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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 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 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 $45.00. 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 no deductible for prescription drugs. During the initial coverage phase, you will pay varying copays or coinsurance amounts depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred and mail order pharmacies. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, you will pay $0.10 for each prescription.
Additional Benefits
The Tufts Medicare Preferred HMO Basic Rx (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, and outpatient services have copays depending on the service. Emergency and urgent care services have copays, and primary care visits start at a $10 copay. The plan covers preventive, hearing, vision, and dental services, with different copays and coverage limits. It also includes coverage for ambulance, home health, and other services. The plan provides coverage for home infusion, dialysis, medical equipment, and diagnostic services, with some services requiring coinsurance.
Inpatient Hospital See details
Inpatient Hospital services are covered under this plan, including acute and psychiatric care. For acute care, you will pay a $275 copay for days 1-5, and no copay for days 6-90; for psychiatric care, you will pay a $275 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Tufts Medicare Preferred HMO Basic Rx (HMO) plan. Outpatient hospital services have a copay between $0 and $270, Observation Services have a $270 copay, Ambulatory Surgical Center (ASC) Services have no copay, and both individual and group sessions for outpatient substance abuse have a copay of $25.
Partial Hospitalization See details
Partial Hospitalization is covered. There is no copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, as well as transportation to plan-approved health-related locations. Both ground and air ambulance services have a copay of $325.00. Transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Tufts Medicare Preferred HMO Basic Rx (HMO) plan. Emergency Services have a $125 copay and no coinsurance, while Urgently Needed Services have a $45 copay and no coinsurance. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $325 copay; all of these have no coinsurance.
Primary Care See details
Primary Care Physician Services have a $10 copay, while Chiropractic Services have a $15 copay, but routine care is not covered. Occupational Therapy Services have a $30 copay, and Physician Specialist Services have a $40 copay. Mental Health and Psychiatric individual and group sessions have a copay between $0 and $25, Physical Therapy and Speech-Language Pathology Services have a $30 copay, and Other Health Care Professional visits have a copay between $10 and $40. Additional Telehealth Benefits have a copay between $0 and $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, additional preventive services, and kidney disease education services. The plan's additional preventive services have a coinsurance, and there is a $20 copay for EKG following a Welcome Visit.
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 inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $15-$40, and routine eye exams have a copay of $15. Eyewear has a combined maximum benefit of $150 every year.
Dental Services See details
Dental Services are covered, with a $1,000 annual maximum. Medicare dental services require prior authorization and a doctor referral, with a $40 copay. Oral exams have a coinsurance of 0% to 50%, dental x-rays have a coinsurance of 0% to 50%, and prophylaxis (cleaning) is covered. Fluoride treatment is not covered, and orthodontics is covered under Diagnostic and Preventive Dental. Restorative services, adjunctive general services, oral and maxillofacial surgery, and periodontics have a 50% coinsurance; however, endodontics, prosthodontics (removable and fixed), implant services, and orthodontics are either not covered or offered as optional supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, and the plan covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs 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. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered by the Tufts Medicare Preferred HMO Basic Rx (HMO) plan, including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with coinsurance, and Diabetic Equipment. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Tufts Medicare Preferred HMO Basic Rx (HMO) plan. Diagnostic Procedures/Tests have a copay between $10 and $45, Lab Services have no copay, Diagnostic Radiological Services have a copay between $100 and $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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the sub-services are 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, 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 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 the plan provides a meal benefit for a chronic illness. Medical stockings and sleeves are covered with 20% coinsurance, and prior authorization is required. 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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