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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 2025, 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 out of 5 stars in 2025.
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 $30.60. 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 $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:
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Drug Coverage
The Tufts Health Plan Senior Care Options CW (HMO D-SNP) plan has a deductible of $590.00. After your deductible is met, you will pay the costs for your drugs according to the plan's formulary. Once your total drug costs reach $2,000, you will enter the next coverage phase. If you qualify for the low-income subsidy (LIS), you may have a reduced premium for this plan. After your yearly out-of-pocket drug costs reach $2,000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Tufts Health Plan Senior Care Options CW (HMO D-SNP) plan offers a range of benefits with a focus on cost-sharing through coinsurance. Many services, including outpatient services, primary care, vision, hearing, and dental services, have a 20% coinsurance. There is no copay for ambulance services or preventive services, and home health services are covered with no copay or coinsurance. The plan also covers inpatient hospital stays, emergency services, and home infusion services, with varying cost-sharing. The plan provides coverage for diagnostic and radiological services with no copay, as well as medical equipment and other services. However, certain services like routine chiropractic care, podiatry services, and some dental services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with prior authorization required for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. The plan uses the Medicare-defined cost share, and additional days, non-Medicare stays, and upgrades for inpatient hospital services are not covered.
Outpatient Services See details
Outpatient Services are covered by the Tufts Health Plan Senior Care Options CW (HMO D-SNP) plan. Outpatient Hospital Services and Observation Services have a 20% coinsurance, while Ambulatory Surgical Center (ASC) Services have a coinsurance between 20% and 20%. Outpatient Substance Abuse Services also have a coinsurance between 20% and 20% for both individual and group sessions. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial hospitalization is covered with a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Tufts Health Plan Senior Care Options CW (HMO D-SNP). Ambulance services have no copay, but do have a 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 CW (HMO D-SNP), with a 20% coinsurance for both Emergency Services and Urgently Needed Services, and no copay. Worldwide Emergency Services also includes Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
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 are covered, with 20% coinsurance for most services. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive services are covered, including no copay for Medicare-covered preventive services. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with 20% coinsurance. Health Education, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Nutritional/Dietary Benefit, and Fitness Benefit are covered. In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services are partially covered by the Tufts Health Plan Senior Care Options CW (HMO D-SNP), with a coinsurance of at most 20% for routine hearing exams, but prescription and OTC hearing aids, along with fitting/evaluation for hearing aids, are not covered. There is no deductible for hearing services.
Vision Services See details
Vision Services are covered, with a 20% coinsurance for eye exams and contact lenses. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services offered by the Tufts Health Plan Senior Care Options CW (HMO D-SNP) include coverage for Medicare Dental Services with a 20% coinsurance, and Implant Services, with coverage for up to four implants per year per member, and Orthodontic Services. However, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies (non-Medicare benefit), and Diabetic Equipment, with a 20% coinsurance for many services. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay for all services. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services, Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 0%.
Home Health Services See details
Home Health Services are covered by the Tufts Health Plan Senior Care Options CW (HMO D-SNP), with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Tufts Health Plan Senior Care Options CW (HMO D-SNP), but none of the sub-services are covered. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered. You may have to pay coinsurance for covered services, and prior authorization is required.
Other Services See details
Other Services includes coverage for over-the-counter (OTC) items, but does not cover acupuncture, meal benefit, 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, and Self-Directed Personal Assistance Services. The plan offers OTC items as a supplemental benefit under Part C, including Nicotine Replacement Therapy (NRT) and Naloxone coverage.
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