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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 2026, 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 2026.
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 $55.00. 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 Basic Rx (HMO) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. You will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when using a preferred pharmacy or standard mail order, while standard pharmacies charge copays starting at $6 and $11 respectively. Additionally, Tier 6 vaccines are covered with no copay at both preferred and standard pharmacies. For brand-name and specialty medications, your costs are determined by coinsurance. Tier 3 preferred brand drugs require a 20% coinsurance, Tier 4 non-preferred drugs require a 40% coinsurance, and Tier 5 specialty drugs carry a 33% coinsurance for a one-month supply. These coinsurance rates apply across preferred pharmacies, standard pharmacies, and standard mail-order options.
Additional Benefits
The Tufts Medicare Preferred HMO Basic Rx (HMO) plan offers comprehensive coverage with predictable cost-sharing, featuring no coinsurance for many core medical services. Members pay a low $10 copay for primary care visits, a $40 copay for specialists, and no copay for home health care or partial hospitalization. For hospital care, there is a $275 daily copay for the first five days of an inpatient stay, while emergency visits require a $125 copay, which is waived upon admission. Additional benefits include routine vision and hearing exams with no copay, a $150 annual eyewear allowance, and up to $1,000 in dental coverage with coinsurance ranging from 0% to 50%. The plan also features unlimited, free one-way transportation to plan-approved health locations and acupuncture sessions with no copay. However, some services such as cardiac rehabilitation, over-the-counter items, and routine podiatry are not covered.
Inpatient Hospital See details
Tufts Medicare Preferred HMO Basic Rx (HMO) inpatient hospital benefits are covered with no coinsurance, requiring a $275 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute care days are covered, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay. Outpatient hospital services feature a copay ranging from $0 to $270, observation services require a $270 copay per stay, and outpatient substance abuse sessions have a $25 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by Tufts Medicare Preferred HMO Basic Rx (HMO) with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Tufts Medicare Preferred HMO Basic Rx (HMO) plan, featuring a $325 copay and no coinsurance for ground and air ambulance services. Transportation services are partially covered, offering unlimited one-way rides to plan-approved health-related locations with no copay and no coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers emergency services with a $125 copay, which is waived if admitted to the hospital within one day, and no coinsurance. Urgently needed services require a $45 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $125, $45, and $325 respectively.
Primary Care See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers primary care physician services for a $10 copay and specialist visits for a $40 copay, with no coinsurance required for either. While most other primary care services are covered with varying copays and no coinsurance, podiatry services and routine chiropractic care are not covered under this plan.
Preventive Services See details
Preventive services are partially covered by Tufts Medicare Preferred HMO Basic Rx (HMO), with most services, including annual physical exams and kidney disease education, featuring no copay and no coinsurance. Some benefits require cost-sharing, such as a $20 copay for EKGs and a 20% coinsurance for home safety devices, while services like personal emergency response systems (PERS), adult day health, and in-home support are not covered.
Hearing Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) hearing services are partially covered, featuring Medicare-covered exams for a $40 copay and annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids have no coinsurance and copays ranging from $250 to $1,150, but over-the-counter, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Tufts Medicare Preferred HMO Basic Rx (HMO), as other eye exam services are not covered. Covered eye exams require a $15 to $40 copay with no deductible or coinsurance, while eyewear is covered up to a $150 annual maximum with no copay, coinsurance, or deductible.
Dental Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) partially covers dental services, offering Medicare-covered dental with a $40 copay and no coinsurance, and other covered dental services with no copay and 0% to 50% coinsurance up to a $1,000 annual limit. Services such as fluoride treatments, other diagnostic or preventive dental, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs require a 0% to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance.
Dialysis Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Tufts Medicare Preferred HMO Basic Rx (HMO) with no copays, requiring a 20% coinsurance for durable medical equipment and prosthetics, and 0% to 20% coinsurance for medical supplies. Diabetic equipment is partially covered with no copay or coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Tufts Medicare Preferred HMO Basic Rx (HMO) plan with no coinsurance, though prior authorization is required. Members pay no copay for lab services, a $10 to $45 copay for diagnostic procedures and tests, a $10 copay for outpatient X-rays, a minimum $60 copay for therapeutic radiology, and a minimum $100 copay for diagnostic radiology.
Home Health Services See details
Tufts Medicare Preferred HMO Basic Rx (HMO) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to access these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Tufts Medicare Preferred HMO Basic Rx (HMO) plan. This non-coverage applies to all related sub-services, including standard and intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by Tufts Medicare Preferred HMO Basic Rx (HMO) with no coinsurance and no prior three-day hospital stay required. Copayments are $20 per day for days 1 to 20, $160 per day for days 21 to 44, and no copay for days 45 to 100, though prior authorization is required and additional days beyond the Medicare limit are not covered.
Other Services See details
Other services are partially covered by Tufts Medicare Preferred HMO Basic Rx (HMO), which features acupuncture with no copay and no coinsurance for unlimited treatments. Over-the-counter (OTC) items and meal benefits are not covered under this plan.
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