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Tufts Health One Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Tufts Health One Care (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Tufts Health One Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Tufts Health One Care (HMO D-SNP) is a HMO D-SNP plan offered by Point32Health, Inc. available for enrollment in 2026 to people living in Most of Massachusetts. The overall rating for this plan is not yet available for 2026.
It's important to know that Tufts Health One Care (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Tufts Health One Care (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Tufts Health One Care (HMO D-SNP).
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 Health One Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $36.60. 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 $9250.00 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 Health One Care (HMO D-SNP) plan features an annual prescription drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your medications before your plan coverage begins to pay. Understanding this initial cost is essential for budgeting your yearly Medicare prescription drug expenses. Specific drug coverage tier details, including copays and coinsurance rates, are currently unavailable for this plan. To find out how your specific medications are covered under Tufts Health One Care (HMO D-SNP), it is best to consult the plan's comprehensive formulary list.
Additional Benefits
The Tufts Health One Care (HMO D-SNP) plan offers comprehensive coverage for several essential services with no copay and no coinsurance, including inpatient hospital stays, skilled nursing facility care, home health services, and diagnostic laboratory tests. However, many outpatient and medical services under this plan require a 20% coinsurance alongside no copay, which applies to primary care, specialist visits, emergency care, outpatient hospital services, and durable medical equipment. Prior authorization or referrals are commonly required to access these benefits. While the plan covers Medicare-covered preventive and diagnostic services, key routine benefits are excluded from coverage. Routine dental, vision, and hearing exams, along with eyeglasses, hearing aids, acupuncture, over-the-counter items, and plan-approved transportation, are not covered. Additionally, prescription Part B insulin carries a $35 copay with no coinsurance, while other Part B chemotherapy and drugs feature a 0% to 20% coinsurance.
Inpatient Hospital See details
Tufts Health One Care (HMO D-SNP) partially covers inpatient hospital services with no copay and no coinsurance for acute and psychiatric stays, though prior authorization is required for acute care. Additional days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
Outpatient services under Tufts Health One Care (HMO D-SNP) are covered with no copay, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, blood, and outpatient substance abuse services. Prior authorization and referrals are required for several of these services, including ambulatory surgical center and outpatient hospital services.
Partial Hospitalization See details
Tufts Health One Care (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance.
Ambulance and Transportation Services See details
Tufts Health One Care (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, though prior authorization is required. While transportation benefits are technically covered, some services are covered but transportation to plan-approved health-related locations and any health-related locations are not covered in practice.
Emergency Services See details
Tufts Health One Care (HMO D-SNP) covers emergency and urgent care services with a 20% coinsurance and no copay, up to a maximum of $115 per emergency visit and $40 per urgent care visit. For worldwide emergency services, some services are covered but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Tufts Health One Care (HMO D-SNP) covers primary care, specialist visits, mental health, telehealth, and therapy services with no copay and 20% coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Tufts Health One Care (HMO D-SNP) provides coverage for Medicare-covered zero-dollar preventive services with no copay, while kidney disease education, glaucoma screenings, diabetes self-management, digital rectal exams, and post-welcome-visit EKGs feature no copay and a 20% coinsurance. This benefit is partially covered, as annual physical exams and all additional preventive services—including fitness, health education, weight management, and in-home safety assessments—are not covered.
Hearing Services See details
Hearing services under Tufts Health One Care (HMO D-SNP) cover some services, featuring diagnostic hearing exams with no copay and no coinsurance. However, routine hearing exams, fitting evaluations, OTC hearing aids, and all types of prescription hearing aids are not covered.
Vision Services See details
Vision services are not covered under Tufts Health One Care (HMO D-SNP), as all eye exam and eyewear sub-services—including routine eye exams, contact lenses, and eyeglasses—are not covered in practice.
Dental Services See details
Dental services are partially covered by Tufts Health One Care (HMO D-SNP), with coverage limited to Medicare-covered dental services featuring no copay and a 20% coinsurance. Other dental services, including preventive care, oral exams, cleanings, x-rays, restorative treatments, and orthodontics, are not covered under this plan.
Home Infusion bundled Services See details
Tufts Health One Care (HMO D-SNP) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while Part B chemotherapy and other drugs have no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Tufts Health One Care (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Tufts Health One Care (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with no copay and 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Tufts Health One Care (HMO D-SNP) with prior authorization required and no copayments. Lab services feature no coinsurance, while diagnostic procedures, radiological services, and outpatient X-rays require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Tufts Health One Care (HMO D-SNP) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Tufts Health One Care (HMO D-SNP) covers some cardiac rehabilitation services with no copay and no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Tufts Health One Care (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. The plan allows for admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered under the Tufts Health One Care (HMO D-SNP) plan, as acupuncture, over-the-counter items, and meal benefits are all excluded from coverage.
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