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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 2025, 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 2025.
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 $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 Basic No Rx (HMO).
Additional Benefits
The Tufts Medicare Preferred HMO Basic No Rx (HMO) plan offers a range of benefits beyond standard Medicare coverage. This plan includes coverage for inpatient and outpatient hospital services, along with ambulance, emergency, and primary care services, each with varying copays. Additional benefits include preventive, hearing, vision, dental, and home health services, with specific copays or coinsurance amounts. The plan also covers services like home infusion, dialysis, medical equipment, and diagnostic services.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $275 copay for days 1-5, and no copay for days 6-90; Additional Days are covered, but Non-Medicare-covered Stay and Upgrades are not covered. For Inpatient Hospital Psychiatric, you will pay a $275 copay for days 1-5, and no copay for days 6-90; Additional Days and Non-Medicare-covered Stay are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $270, Observation Services with a $270 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $25 copay for both individual and group sessions, and Outpatient Blood Services. Prior authorization and a doctor referral are required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered. The plan covers this benefit, but no further details are provided.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services, each with a $325 copay. Transportation Services to a plan-approved health-related location are also covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Tufts Medicare Preferred HMO Basic No Rx (HMO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $45 copay, while Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $325 copay; all services have no coinsurance.
Primary Care See details
Primary Care services include coverage for Primary Care Physician Services with a $10 copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $30 copay, Physician Specialist Services with a $40 copay, and Physical Therapy and Speech-Language Pathology Services with a $30 copay. Mental Health Specialty Services and Psychiatric Services have a $0-$25 copay for individual and group sessions, and Other Health Care Professional services have a $10-$40 copay. Additional Telehealth Benefits have a copay of $0-$270 and Opioid Treatment Program Services have a $25 copay. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered zero dollar preventive services, annual physical exams, health education, in-home safety assessments, kidney disease education services, wigs for hair loss related to chemotherapy with a maximum benefit of $500 per year, weight management programs with a maximum benefit of $150 per year, alternative therapies, therapeutic massage, nutritional/dietary benefits, fitness benefits, and home and bathroom safety devices and modifications with a 20% coinsurance. Additional preventive services include a copay for glaucoma screening and a copay of $20 for EKG following a welcome visit. Personal emergency response systems (PERS), post-discharge in-home medication reconciliation, re-admission prevention, 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, and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $40 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) have a copay between $250 and $1150, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Tufts Medicare Preferred HMO Basic No Rx (HMO) plan covers vision services, including eye exams with a copay of $15-$40, and eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, subject to a combined maximum benefit of $150 per year. Routine eye exams are covered with a $15 copay for one visit per year.
Dental Services See details
The Tufts Medicare Preferred HMO Basic No Rx (HMO) plan covers dental services, including oral exams with a 0-50% coinsurance, and dental x-rays with a 0-50% coinsurance. Other covered services include prophylaxis (cleaning) with no coinsurance. Fluoride treatment, Maxillofacial Prosthetics, Implant Services and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Tufts Medicare Preferred HMO Basic No Rx (HMO) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 0% - 20% coinsurance; however, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $10 and $45, lab services with no copay, diagnostic radiological services with a copay up to $250, therapeutic radiological services with a copay up to $60, and outpatient X-ray services with a $10 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Tufts Medicare Preferred HMO Basic No Rx (HMO) plan with no copay and no coinsurance, though 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 covered, but none of the sub-services are covered, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor referral are required.
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 $160, and for days 45-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture, meal benefits, and "Other 1". Acupuncture is covered with no copay, and no coinsurance, while meal benefits are offered for chronic illnesses. "Other 1" has a 20% coinsurance for medical stockings and sleeves, and requires prior authorization. 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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