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Tufts Medicare Preferred PPO RX (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Tufts Medicare Preferred PPO 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 PPO RX (PPO) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Tufts Medicare Preferred PPO RX (PPO) is a PPO plan offered by Tufts Associated Health Maintenance Organization available for the 2026 plan year to people living in Most of Massachusetts. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Tufts Medicare Preferred PPO 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 PPO 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 PPO RX (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $20.00. 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 $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6750.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $6750.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $10100.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of 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 Medicare Preferred PPO RX (PPO) plan has an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay at preferred pharmacies or through standard mail order, while Tier 6 vaccines also feature no copay at both preferred and standard pharmacies. Tier 2 generic drugs are highly affordable, costing as little as a $2 copay for a one-month supply at preferred pharmacies and standard mail order. For brand-name and specialty medications, the plan transitions to coinsurance costs. Tier 3 preferred brands require a 20% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 25% coinsurance. These coinsurance rates remain consistent across preferred, standard, and standard mail-order pharmacies, though Tier 5 specialty drugs are restricted to a one-month supply.
Additional Benefits
The Tufts Medicare Preferred PPO RX (PPO) plan offers robust coverage for essential medical services, featuring no coinsurance for most doctor visits and hospital stays. Members enjoy no copay for primary care visits, home health services, and annual preventive exams, while specialist visits require a $65 copay. For hospital care, inpatient acute stays incur a $450 daily copay for the first six days, and outpatient services range from no copay up to a $390 copay. Specialty care under this plan includes no copay for over-the-counter hearing aids and routine annual eye exams, though routine dental and eyewear are not covered. Diagnostic labs, home infusions, and acupuncture are also available with no copay, while emergency care carries a $130 copay. For medical equipment and dialysis, members will pay no copay alongside a coinsurance of up to 20%.
Inpatient Hospital See details
Tufts Medicare Preferred PPO RX (PPO) covers inpatient hospital services with no coinsurance, requiring a daily copay of $450 for days 1 to 6 of acute stays and $400 for days 1 to 4 of psychiatric stays, followed by no copay for subsequent stay days. This benefit is partially covered, as upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under Tufts Medicare Preferred PPO RX (PPO) are covered with no coinsurance, featuring a copay of $0 to $390 for outpatient hospital services and a $390 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Tufts Medicare Preferred PPO RX (PPO) plan with no copay and no coinsurance.
Ambulance and Transportation Services See details
Tufts Medicare Preferred PPO RX (PPO) partially covers ambulance and transportation services, offering ground and air ambulance services with a $350 copay and no coinsurance, subject to prior authorization. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Tufts Medicare Preferred PPO RX (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within one day, and urgent care with a $50 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $130, $50, and $350, respectively.
Primary Care See details
Tufts Medicare Preferred PPO RX (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $65 copay and no coinsurance. Other services like physical, occupational, and speech therapies have a $30 copay and no coinsurance, though routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered under the Tufts Medicare Preferred PPO RX (PPO), featuring no copay and no coinsurance for annual physical exams, kidney disease education, and zero-dollar preventive care. While a $30 copay (and no coinsurance) applies to post-welcome visit EKGs and a 20% coinsurance (and no copay) is required for home safety devices, several services such as personal emergency response systems, in-home support, and caregiver support are not covered.
Hearing Services See details
Hearing services are covered by Tufts Medicare Preferred PPO RX (PPO), featuring annual routine exams and fittings for a $65 copay and no coinsurance, as well as unlimited OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with a copay between $250 and $1,150 and no coinsurance for up to two devices per year, though inner ear, outer ear, and over the ear types are not covered.
Vision Services See details
Tufts Medicare Preferred PPO RX (PPO) vision services are partially covered, offering one routine eye exam annually with a $0 to $65 copay, no coinsurance, and no deductible. Other eye exam services and all eyewear, including contact lenses and eyeglasses, are not covered.
Dental Services See details
Tufts Medicare Preferred PPO RX (PPO) offers partial dental coverage, which is limited to Medicare-covered dental services with a $65 copay, no coinsurance, and prior authorization required. Routine preventive and comprehensive dental services, including cleanings, exams, x-rays, and orthodontic treatments, are not covered.
Home Infusion bundled Services See details
Tufts Medicare Preferred PPO RX (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs carry a $35 copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other drugs have a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Tufts Medicare Preferred PPO RX (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Tufts Medicare Preferred PPO RX (PPO) covers durable medical equipment, prosthetics, and diabetic supplies with no copay, though prior authorization is required. Coinsurance for these covered benefits ranges from no coinsurance to 20% depending on the specific equipment or supply.
Diagnostic and Radiological Services See details
Tufts Medicare Preferred PPO RX (PPO) covers diagnostic and radiological services with no coinsurance, although prior authorization is required. Members pay no copay for lab services and outpatient X-rays, a $0 to $65 copay for diagnostic procedures and tests, a minimum $100 copay for diagnostic radiological services, and a minimum $60 copay for therapeutic radiological services.
Home Health Services See details
Home health services are covered under the Tufts Medicare Preferred PPO RX (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by Tufts Medicare Preferred PPO RX (PPO) with no coinsurance, an applicable copayment for additional cardiac rehabilitation services, and prior authorization required. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered under Tufts Medicare Preferred PPO RX (PPO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard 100-day limit are not covered.
Other Services See details
Tufts Medicare Preferred PPO RX (PPO) partially covers other services, providing acupuncture and over-the-counter (OTC) items with no copay and no coinsurance. Meal benefits are not covered under this plan.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
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