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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 Essex and Suffolk Counties. 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 comprehensive range of benefits with varying cost-sharing. This plan includes coverage for inpatient and outpatient services, with copays for specific services like hospital stays, emergency care, and specialist visits. The plan also includes coverage for Ambulance and Transportation Services, as well as a broad selection of services like hearing, vision, and dental, with copays and coinsurance applicable to certain services. In addition to the core medical benefits, this plan provides coverage for preventive services, including exams and screenings, and offers additional benefits such as home health services, cardiac rehabilitation, and skilled nursing facility stays. The plan also covers home infusion services, medical equipment, and diagnostic services, with specific copays or coinsurance applying. Other benefits include acupuncture, meal benefits, and medical stockings and sleeves.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $275 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. Inpatient Hospital Psychiatric benefits are covered, with a copay of $275 for days 1-5 and no copay for days 6-90, but additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the Tufts Medicare Preferred HMO Basic No Rx (HMO) plan, with varying copays depending on the service. Outpatient Hospital Services have a copay between $0 and $270, Observation Services have a $270 copay, Ambulatory Surgical Center (ASC) Services have no copay, and both Individual and Group Sessions for Outpatient Substance Abuse have a copay of $25. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Tufts Medicare Preferred HMO Basic No Rx (HMO) plan. There is no information about the cost of this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a $325 copay. Transportation Services to a plan-approved health-related location are covered, while transportation to any health-related location is not 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 no coinsurance, Urgently Needed Services have a $45 copay and no coinsurance, Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $325 copay, with no coinsurance for any of these services.
Primary Care See details
The Tufts Medicare Preferred HMO Basic No Rx (HMO) plan covers primary care physician services with a $10 copay, chiropractic services with a $15 copay, occupational therapy with a $30 copay, specialist services with a $40 copay, and physical therapy and speech-language pathology services with a $30 copay. Mental health and psychiatric services have a copay between $0 and $25, and other health care professional services have a copay between $10 and $40. Additional telehealth benefits have a copay between $0 and $270, and Opioid Treatment Program Services have a $25 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services, including annual physical exams, are covered. This plan also covers additional preventive services, health education, in-home safety assessments, medical nutrition therapy, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, nutritional/dietary benefits, fitness benefits, kidney disease education services, and home and bathroom safety devices and modifications. Some services, such as Medicare-covered glaucoma screenings and EKG following a Welcome Visit, have a copay, while home and bathroom safety devices and modifications have 20% coinsurance. Personal emergency response systems, post-discharge in-home medication reconciliation, re-admission prevention, 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 coverage for hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $250 and $1150. 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 to $40, and eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum benefit of $150 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, dental x-rays with a 0-50% coinsurance, and prophylaxis (cleaning). Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Restorative services, adjunctive general services, oral and maxillofacial surgery, and periodontics are covered with a 50% coinsurance, while endodontics, prosthodontics (removable and fixed) are optional supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered with prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while 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 for these services.
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% to 20% coinsurance. 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, including diagnostic procedures/tests with a copay between $10 and $45, lab services with no copay, diagnostic radiological services with a copay between $100 and $250, therapeutic radiological services with a $60 copay, and outpatient X-ray services with a $10 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires prior authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are 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.
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 are not covered.
Other Services See details
The "Other Services" benefit covers acupuncture, meal benefits for a chronic illness, and medical stockings and sleeves. Acupuncture is covered with no copay or coinsurance, while medical stockings and sleeves require prior authorization and have a 20% coinsurance. Other services like over-the-counter items, and other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services are not covered.
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