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Tufts Health Plan Senior Care Options CW (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 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 Plan Senior Care Options CW (HMO D-SNP) in 2026, please refer to our full plan details page.
Tufts Health Plan Senior Care Options CW (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 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 Plan Senior Care Options 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 Plan Senior Care Options 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 Plan Senior Care Options CW (HMO D-SNP), 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 a $400.00 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 CW (HMO D-SNP)
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Drug Coverage
The Tufts Health Plan Senior Care Options CW (HMO D-SNP) features an annual drug deductible of $400. During the initial coverage phase, Tier 1 prescription drugs filled at standard retail pharmacies or through standard mail order require a 25% coinsurance. This 25% coinsurance rate applies to one-month, two-month, and three-month supplies of your medications. Evaluating Medicare plan drug coverage helps ensure you find affordable rates for your specific prescriptions. This Tufts Health Plan drug coverage details standard coinsurance rates to help you plan your healthcare budget.
Additional Benefits
The Tufts Health Plan Senior Care Options CW (HMO D-SNP) offers comprehensive coverage with no copayments for many essential services, including inpatient hospital stays, skilled nursing facility care, and home health services. Beneficiaries can also access select preventive care, dental benefits, and unlimited over-the-counter hearing aids with no copay and no coinsurance. For other critical benefits like outpatient care, emergency services, and primary care visits, the plan features no copay but requires a 20% coinsurance. While diagnostic lab work and home infusion services carry no copay, certain medical equipment, dialysis, and radiological procedures are subject to a 20% coinsurance. It is important to note that this plan does not cover routine vision services, non-emergency transportation, or routine hearing exams. Additionally, several covered services, such as inpatient stays and diagnostic testing, require prior authorization or referrals before treatment.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Tufts Health Plan Senior Care Options CW (HMO D-SNP) 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 plan.
Outpatient Services See details
Outpatient services under the Tufts Health Plan Senior Care Options CW (HMO D-SNP) are covered with no copay, but are subject to a 20% coinsurance for outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization and referrals are required for several of these outpatient treatments.
Partial Hospitalization See details
Partial hospitalization is covered by Tufts Health Plan Senior Care Options CW (HMO D-SNP) with no copay and a 20% coinsurance.
Ambulance and Transportation Services See details
Tufts Health Plan Senior Care Options CW (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Tufts Health Plan Senior Care Options CW (HMO D-SNP) covers emergency services and urgently needed services with a 20% coinsurance and no copay, up to a maximum of $115 and $40 per visit respectively. 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 CW (HMO D-SNP) covers primary care, specialist visits, mental health, telehealth, and therapy services with no copay and a 20% coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Preventive services under Tufts Health Plan Senior Care Options CW (HMO D-SNP) are partially covered, offering annual physical exams, fitness benefits, and weight management programs with no copay and no coinsurance. Kidney disease education, glaucoma screenings, and diabetes self-management training require a 20% coinsurance and no copay, while services such as in-home safety assessments, personal emergency response systems, and medical nutrition therapy are not covered.
Hearing Services See details
Tufts Health Plan Senior Care Options CW (HMO D-SNP) covers hearing services with no deductible, offering diagnostic hearing exams and unlimited OTC hearing aids with no copay and no coinsurance. Some services are covered, but routine hearing exams, fitting evaluations, and prescription hearing aids (including inner ear, outer ear, and over-the-ear types) are not covered.
Vision Services See details
Vision services are not covered in practice by Tufts Health Plan Senior Care Options CW (HMO D-SNP), as routine eye exams, contact lenses, and eyeglasses are all excluded from coverage despite a technical cost-share of no copay and 20% coinsurance with no deductible.
Dental Services See details
Tufts Health Plan Senior Care Options CW (HMO D-SNP) partially covers dental services, offering Medicare-covered dental care with no copay and a 20% coinsurance, and other covered preventive and comprehensive dental benefits with no copay and no coinsurance. 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 CW (HMO D-SNP) with no copay, though prior authorization is required. 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.
Dialysis Services See details
Dialysis services are covered by Tufts Health Plan Senior Care Options CW (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Tufts Health Plan Senior Care Options CW (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required for these covered services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Tufts Health Plan Senior Care Options CW (HMO D-SNP) with no copays, though prior authorization is required. Covered lab services carry 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 Plan Senior Care Options CW (HMO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Tufts Health Plan Senior Care Options CW (HMO D-SNP) with no copay, though some services are covered while others are not. Specifically, 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 CW (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. While the plan waives the 3-day inpatient hospital stay requirement prior to admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Tufts Health Plan Senior Care Options CW (HMO D-SNP), which offers over-the-counter (OTC) items with no copay and no coinsurance. However, acupuncture, meal benefits, and other additional services under this category are not covered.
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