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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 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 Essex and Suffolk Counties. 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:
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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 comprehensive medical coverage with predictable costs, featuring no coinsurance for most primary care and outpatient services. Members pay a $10 copay for primary care doctor visits, a $40 copay for specialists, and no copay for annual physicals and Medicare-covered preventive care. For hospital care, inpatient stays require a $275 daily copay for the first five days, with no copay for days six through 90. This plan also provides valuable dental, vision, and hearing benefits to help reduce out-of-pocket expenses. Dental coverage includes no copay for cleanings and a 50% coinsurance for restorative services up to a $1,000 annual limit, while routine eye exams carry a $15 copay and routine hearing exams have no copay. Additionally, members can access unlimited rides to plan-approved health locations and home health services 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. This benefit is partially covered as 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 Basic No Rx (HMO) with no coinsurance for all services, including no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services have a copay of $0 to $270, observation services require a $270 copay per stay, and outpatient substance abuse sessions have a $25 copay.
Partial Hospitalization See details
Tufts Medicare Preferred HMO Basic No Rx (HMO) covers partial hospitalization services. Members will pay no copay and no coinsurance for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Tufts Medicare Preferred HMO Basic No Rx (HMO), featuring a $325 copay and no coinsurance for both ground and air ambulance services, which require prior authorization. Transportation services are partially covered, offering unlimited one-way rides to plan-approved health-related locations with no copay or 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 Basic No Rx (HMO) with a $125 copay, which is waived if admitted to the hospital within one day, and no coinsurance. Urgently needed services require a $45 copay with no coinsurance, and worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $45 to $325.
Primary Care See details
Tufts Medicare Preferred HMO Basic No Rx (HMO) covers primary care physician visits for a $10 copay and specialist visits for a $40 copay, with no coinsurance for either service. Other covered benefits like physical therapy, chiropractic care, and mental health services feature copays ranging from no copay up to $40 with no coinsurance, though routine chiropractic and podiatry services are not covered.
Preventive Services See details
Tufts Medicare Preferred HMO Basic No Rx (HMO) covers preventive services with no copay and no coinsurance for annual physical exams, kidney disease education, and Medicare-covered preventive care. Additional preventive benefits are partially covered, featuring no copay and no coinsurance for fitness and weight management, but require a 20% coinsurance and no copay for home safety devices, and a $20 copay and no coinsurance for post-welcome visit EKGs. Uncovered services under this benefit include counseling, caregiver support, and personal emergency response systems.
Hearing Services See details
Tufts Medicare Preferred HMO Basic No Rx (HMO) covers Medicare-covered hearing exams for a $40 copay and routine exams and hearing aid fittings once per year with no copay, all with no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $250 to $1,150 and no coinsurance for up to two aids yearly, though inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Tufts Medicare Preferred HMO Basic No Rx (HMO) offers partially covered vision services with no deductibles, featuring a $15 copay and no coinsurance for one annual routine eye exam, though other eye exam services are not covered. Covered eyewear, including contacts, lenses, and frames, has no copay and no coinsurance up to a $150 annual combined maximum.
Dental Services See details
Tufts Medicare Preferred HMO Basic No Rx (HMO) covers Medicare-covered dental services with a $40 copay and no coinsurance, alongside additional dental coverage up to a $1,000 yearly maximum. Cleanings feature no copay and no coinsurance, while covered restorative, periodontal, and surgical services require no copay and 50% coinsurance; however, fluoride, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Tufts Medicare Preferred HMO Basic No Rx (HMO) covers home infusion bundled services with no copay, although prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs require no copay and a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Tufts Medicare Preferred HMO Basic No Rx (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by the Tufts Medicare Preferred HMO Basic No Rx (HMO) with no copay, requiring a 20% coinsurance for durable medical equipment (DME) and prosthetics, and 0% to 20% 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 Basic No Rx (HMO) covers diagnostic and radiological services with no coinsurance, although prior authorization is required. Lab services have no copay, outpatient X-rays carry a $10 copay, diagnostic tests range from a $10 to $45 copay, and other radiological services require a minimum copay of $60 for therapeutic or $100 for diagnostic procedures.
Home Health Services See details
Tufts Medicare Preferred HMO Basic No Rx (HMO) covers Home Health Services with no copay and no coinsurance. Both a referral and prior authorization are required to receive these covered services.
Cardiac Rehabilitation Services See details
Some Cardiac Rehabilitation Services are covered under the Tufts Medicare Preferred HMO Basic No Rx (HMO) plan with no copay and no coinsurance, but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Tufts Medicare Preferred HMO Basic No Rx (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 to 20, a $160 daily copay for days 21 to 44, and no copay for days 45 to 100. Prior authorization is required, no prior three-day hospital stay is needed, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
Tufts Medicare Preferred HMO Basic No Rx (HMO) partially covers other services, offering unlimited acupuncture treatments with no copay and no coinsurance. Supplemental benefits such as over-the-counter (OTC) items and meal benefits are not covered.
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