A non-government entity
Tufts Medicare Preferred HMO Basic No Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Tufts Medicare Preferred HMO Basic 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 Basic No Rx (HMO) in 2026, please refer to our full plan details page.
Tufts Medicare Preferred HMO Basic 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 Basic 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 Basic 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 Basic 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:
Sign up for Tufts Medicare Preferred HMO Basic No Rx (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
Prescription drugs are not covered by Tufts Medicare Preferred HMO Basic No Rx (HMO).
Additional Benefits
The Tufts Medicare Preferred HMO Basic No Rx (HMO) plan offers robust coverage with predictable costs, featuring no coinsurance for many core medical services. Under this plan, primary care visits carry a low $10 copay, specialist visits require a $40 copay, and routine preventive services, home health care, and lab tests are available with no copay. For hospital stays, members pay a $275 daily copay for the first five days of inpatient care and no copay for subsequent days up to day 90. Emergency care is covered with a $125 copay, which is waived if admitted, while urgent care has a $45 copay. Essential extras like routine dental cleanings, routine hearing exams, and unlimited acupuncture are offered with no copay, and dental services include up to a $1,000 annual benefit limit. Vision benefits provide eye exams with a $15 to $40 copay alongside a $150 annual allowance for eyewear with no copay.
Inpatient Hospital See details
Tufts Medicare Preferred HMO Basic No Rx (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $275 daily copay for days 1 through 5 and no copay for days 6 through 90. The benefit is partially covered, as upgrades, psychiatric additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Tufts Medicare Preferred HMO Basic No Rx (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services require a $0 to $270 copay, observation services have a $270 copay per stay, and outpatient substance abuse sessions have a $25 copay, all with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Tufts Medicare Preferred HMO Basic No Rx (HMO) plan with no copay and no coinsurance.
Ambulance and Transportation Services See details
Tufts Medicare Preferred HMO Basic No Rx (HMO) covers ground and air ambulance services with a $325 copay and no coinsurance per trip. Transportation services are partially covered, offering unlimited rides to plan-approved health-related locations with no copay or coinsurance, while transportation to other health-related locations is not covered.
Emergency Services See details
Tufts Medicare Preferred HMO Basic No Rx (HMO) covers emergency services with a $125 copay—which is waived if admitted to the hospital within one day—and urgent care with a $45 copay, both featuring no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $125, $45, and $325 respectively.
Primary Care See details
Primary care benefits under the Tufts Medicare Preferred HMO Basic No Rx (HMO) plan are partially covered, featuring a $10 copay and no coinsurance for primary care visits, and a $40 copay with no coinsurance for specialist visits. Other covered services like therapy, mental health, and telehealth range from no copay up to a $270 copay with no coinsurance, while routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Tufts Medicare Preferred HMO Basic No Rx (HMO) covers preventive services, including annual physical exams and kidney disease education with no copay and no coinsurance. Additional preventive benefits are partially covered, excluding personal emergency response systems, adult day health, in-home support, and counseling, while requiring a 20% coinsurance for home safety devices and a $20 copay for post-welcome visit EKGs.
Hearing Services See details
Tufts Medicare Preferred HMO Basic No Rx (HMO) covers hearing services with no deductibles or coinsurance, offering routine hearing exams and fitting evaluations with no copay and Medicare-covered exams for a $40 copay. Prescription hearing aids are partially covered with copays ranging from $250 to $1,150 for up to two devices per year, but inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services under Tufts Medicare Preferred HMO Basic No Rx (HMO) are partially covered with no deductibles, featuring eye exams with a $15 to $40 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $150 annual combined maximum for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by Tufts Medicare Preferred HMO Basic No Rx (HMO), featuring a $40 copay and no coinsurance for Medicare-covered dental, and up to a $1,000 annual limit for other dental services with no copay and either no coinsurance or 50% coinsurance. Routine cleanings have no copay and no coinsurance, but fluoride treatments, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Tufts Medicare Preferred HMO Basic No Rx (HMO) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Dialysis Services are covered by Tufts Medicare Preferred HMO Basic No Rx (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered by the Tufts Medicare Preferred HMO Basic No Rx (HMO), with durable medical equipment and prosthetics requiring prior authorization and carrying no copay and 20% coinsurance (0% to 20% coinsurance for medical supplies). Diabetic equipment has no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Tufts Medicare Preferred HMO Basic No Rx (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services have no copay, outpatient x-rays require a $10 copay, diagnostic procedures range from a $10 to $45 copay, and diagnostic and therapeutic radiology services have minimum copays of $100 and $60, respectively.
Home Health Services See details
Home Health Services are covered under the Tufts Medicare Preferred HMO Basic No Rx (HMO) plan 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 Basic No Rx (HMO) plan, as all specific sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is partially covered by Tufts Medicare Preferred HMO Basic No Rx (HMO) with no coinsurance, as additional days beyond the Medicare-covered limit are not covered. Prior authorization is required, and patients pay a $20 daily copay for days 1-20, a $160 daily copay for days 21-44, and no copay for days 45-100.
Other Services See details
Tufts Medicare Preferred HMO Basic No Rx (HMO) partially covers other services, providing unlimited acupuncture treatments with no copay and no coinsurance. Over-the-counter (OTC) items and meal benefits are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved