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Tufts Medicare Preferred HMO Smart Saver Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Tufts Medicare Preferred HMO Smart Saver 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 Smart Saver Rx (HMO) in 2026, please refer to our full plan details page.
Tufts Medicare Preferred HMO Smart Saver Rx (HMO) is a HMO plan offered by Point32Health, Inc. available for enrollment in 2025 to people living in Most of Massachusetts. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Tufts Medicare Preferred HMO Smart Saver Rx (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Tufts Medicare Preferred HMO Smart Saver 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 Smart Saver 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.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6400.00 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
The Tufts Medicare Preferred HMO Smart Saver Rx (HMO) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay at preferred pharmacies or through standard mail order, while standard pharmacies charge a $5 copay for a one-month supply. Tier 2 generic drugs cost as little as a $2 copay for a one-month supply at preferred pharmacies, and Tier 6 vaccines are covered with no copay at both preferred and standard pharmacies. For higher-tier medications, costs are determined by coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance across preferred pharmacies, standard pharmacies, and standard mail order. This tier structure allows you to plan your prescription expenses based on your specific medication needs and pharmacy choice.
Additional Benefits
The Tufts Medicare Preferred HMO Smart Saver Rx (HMO) plan offers robust coverage for essential medical needs, featuring no copay for primary care visits and annual physicals. Specialist visits require a $50 copay, while emergency care has a $130 copay that is waived if you are admitted. For hospital stays, inpatient acute care requires a $425 daily copay for the first six days, whereas outpatient hospital services range from no copay up to a $370 copay. Additional benefits include vision coverage with a $15 to $40 copay for exams and up to a $250 annual allowance for eyewear with no copay. Dental services feature a $40 copay for Medicare-covered care, alongside other dental coverage up to a $1,500 yearly limit with coinsurance ranging from zero to 50 percent. Over-the-counter hearing aids, acupuncture, and home health services are also fully covered with no copay.
Inpatient Hospital See details
Tufts Medicare Preferred HMO Smart Saver Rx (HMO) inpatient hospital services are partially covered with no coinsurance, excluding upgrades, non-Medicare-covered stays, and additional psychiatric days. Acute stays require a $425 daily copay for days 1 to 6 and no copay for days 7 to 90, while psychiatric stays require a $370 daily copay for days 1 to 5 and no copay for days 6 to 90.
Outpatient Services See details
Tufts Medicare Preferred HMO Smart Saver Rx (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services require a copay ranging from no copay to $370 (including a $370 copay per stay for observation services), while outpatient substance abuse sessions carry a $30 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Tufts Medicare Preferred HMO Smart Saver Rx (HMO) plan with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Tufts Medicare Preferred HMO Smart Saver Rx (HMO), requiring a $350 copay and no coinsurance for Medicare-covered ground and air ambulance services. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Tufts Medicare Preferred HMO Smart Saver Rx (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within one day. Urgently needed services require a $50 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130, $50, and $350 respectively.
Primary Care See details
Tufts Medicare Preferred HMO Smart Saver Rx (HMO) offers primary care physician services with no copay and no coinsurance, though the benefit is partially covered as routine chiropractic care and podiatry services are not covered. Other covered services under this plan feature no coinsurance, with copayments ranging from $15 for chiropractic evaluations to $50 for specialist visits, and $30 for physical, occupational, and speech therapy.
Preventive Services See details
Preventive Services are partially covered by Tufts Medicare Preferred HMO Smart Saver Rx (HMO), offering annual physicals and kidney disease education with no copay and no coinsurance. An EKG requires a $20 copay and no coinsurance, home safety devices require a 20% coinsurance and no copay, and sub-services like personal emergency response systems and caregiver support are not covered.
Hearing Services See details
Tufts Medicare Preferred HMO Smart Saver Rx (HMO) covers hearing services, including annual routine exams and fittings for a $40 copay and no coinsurance, and unlimited OTC hearing aids with no copay or coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay of $250 to $1150 for up to two devices yearly, excluding inner ear, outer ear, and over-the-ear prescription hearing aids.
Vision Services See details
Tufts Medicare Preferred HMO Smart Saver Rx (HMO) covers vision services with no deductibles, offering 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 and no coinsurance up to a $250 annual maximum for contact lenses, eyeglasses, and upgrades.
Dental Services See details
Tufts Medicare Preferred HMO Smart Saver Rx (HMO) partially covers dental services, offering Medicare-covered dental for a $40 copay and no coinsurance, and other services with no copay and coinsurance ranging from no coinsurance to 50% up to a $1,500 annual limit. Excluded from coverage are other diagnostic dental, fluoride treatment, other preventive dental, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Tufts Medicare Preferred HMO Smart Saver Rx (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Medicare Part B chemotherapy, radiation, and other drugs under this benefit have a 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance.
Dialysis Services See details
Tufts Medicare Preferred HMO Smart Saver Rx (HMO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by the Tufts Medicare Preferred HMO Smart Saver Rx (HMO) with no copay, though prior authorization is required. Durable medical equipment, prosthetic devices, and diabetic therapeutic shoes or inserts require a 20% coinsurance, while medical and diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Tufts Medicare Preferred HMO Smart Saver Rx (HMO) with no coinsurance, though prior authorization is required. Lab services and outpatient X-rays have no copay, while diagnostic procedures range from a $0 to $50 copay, therapeutic radiology has a minimum $60 copay, and diagnostic radiology has a minimum $100 copay.
Home Health Services See details
Tufts Medicare Preferred HMO Smart Saver Rx (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization and a referral are required for these services.
Cardiac Rehabilitation Services See details
Tufts Medicare Preferred HMO Smart Saver Rx (HMO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, but only some services are covered because cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Tufts Medicare Preferred HMO Smart Saver Rx (HMO) with no coinsurance, as additional days beyond the standard Medicare limit are not covered. For covered days, there is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with prior authorization required and no prior three-day hospital stay needed.
Other Services See details
Tufts Medicare Preferred HMO Smart Saver Rx (HMO) partially covers other services, offering acupuncture and over-the-counter (OTC) items with no copay and no coinsurance. Meal benefits and other miscellaneous services are not covered under this plan.
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