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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 2026, 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 2026.
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 $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 Value No Rx (HMO).
Additional Benefits
The Tufts Medicare Preferred HMO Value No Rx (HMO) plan offers affordable access to core medical care, featuring a $10 copay for primary care visits, a $25 copay for specialists, and no coinsurance for these services. For hospital care, inpatient stays require a $200 daily copay for the first five days with no copay thereafter, while outpatient hospital services range from no copay up to a $150 copay. Emergency care is covered with a $125 copay, which is waived if admitted, and urgent care visits require a $30 copay. For extra benefits, the plan provides preventive dental cleanings and home health visits with no copay, while routine vision exams require a $15 copay and routine hearing exams require a $25 copay. Prescription hearing aids are covered with copays ranging from $250 to $1,150, and you receive up to a $150 annual allowance for eyewear with no copay. Additionally, members can access unlimited acupuncture treatments and unlimited transportation to plan-approved medical locations with no copay.
Inpatient Hospital See details
Tufts Medicare Preferred HMO Value No Rx (HMO) covers inpatient hospital services with no coinsurance, requiring a $200 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered because room upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Tufts Medicare Preferred HMO Value No Rx (HMO) with no coinsurance, featuring a $0 to $150 copay for outpatient hospital services and a $150 copay per stay for observation services. Ambulatory surgical center services and outpatient blood services have no copay, while outpatient substance abuse individual and group sessions require a $20 copay.
Partial Hospitalization See details
Tufts Medicare Preferred HMO Value No Rx (HMO) covers partial hospitalization services with no copay and no coinsurance.
Ambulance and Transportation Services See details
Tufts Medicare Preferred HMO Value No Rx (HMO) covers ground and air ambulance services with a $225 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered, providing unlimited one-way rides to plan-approved health-related locations with no copay and no coinsurance, though transportation to any other health-related location is not covered.
Emergency Services See details
Emergency services are covered by Tufts Medicare Preferred HMO Value No Rx (HMO) with a $125 copay and no coinsurance, which is waived if admitted to the hospital within one day, and urgently needed care is covered with a $30 copay and no coinsurance. Worldwide emergency services are also covered with no coinsurance, requiring copays of $125 for emergency care, $30 for urgent care, and $225 for emergency transportation.
Primary Care See details
Primary care benefits under the Tufts Medicare Preferred HMO Value No Rx (HMO) are covered with no coinsurance, requiring a $10 copay for primary care visits and a $25 copay for specialists. Other services such as mental health, physical therapy, and telehealth are covered with no coinsurance and copays ranging from no copay up to $150, though chiropractic services are only partially covered (excluding routine care) and podiatry is not covered.
Preventive Services See details
Preventive services are partially covered under the Tufts Medicare Preferred HMO Value No Rx (HMO), with many key benefits like annual physical exams and kidney disease education featuring no copay and no coinsurance. Some covered services require cost-sharing, such as a $10 copay for post-welcome-visit EKGs and a 10% coinsurance for home safety devices, while other services like personal emergency response systems, adult day health, and in-home support are not covered.
Hearing Services See details
Tufts Medicare Preferred HMO Value No Rx (HMO) covers annual routine hearing exams and fittings for a $25 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $250 to $1,150 for up to two aids per year, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Tufts Medicare Preferred HMO Value No Rx (HMO) partially covers vision services with no deductibles, offering one routine eye exam per year with a referral for a $15 copay and no coinsurance, while other eye exams are not covered. Eyewear is covered with no copay and no coinsurance up to a $150 annual maximum.
Dental Services See details
Tufts Medicare Preferred HMO Value No Rx (HMO) partially covers dental services up to a $1,000 annual maximum, with Medicare-covered dental requiring a $25 copay and no coinsurance. Preventive cleanings have no copay and no coinsurance, whereas other covered services like exams, X-rays, restorative care, periodontics, and oral surgery have no copay and 0% to 50% coinsurance. Fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are partially covered by Tufts Medicare Preferred HMO Value No Rx (HMO) with no copay and no coinsurance, although prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin is covered with no copay or coinsurance, but Medicare Part B chemotherapy or radiation drugs and other Medicare Part B drugs are not covered.
Dialysis Services See details
Dialysis Services are covered under the Tufts Medicare Preferred HMO Value No Rx (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Tufts Medicare Preferred HMO Value No Rx (HMO) covers medical equipment with no copay, 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 or coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Tufts Medicare Preferred HMO Value No Rx (HMO) partially covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Under this plan, lab services have no copay, outpatient X-rays cost a $10 copay, diagnostic procedures and tests range from a $10 to $30 copay, and diagnostic radiology has a minimum $100 copay, while therapeutic radiological services are not covered.
Home Health Services See details
Tufts Medicare Preferred HMO Value No Rx (HMO) covers Home Health Services 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 not covered under the Tufts Medicare Preferred HMO Value No Rx (HMO) plan, as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Tufts Medicare Preferred HMO Value No Rx (HMO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 through 20, a $120 daily copay for days 21 through 44, and no copay for days 45 through 100. Prior authorization is required, and while a prior three-day hospital stay is not needed, additional days beyond the standard 100-day limit are not covered.
Other Services See details
Tufts Medicare Preferred HMO Value No Rx (HMO) partially covers other services, offering unlimited acupuncture treatments with no copay and no coinsurance. Over-the-counter (OTC) items and meal benefits are not covered under this plan.
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