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Tufts Health One Care CW (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Tufts Health One Care CW (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 CW (HMO D-SNP) in 2026, please refer to our full plan details page.
Tufts Health One Care CW (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 CW (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 CW (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 CW (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 CW (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $14.70. 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 CW (HMO D-SNP) Medicare plan has an annual prescription drug deductible of $615. This deductible represents the amount you must pay for your covered medications before the plan's prescription coverage begins to pay. Knowing this deductible amount is essential for calculating your potential out-of-pocket drug costs for the year. Specific drug coverage tier details, including individual copayments and coinsurance amounts, are currently unavailable for this plan. To fully understand your medication costs, it is recommended to check the plan's formulary to see how your specific prescriptions are categorized.
Additional Benefits
The Tufts Health One Care CW (HMO D-SNP) plan offers comprehensive medical coverage with no copayments for most services, including inpatient hospital stays, primary care, specialist visits, and home health care. However, many outpatient services, emergency visits, diagnostics, and durable medical equipment are subject to a twenty percent coinsurance. Skilled nursing facility stays and home health services are fully covered with no copay and no coinsurance, though prior authorizations may be required. While the plan covers Medicare-approved preventive and diagnostic services, it features significant exclusions for routine care. Routine dental, routine vision, routine hearing exams, and hearing aids are not covered, and patients will face a twenty percent coinsurance for basic Medicare-covered dental and vision treatments. Additionally, everyday lifestyle benefits such as transportation, over-the-counter items, fitness programs, and meal services are excluded from this plan.
Inpatient Hospital See details
Tufts Health One Care CW (HMO D-SNP) covers inpatient hospital services with no copay and no coinsurance for acute and psychiatric stays, though prior authorization is required for acute care. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Tufts Health One Care CW (HMO D-SNP) covers outpatient services with no copay, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization and referrals are required for select services, including outpatient hospital and ambulatory surgical center visits.
Partial Hospitalization See details
Tufts Health One Care CW (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance services are covered by Tufts Health One Care CW (HMO D-SNP) with a 20% coinsurance and no copay for ground and air transport, requiring prior authorization. Transportation services are not covered, as trips to plan-approved or any health-related locations are excluded.
Emergency Services See details
Emergency services are covered by Tufts Health One Care CW (HMO D-SNP) with a 20% coinsurance and no copay up to a maximum of $115 per visit, while urgently needed services require a 20% coinsurance and no copay up to a maximum of $40 per visit. Worldwide emergency, urgent care, and emergency transportation services are not covered.
Primary Care See details
Tufts Health One Care CW (HMO D-SNP) covers primary care, specialist visits, occupational, physical, and speech therapies, mental health, psychiatric, and telehealth services with no copay and a 20% coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Tufts Health One Care CW (HMO D-SNP) covers Medicare-covered zero-dollar preventive services, kidney disease education, and select screenings with no copay and a 20% coinsurance. However, annual physical exams and additional preventive services—including fitness benefits, health education, and in-home safety assessments—are not covered.
Hearing Services See details
Hearing exams are partially covered by Tufts Health One Care CW (HMO D-SNP) with no copay, no coinsurance, and no deductible, excluding routine hearing exams and fitting evaluations. For prescription hearing aids, some services are covered, but prescription hearing aids of all types—including inner ear, outer ear, and over the ear—and OTC hearing aids are not covered.
Vision Services See details
Tufts Health One Care CW (HMO D-SNP) offers vision services with no copay and 20% coinsurance, though routine eye exams, contact lenses, and eyeglasses are not covered in practice.
Dental Services See details
Tufts Health One Care CW (HMO D-SNP) partially covers dental services, offering coverage only for Medicare-covered dental services with no copay and a 20% coinsurance. Routine and restorative dental services, including exams, cleanings, x-rays, and orthodontics, are not covered.
Home Infusion bundled Services See details
Tufts Health One Care CW (HMO D-SNP) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and coinsurance ranging from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Tufts Health One Care CW (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Tufts Health One Care CW (HMO D-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetic devices, medical supplies, and diabetic equipment. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Tufts Health One Care CW (HMO D-SNP) covers diagnostic and radiological services with no copays, although prior authorization is required. Lab services feature no coinsurance, while diagnostic procedures, diagnostic and therapeutic radiological services, and outpatient X-rays require a 20% coinsurance.
Home Health Services See details
Tufts Health One Care CW (HMO D-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Tufts Health One Care CW (HMO D-SNP) with no copay, though some services are not covered. Specifically, intensive cardiac rehabilitation, pulmonary rehabilitation, SET for PAD, and additional cardiac rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Tufts Health One Care CW (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. The benefit is partially covered because additional days beyond the standard Medicare-covered limit are not covered, although a three-day prior inpatient hospital stay is not required for admission.
Other Services See details
Other services are not covered under the Tufts Health One Care CW (HMO D-SNP) plan, including acupuncture, over-the-counter (OTC) items, and meal benefits.
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