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Tufts Health Plan Senior Care Options (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Tufts Health Plan Senior Care Options (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 Plan Senior Care Options (HMO D-SNP) in 2026, please refer to our full plan details page.
Tufts Health Plan Senior Care Options (HMO D-SNP) is a HMO D-SNP plan offered by Point32Health, Inc. available for enrollment in 2025 to people living in Most of Massachusetts. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Tufts Health Plan Senior Care Options (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 Plan Senior Care Options (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 Plan Senior Care Options (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 Plan Senior Care Options (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $6.60. 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:
Sign up for Tufts Health Plan Senior Care Options (HMO D-SNP)
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Drug Coverage
The Tufts Health Plan Senior Care Options (HMO D-SNP) has an annual prescription drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your covered medications before the plan starts to cover its share of your drug costs. Detailed information regarding drug coverage tiers, including specific copayments and coinsurance amounts, is not available for this plan. To determine how your specific medications are covered and estimate your ongoing costs, you should consult the plan's comprehensive formulary.
Additional Benefits
Tufts Health Plan Senior Care Options (HMO D-SNP) offers comprehensive coverage with no copay or coinsurance for key services like inpatient hospital stays, skilled nursing facility care, and home health services. Beneficiaries also enjoy no copay and no coinsurance for annual physicals, over-the-counter items, and diagnostic hearing exams. Most outpatient services, primary and specialist care, emergency visits, and durable medical equipment require a twenty percent coinsurance with no copay. Additionally, diagnostic lab services feature no copay and no coinsurance, helping members manage their routine healthcare costs effectively.
Inpatient Hospital See details
Tufts Health Plan Senior Care Options (HMO D-SNP) partially covers inpatient hospital services, offering acute and psychiatric care with no copay or coinsurance. Prior authorization is required for acute stays, but additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Tufts Health Plan Senior Care Options (HMO D-SNP) with no copay, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, outpatient substance abuse, and blood services. Prior authorization and referrals are required for select outpatient and ambulatory surgical services.
Partial Hospitalization See details
Tufts Health Plan Senior Care Options (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance.
Ambulance and Transportation Services See details
Tufts Health Plan Senior Care Options (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, though prior authorization is required. While transportation services are technically covered, trips to plan-approved or any health-related locations are not covered in practice.
Emergency Services See details
Emergency services and urgently needed services are covered under Tufts Health Plan Senior Care Options (HMO D-SNP) with a 20% coinsurance and no copay, up to a maximum of $115 per emergency visit and $40 per urgent care visit. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance.
Primary Care See details
Tufts Health Plan Senior Care Options (HMO D-SNP) covers primary care, specialist, mental health, therapy, and telehealth services with no copay and 20% coinsurance. Podiatry and chiropractic services are not covered under this plan.
Preventive Services See details
Tufts Health Plan Senior Care Options (HMO D-SNP) offers partially covered preventive services, featuring no copay and no coinsurance for annual physicals, health education, nutrition, fitness, and weight management up to $200 annually. Kidney education and screenings, including glaucoma, diabetes self-management, digital rectal exams, and EKGs, are covered with no copay and a 20% coinsurance. Uncovered sub-services include in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, chemotherapy wigs, alternative therapies, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, bathroom safety, and counseling.
Hearing Services See details
Tufts Health Plan Senior Care Options (HMO D-SNP) partially covers hearing services, providing diagnostic hearing exams and unlimited OTC hearing aids with no copay and no coinsurance. Routine hearing exams, fitting and evaluation services, and all types of prescription hearing aids (including inner ear, outer ear, and over-the-ear) are not covered by the plan.
Vision Services See details
Tufts Health Plan Senior Care Options (HMO D-SNP) does not cover vision services in practice, as routine eye exams, contact lenses, and eyeglasses are all not covered. Although eye exams and eyewear technically feature no copay and a 20% coinsurance with no deductible, none of the actual sub-services are covered under this plan.
Dental Services See details
Tufts Health Plan Senior Care Options (HMO D-SNP) partially covers dental services, offering Medicare-covered dental care with no copay and a 20% coinsurance. Other covered preventive and comprehensive dental services have no copay and no coinsurance, while other diagnostic dental services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Tufts Health Plan Senior Care Options (HMO D-SNP) with no copay, subject to prior authorization. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Dialysis Services are covered by Tufts Health Plan Senior Care Options (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Tufts Health Plan Senior Care Options (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Tufts Health Plan Senior Care Options (HMO D-SNP) with no copayments, though prior authorization is required. Lab services feature no coinsurance, while diagnostic procedures, radiological services, therapeutic radiology, and outpatient X-rays require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Tufts Health Plan Senior Care Options (HMO D-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Tufts Health Plan Senior Care Options (HMO D-SNP) offers Cardiac Rehabilitation Services with no copay and no coinsurance, though only some services are covered; 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 Plan Senior Care Options (HMO D-SNP) covers skilled nursing facility (SNF) care with no copay or coinsurance, though prior authorization is required. While a prior three-day inpatient hospital stay is not required for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Tufts Health Plan Senior Care Options (HMO D-SNP) partially covers Other Services, offering over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, and other miscellaneous services are not covered under this plan.
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