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Tufts Medicare Preferred HMO Prime No Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Tufts Medicare Preferred HMO Prime No 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 No Rx (HMO) in 2026, please refer to our full plan details page.
Tufts Medicare Preferred HMO Prime No 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 No Rx (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Tufts Medicare Preferred HMO Prime No 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 No Rx (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by Tufts Medicare Preferred HMO Prime No Rx (HMO).
Additional Benefits
The Tufts Medicare Preferred HMO Prime No Rx (HMO) plan offers robust medical coverage with affordable copays and no coinsurance for most key services. Inpatient hospital stays require a $300 copay, while primary care visits have a $10 copay and specialist appointments have a $15 copay. Many essential services, including preventive care, home health services, and ambulatory surgical center visits, are fully covered with no copay and no coinsurance. This plan also includes helpful everyday benefits like routine vision and hearing exams for a low $15 copay, alongside an annual $150 eyewear allowance with no copay. Members can take advantage of unlimited acupuncture with no copay and health-related transportation services with no copay for unlimited one-way trips. Emergency care is accessible with a $110 copay, which is waived if you are admitted to the hospital.
Inpatient Hospital See details
Tufts Medicare Preferred HMO Prime No Rx (HMO) partially covers inpatient hospital services with a $300 copay per stay and no coinsurance for Medicare-covered acute and psychiatric admissions. While unlimited additional days are covered for acute stays, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Tufts Medicare Preferred HMO Prime No Rx (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $100, observation services have a $100 copay per stay, and outpatient substance abuse sessions carry a $10 copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by the Tufts Medicare Preferred HMO Prime No Rx (HMO) plan with no copay and no coinsurance.
Ambulance and Transportation Services See details
Tufts Medicare Preferred HMO Prime No Rx (HMO) covers ground and air ambulance services with a $175 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered with no copay and no coinsurance for unlimited one-way trips to plan-approved health-related locations, though transportation to any health-related location is not covered.
Emergency Services See details
Tufts Medicare Preferred HMO Prime No Rx (HMO) covers emergency services with a $110 copay, which is waived if admitted to the hospital within one day, and urgently needed services with a $30 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $110, $30, and $175 respectively.
Primary Care See details
Tufts Medicare Preferred HMO Prime No Rx (HMO) covers primary care physician visits with a $10 copay and specialist, physical therapy, and occupational therapy services with a $15 copay, all with no coinsurance. Mental health, psychiatric, and telehealth services are also covered with copays ranging from no copay up to $100 and no coinsurance, though routine chiropractic and podiatry services are not covered.
Preventive Services See details
Tufts Medicare Preferred HMO Prime No Rx (HMO) provides partial coverage for preventive services, offering most benefits like annual physical exams and screenings with no copay and no coinsurance, while home and bathroom safety devices require a 10% coinsurance and no copay. Non-covered services under this benefit include personal emergency response systems, adult day health, home-based palliative care, in-home support, telemonitoring, and counseling.
Hearing Services See details
Tufts Medicare Preferred HMO Prime No Rx (HMO) partially covers hearing services, including one routine hearing exam and fitting evaluation per year for a $15 copay and no coinsurance. Up to two prescription hearing aids are covered annually with a copay ranging from $250 to $1,150 and no coinsurance, though OTC hearing aids and inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Vision services are partially covered by Tufts Medicare Preferred HMO Prime No Rx (HMO) with no deductibles, as other eye exam services are not covered. Covered benefits include one annual routine eye exam for a $15 copay and no coinsurance, and eyewear up to a $150 annual maximum with no copay and no coinsurance.
Dental Services See details
Tufts Medicare Preferred HMO Prime No Rx (HMO) partially covers dental services, offering Medicare-covered dental care for a $15.00 copay and no coinsurance, with prior authorization and referral required. Routine and comprehensive services—including oral exams, cleanings, x-rays, restorative treatments, endodontics, periodontics, and orthodontics—are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Tufts Medicare Preferred HMO Prime No Rx (HMO) with no copay and no coinsurance, although prior authorization and step therapy apply. This benefit is only partially covered, as it includes Medicare Part B insulin drugs with no copay and no coinsurance, but excludes Medicare Part B chemotherapy, radiation, and other Part B drugs.
Dialysis Services See details
Dialysis Services are covered by the Tufts Medicare Preferred HMO Prime No Rx (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment is partially covered by Tufts Medicare Preferred HMO Prime No Rx (HMO), featuring no copays for covered items, although diabetic supplies and diabetic therapeutic shoes or inserts are not covered. Covered durable medical equipment and prosthetics require a 10% coinsurance, medical supplies carry a 0% to 10% coinsurance, and diabetic equipment has no coinsurance.
Diagnostic and Radiological Services See details
Tufts Medicare Preferred HMO Prime No Rx (HMO) partially covers diagnostic and radiological services, as therapeutic radiological services are not covered. Diagnostic services feature no coinsurance, offering no copay for lab services and a $0 to $30 copay for procedures, while diagnostic radiological services require a copay and a minimum 20% coinsurance, and outpatient X-rays require no copay.
Home Health Services See details
Home health services are covered by Tufts Medicare Preferred HMO Prime No Rx (HMO) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Tufts Medicare Preferred HMO Prime No Rx (HMO) with no copay and no coinsurance, although 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
Skilled Nursing Facility (SNF) services are covered by Tufts Medicare Preferred HMO Prime No Rx (HMO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. For the first 100 days, you will pay a $20 daily copay for days 1 to 20, an $80 daily copay for days 21 to 44, and no copay for days 45 to 100, though additional days beyond this limit are not covered.
Other Services See details
Tufts Medicare Preferred HMO Prime No Rx (HMO) partially covers other services, offering unlimited acupuncture with no copay and no coinsurance. Over-the-counter (OTC) items and meal benefits are not covered under this plan.
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