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Tufts Medicare Preferred HMO Value No Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Tufts Medicare Preferred HMO Value 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 Value No Rx (HMO) in 2025, please refer to our full plan details page.
Tufts Medicare Preferred HMO Value 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 2025.
It's important to know that Tufts Medicare Preferred HMO Value 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 Value 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 Value 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 $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
Prescription drugs are not covered by Tufts Medicare Preferred HMO Value No Rx (HMO).
Additional Benefits
The Tufts Medicare Preferred HMO Value No Rx (HMO) plan offers coverage for a variety of services with varying cost-sharing amounts. Inpatient hospital stays require a $200 copay for the first five days, and then no copay for the remainder of the stay. Outpatient services and primary care visits have copays ranging from $0 to $150, and specialist visits have a $25 copay. This plan also includes coverage for ambulance services, emergency services, and transportation to health-related locations, with copays ranging from $30 to $225. Preventive services, hearing exams, and vision services are covered, and dental services are offered with coinsurance or copays. Additionally, the plan covers home health services, medical equipment with a 10% coinsurance, and skilled nursing facility stays with varying copays based on the length of stay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $200 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will also pay a $200 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, but non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $150, observation services with a $150 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a $20 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered by this plan. There is no copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a copay of $225, while transportation services to a plan-approved health-related location are covered with no copay or coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay, and Urgently Needed Services have a $30 copay, and Worldwide Emergency Services have a copay of $125 for Worldwide Emergency Coverage, a $30 copay for Worldwide Urgent Coverage, and a $225 copay for Worldwide Emergency Transportation.
Primary Care See details
The Tufts Medicare Preferred HMO Value No Rx (HMO) plan covers primary care physician services with a $10 copay, chiropractic services with a $15 copay (excluding routine care), occupational therapy services with a $20 copay, and specialist services with a $25 copay. The plan also covers mental health and psychiatric individual and group sessions with a copay between $0-$20, physical therapy and speech-language pathology services with a $20 copay, telehealth services with a copay between $0-$150, and opioid treatment program services with a $25 copay. Other Health Care Professional services are covered with a copay between $10-$25.
Preventive Services See details
The Tufts Medicare Preferred HMO Value No Rx (HMO) plan covers preventive services, including annual physical exams, health education, in-home safety assessments, kidney disease education services, and other preventive services. The plan also covers wigs for hair loss related to chemotherapy, and weight management programs, with the latter having a maximum benefit of $150 per year. However, the plan does not cover personal emergency response systems (PERS), post-discharge in-home medication reconciliation, re-admission prevention, counseling services, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, or home and bathroom safety devices and modifications.
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, limited to two visits per year, 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 routine eye exams with a copay of $15-$25, and eyewear benefits including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum plan benefit coverage of $150 per year.
Dental Services See details
The Tufts Medicare Preferred HMO Value No Rx (HMO) plan covers dental services with a $25 copay for Medicare Dental Services, and covers oral exams and dental x-rays with a 0-50% coinsurance, as well as prophylaxis (cleaning). Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. Restorative Services, Adjunctive General Services, Periodontics, and Oral and Maxillofacial Surgery are covered with a 50% coinsurance. Endodontics, Prosthodontics, removable, and Prosthodontics, fixed are offered as supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Tufts Medicare Preferred HMO Value No Rx (HMO) plan, with prior authorization required. The plan covers Medicare Part B Insulin Drugs, while Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered by the Tufts Medicare Preferred HMO Value No Rx (HMO) plan. You will pay 20% coinsurance for this service.
Medical Equipment See details
Medical equipment is covered under this plan, with 10% coinsurance for Durable Medical Equipment (DME) and Prosthetic Devices. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Tufts Medicare Preferred HMO Value No Rx (HMO) plan. Diagnostic Procedures/Tests have a copay between $10 and $30, while Lab Services have no copay. Diagnostic Radiological Services have a $100 copay, and Outpatient X-Ray Services have a $10 copay, but Therapeutic Radiological Services are not covered.
Home Health Services See details
Home Health Services are covered by the Tufts Medicare Preferred HMO Value No Rx (HMO) plan with no copay and no coinsurance, but prior authorization and a referral are required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required for these services.
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
Other Services include acupuncture, a meal benefit for chronic illness, and medical stockings and sleeves. Acupuncture is covered with no copay or coinsurance, and the meal benefit is also covered. Medical stockings and sleeves are covered with a 10% coinsurance. However, 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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