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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 2025, 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 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5200.00 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 has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $6 copay at preferred and mail order pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Tufts Medicare Preferred HMO Smart Saver Rx (HMO) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a copay for the first few days, with no copay thereafter. Outpatient services, including primary care, have a range of copays. Emergency and ambulance services are covered, as are hearing and vision services, with copays for exams and coverage for glasses and hearing aids. The plan also includes dental coverage with a maximum annual benefit, plus home health services with no copay. Additionally, it provides coverage for diagnostic and radiological services, skilled nursing facilities, and home infusion services with varying copays and coinsurance. Other notable benefits include coverage for over-the-counter items, a meal benefit, and certain medical supplies.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $380 copay for days 1-5 and no copay for days 6-90. For Inpatient Hospital Psychiatric, you pay a $370 copay for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital Psychiatric, Non-Medicare-covered Stay for Inpatient Hospital-Acute, and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $370, observation services with a $370 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $25 copay for 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 by the Tufts Medicare Preferred HMO Smart Saver Rx (HMO) plan. The plan covers the cost of partial hospitalization services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Tufts Medicare Preferred HMO Smart Saver Rx (HMO) plan. Ground and air ambulance services have a copay of $350.00, and transportation services to a plan-approved health-related location are covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services has a $125 copay, Urgently Needed Services has a $50 copay, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $50 copay, and Worldwide Emergency Transportation has a $350 copay.
Primary Care See details
Primary Care Physician Services have no copay, while Chiropractic Services have a $15 copay. Occupational Therapy Services require a $30 copay, and Physician Specialist Services have a $40 copay. Mental Health and Psychiatric Services, as well as Other Health Care Professional services, have copays ranging from $0 to $25. Physical Therapy and Speech-Language Pathology Services have a $30 copay, while Additional Telehealth Benefits have a copay ranging from $0 to $370. Opioid Treatment Program Services have a $25 copay. Podiatry Services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, annual physical exams, health education, in-home safety assessments, kidney disease education services, and other preventive services. This plan does not cover personal emergency response systems, 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. Other services are covered, including wigs for hair loss related to chemotherapy with a $500 maximum plan benefit, weight management programs with a $150 maximum plan benefit, alternative therapies, therapeutic massage, nutritional/dietary benefits, fitness benefits, and home and bathroom safety devices and modifications with 20% coinsurance. Glaucoma screening has a copay, and EKG following a Welcome Visit has a $20 copay.
Hearing Services See details
Hearing services include routine hearing exams with a $40 copay, and fitting/evaluation for hearing aids, each limited to one visit per year. Prescription hearing aids are partially covered, with a copay between $250 and $1150 for all types of hearing aids (excluding inner ear, outer ear, and over the ear hearing aids), with two visits per year. Over-the-counter hearing aids are also covered.
Vision Services See details
Vision services are covered, including routine eye exams with a copay of $15.00, and eyeglasses with a combined maximum of $250.00 per year. Contact lenses, eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $40 copay, and other dental services with a maximum benefit of $2,500 per year. Oral exams have a 0% - 20% coinsurance and allow for up to 4 visits, while dental X-rays have a 0% - 20% coinsurance and cover up to 5 X-rays. Prophylaxis (Cleaning) is covered, while Fluoride Treatment is not covered. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable & fixed), and Oral and Maxillofacial Surgery are covered with a 20% - 50% coinsurance and 50% coinsurance, respectively, and each have a limit on the number of visits. Orthodontic Services are covered under Diagnostic and Preventive Dental, but 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, and Medicare Part B chemotherapy/radiation drugs and other Medicare Part B drugs with a coinsurance between 0% and 20%. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Tufts Medicare Preferred HMO Smart Saver Rx (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Tufts Medicare Preferred HMO Smart Saver Rx (HMO) plan, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 20% coinsurance, but Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. Additionally, Medical Supplies have a coinsurance of 0% - 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $50, and lab services with no copay. Diagnostic radiological services have a copay between $100 and $140, therapeutic radiological services have a copay of $60, and outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Tufts Medicare Preferred HMO Smart Saver Rx (HMO) plan with no copay and no coinsurance, but 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 not covered by the Tufts Medicare Preferred HMO Smart Saver Rx (HMO) plan. Specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under this plan, with prior authorization required. For days 1-20, there is no copay, a $180 copay for days 21-44, and no copay for days 45-100.
Other Services See details
Other Services include acupuncture, over-the-counter items, a meal benefit, and "Other 1". Acupuncture is covered with no copay or coinsurance. Over-the-counter items are covered up to $140 every three months. The meal benefit is covered for chronic illnesses, and "Other 1" includes medical stockings and sleeves with 20% coinsurance. This plan does not cover 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, or Self-Directed Personal Assistance Services.
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