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Tufts Medicare Preferred Access Rx (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Tufts Medicare Preferred Access Rx (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Tufts Medicare Preferred Access Rx (PPO) in 2025, please refer to our full plan details page.
Tufts Medicare Preferred Access Rx (PPO) is a PPO 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 2025.
It's important to know that Tufts Medicare Preferred Access Rx (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Tufts Medicare Preferred Access Rx (PPO).
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 Medicare Preferred Access Rx (PPO), 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
This plan has a combined Maximum Out-Of-Pocket cost of $9500.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $9500.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page 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:
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Drug Coverage
The Tufts Medicare Preferred Access Rx (PPO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have an $8 copay at preferred pharmacies and a $20 copay at standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. However, you may still be responsible for a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Tufts Medicare Preferred Access Rx (PPO) plan offers a range of benefits with varying cost-sharing structures. Hospital stays have a copay, with outpatient services and emergency services also incurring copays. You'll find no copays for many services, including home health, lab services, and acupuncture, and no copay for many preventative services. This plan also covers primary care, hearing, vision, and dental services, each with specific copays or maximum benefits. Additionally, you can expect coverage for ambulance and transportation, home infusion, dialysis, medical equipment, and diagnostic services with a mix of copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $400 copay for days 1-5, and no copay for days 6-90, while for Inpatient Hospital Psychiatric, you pay a $400 copay for days 1-4, and no copay for days 5-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a copay between $0 and $390, Observation Services have a $390 copay, Individual and Group Sessions for Outpatient Substance Abuse have a copay of $25, and Ambulatory Surgical Center Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Tufts Medicare Preferred Access Rx (PPO) plan. The plan does not provide any cost information for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Both ground and air ambulance services have a $350 copay. Transportation Services to a plan-approved health-related location are covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay, Urgently Needed Services have a $45 copay, Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $350 copay.
Primary Care See details
The Tufts Medicare Preferred Access Rx (PPO) plan covers Primary Care Physician Services, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $30 copay, Physician Specialist Services with a $40 copay, and Mental Health Specialty Services with a copay between $0 and $25 depending on the service. The plan also covers Other Health Care Professional services with a copay between $0 and $40, Psychiatric Services with a copay between $0 and $25 depending on the service, Physical Therapy and Speech-Language Pathology Services with a $30 copay, Additional Telehealth Benefits with a copay between $0 and $390, and Opioid Treatment Program Services with a $25 copay. Podiatry Services are not covered.
Preventive Services See details
The Tufts Medicare Preferred Access Rx (PPO) plan covers various preventive services, including no copay for Medicare-covered services, annual physical exams, health education, and in-home safety assessments. Additional preventive services may have coinsurance, while services like personal emergency response systems, post-discharge in-home medication reconciliation, re-admission prevention, counseling services, and others are not covered.
Hearing Services See details
Hearing services include routine hearing exams with a $40 copay, fitting/evaluation for hearing aids, and prescription hearing aids with a minimum copay of $250 and a maximum copay of $1150. OTC hearing aids are also covered with a maximum benefit of $130 every three months.
Vision Services See details
The Tufts Medicare Preferred Access Rx (PPO) plan covers vision services, including eye exams with a copay of $0-$40, and eyewear with a combined maximum benefit of $250 every year for both in-network and out-of-network services. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental services are covered, with a $40 copay for Medicare dental services. Other dental services have a maximum plan benefit of $1,500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B insulin drugs, Medicare Part B chemotherapy/radiation drugs, and other Medicare Part B drugs, are covered. The plan has a $35 copay for Medicare Part B insulin drugs, and coinsurance between 0% and 20% for Medicare Part B chemotherapy/radiation drugs and other Medicare Part B drugs.
Dialysis Services See details
Dialysis Services are covered by the Tufts Medicare Preferred Access Rx (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by Tufts Medicare Preferred Access Rx (PPO), including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 20% coinsurance. Diabetic Equipment is also covered, with Diabetic Supplies having 0-20% coinsurance and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance.
Diagnostic and Radiological Services See details
The Tufts Medicare Preferred Access Rx (PPO) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $45, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $100 and $140, Therapeutic Radiological Services have a $60 copay, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Tufts Medicare Preferred Access Rx (PPO) plan with no copay and no coinsurance, but authorization is required. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and there is a copay for Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay; for days 21-44, the copay is $190; and for days 45-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under "Other Services," Tufts Medicare Preferred Access Rx (PPO) covers acupuncture with no copay and no coinsurance, over-the-counter (OTC) items with a $130 allowance every three months, and a meal benefit for chronic illness with no copay and no coinsurance. "Other 1" is covered with a 20% coinsurance for medical stockings and sleeves, and the plan does not cover the following 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.
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