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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 2025, 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 out of 5 stars in 2025.
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 $38.40. 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 $590.00 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 $9350.00 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) plan has a $590 deductible for prescription drugs. After meeting the deductible, you will pay the costs for your drugs. The plan's formulary will provide specific details on the costs for each drug tier. Once your total drug costs reach $2000, you will enter the next coverage phase. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Tufts Health Plan Senior Care Options (HMO D-SNP) plan offers a wide range of benefits with varying cost-sharing. Many services, like emergency services, home health services, and diagnostic services, have no copay. However, many other services, including outpatient services, primary care, and vision services, have a coinsurance of 20%. This plan covers inpatient hospital stays with coinsurance following Original Medicare, and includes benefits for ambulance services, with a 20% coinsurance. The plan also includes coverage for home infusion services, offering a $35 copay for Part B Insulin Drugs, and 0-20% coinsurance for other Part B drugs.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with coinsurance costs that follow Original Medicare. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient substance abuse services. Outpatient hospital and observation services have a 20% coinsurance, and ASC services and outpatient substance abuse services have a minimum coinsurance of 20% and a maximum coinsurance of 20%. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the plan, with a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Tufts Health Plan Senior Care Options (HMO D-SNP) plan. There is no copay for ambulance services, but you are responsible for 20% coinsurance for both ground and air ambulance services. 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 Plan Senior Care Options (HMO D-SNP). Emergency Services and Urgently Needed Services have a 20% coinsurance with no copay.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance, while Chiropractic Services, Occupational Therapy Services, Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a 20% coinsurance. Chiropractic Services do not cover routine care, and Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered by the Tufts Health Plan Senior Care Options (HMO D-SNP) plan. This includes no copay for Medicare-covered preventive services, and a 20% coinsurance for kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. The plan also covers wigs for hair loss related to chemotherapy, and weight management programs, with a maximum plan benefit coverage amount of $350 and $200 respectively.
Hearing Services See details
Hearing Services are partially covered by the Tufts Health Plan Senior Care Options (HMO D-SNP) plan. Hearing exams are covered with at most 20% coinsurance, and there is no deductible. Prescription hearing aids, OTC hearing aids, routine hearing exams, and fitting/evaluation for hearing aids are not covered.
Vision Services See details
Vision services are partially covered. Eye exams and eyewear are covered with a 20% coinsurance, while routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered, with a 20% coinsurance for Medicare dental services, but orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered. Prior authorization and a doctor referral are required for Medicare dental services.
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.
Dialysis Services See details
Dialysis Services are covered by the Tufts Health Plan Senior Care Options (HMO D-SNP) plan. There is a 20% coinsurance for this benefit.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered by the Tufts Health Plan Senior Care Options (HMO D-SNP). Durable medical equipment has a 20% coinsurance and requires authorization, while durable medical equipment for use outside the home is not covered. Medical supplies have a 20% coinsurance, and both prosthetic devices and diabetic supplies have a 20% coinsurance. Diabetic therapeutic shoes/inserts also have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services have no coinsurance.
Home Health Services See details
Home Health Services are covered by the Tufts Health Plan Senior Care Options (HMO D-SNP) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Tufts Health Plan Senior Care Options (HMO D-SNP). This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but prior authorization is required. The plan does not cover additional days beyond Medicare-covered for SNF, or non-Medicare-covered stays for SNF.
Other Services See details
The Tufts Health Plan Senior Care Options (HMO D-SNP) plan's Other Services benefit covers over-the-counter (OTC) items, including nicotine replacement therapy and Naloxone, but does not cover acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, 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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