Eyewear, including contacts and eyeglasses, is covered with no copay or coinsurance up to a $150 annual maximum.
Dental Services See details
Dental services are partially covered by Tufts Medicare Preferred HMO Value Rx (HMO), which offers Medicare-covered dental care for a $25 copay and no coinsurance, and other covered dental services with no copay and 0% to 50% coinsurance up to a $1,000 annual limit. Some services are not covered, including fluoride treatments, dental implants, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are partially covered by Tufts Medicare Preferred HMO Value Rx (HMO) with no copay and no coinsurance, though prior authorization and step therapy are required. While insulin and Part D home infusion drugs are covered under this benefit, 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 Value Rx (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Tufts Medicare Preferred HMO Value Rx (HMO) with no copays, featuring a 10% coinsurance for durable medical equipment and prosthetics, and 0% to 10% coinsurance for medical supplies. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Tufts Medicare Preferred HMO Value Rx (HMO) with no coinsurance, though therapeutic radiological services are not covered. Covered services require prior authorization and feature no copay for lab services, a $10 copay for outpatient X-rays, a $10 to $30 copay for diagnostic procedures, and a minimum $100 copay for diagnostic radiological services.
Home Health Services See details
Home health services are covered by the Tufts Medicare Preferred HMO Value Rx (HMO) with no copay and no coinsurance. Both prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Tufts Medicare Preferred HMO Value Rx (HMO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization and referrals are required. 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
Tufts Medicare Preferred HMO Value Rx (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1-20, a $120 daily copay for days 21-44, and no copay for days 45-100. Prior authorization is required, a prior 3-day inpatient hospital stay is not required before admission, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Other services are partially covered by Tufts Medicare Preferred HMO Value Rx (HMO), which offers unlimited acupuncture treatments with no copay and no coinsurance. Over-the-counter (OTC) items and meal benefits are not covered under this benefit.
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