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Tufts Health One Care (Medicare-Medicaid Plan)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Tufts Health One Care (Medicare-Medicaid Plan). 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 (Medicare-Medicaid Plan) in 2025, please refer to our full plan details page.
Tufts Health One Care (Medicare-Medicaid Plan) is a Medicare-Medicaid Plan plan offered by Point32Health, Inc. available for enrollment in 2025 to people living in Counties: NOR, PLY, BRI, MID, SUF, WOR, ESS, BAR. The overall rating for this plan is not yet available for 2025.
It's important to know that Tufts Health One Care (Medicare-Medicaid Plan) 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 (Medicare-Medicaid Plan)is a Medicare-Medicaide (MMP) plan. This means you can only enroll in this plan if you meet specific criteria for both medicare and medicaid. 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 (Medicare-Medicaid Plan).
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 (Medicare-Medicaid Plan), 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
We don't have information on the Maximum Out-Of-Pocket cost for this plan. You can call our licensed insurance specialists by clicking "Call to Enroll" below for more information.
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:
Sign up for Tufts Health One Care (Medicare-Medicaid Plan)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Tufts Health One Care (Medicare-Medicaid Plan) has a $0 deductible for prescription drugs. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. During the initial coverage phase, the cost sharing for prescription drugs is not listed. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Tufts Health One Care (Medicare-Medicaid Plan) offers a wide range of benefits with many services incurring no copay. These include emergency services, primary care, preventive services, hearing, vision, dental, dialysis, medical equipment, home health services, diagnostic and radiological services, and cardiac rehabilitation services. Additionally, the plan covers inpatient and outpatient services, partial hospitalization, ambulance and transportation, home infusion, skilled nursing facility, and other services, with varying levels of coverage and copays depending on the specific service. This plan provides coverage for routine hearing and vision exams, along with prescription hearing aids and eyewear. Dental services, including exams, X-rays, and various treatments, are also covered. While many services have no copay, some benefits may require prior authorization, and certain services are not covered, such as upgrades to inpatient hospital services, specific outpatient services, and certain types of medical supplies.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric services, are covered, including additional days and non-Medicare-covered stays. Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services. Individual and group sessions for outpatient substance abuse are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. There is no copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no copay or coinsurance. However, ground and air ambulance services, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Tufts Health One Care (Medicare-Medicaid Plan) with no copay or coinsurance. However, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered, with no copay or coinsurance for Occupational Therapy and Physical Therapy and Speech-Language Pathology Services. Individual and group sessions for Mental Health Specialty Services and Psychiatric Services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered zero dollar preventive services with prior authorization, annual physical exams, and additional preventive services. Additional sessions of smoking and tobacco cessation counseling, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit are covered. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, fitness benefits, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing services include routine hearing exams and fitting/evaluation for hearing aids, each covered for one visit per year with no deductible or coinsurance. Prescription hearing aids are partially covered, with coverage for inner ear, outer ear, and over-the-ear hearing aids once every three years, and no deductible or coinsurance. Prescription hearing aids (all types) and OTC hearing aids are not covered.
Vision Services See details
The Tufts Health One Care plan covers vision services, including routine eye exams once per year, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered once every two years, and upgrades are not covered.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery. Implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. The plan covers Medicare Part B insulin drugs. However, Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered with this plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Other 1, and Other 2, all with no copay or coinsurance; however, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. Prosthetics/Medical Supplies - Non-Medicare benefit is covered with no copay or coinsurance, but Prosthetic Devices and Medical Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered, and there is no copay.
Home Health Services See details
Home Health Services are covered by the Tufts Health One Care plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services, including Intensive Cardiac Rehabilitation Services and Pulmonary Rehabilitation Services, are covered by the Tufts Health One Care (Medicare-Medicaid Plan). SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, including additional days beyond Medicare-covered and non-Medicare-covered stays. Prior authorization is required, and there is a coinsurance and copay for non-Medicare-covered stays.
Other Services See details
The Tufts Health One Care plan covers acupuncture with no copay, but does not cover over-the-counter items, meal benefits, or several other services. Other services include behavioral health care services, chronic disease and rehabilitation hospital inpatient, adult day health, adult foster care, day habilitation, group adult foster care, hospice, orthotic services, speech and hearing services, behavioral health diversionary services, community-based services, abortion, gender-affirming care, transitional living program, tobacco cessation counseling, telehealth, and prescription digital therapeutics.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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