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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.
Tufts Medicare Preferred PPO RX (PPO) is a PPO plan offered by Point32Health, Inc. available for enrollment in 2026 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 $60.00. 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. 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 combined Maximum Out-Of-Pocket cost of $10100.00 (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 $10100.00 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 PPO RX (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay at preferred pharmacies and standard mail order, compared to a $5 copay for a 1-month supply at standard pharmacies. Tier 2 generic drugs are also highly affordable, starting at a $2 copay for a 1-month supply at preferred pharmacies and standard mail order. Tier 6 vaccines are fully covered with no copay at both preferred and standard pharmacies. For higher-tier medications, you will pay a coinsurance of 20% for Tier 3 preferred brand drugs and 25% for both Tier 4 non-preferred drugs and Tier 5 specialty drugs. These coinsurance rates apply across preferred, standard, and standard mail-order pharmacies.
Additional Benefits
The Tufts Medicare Preferred PPO RX (PPO) plan offers comprehensive medical coverage, including primary care visits, home health services, and annual physical exams with no copay or coinsurance. For inpatient hospital stays, members pay a daily copay of $450 for days one through six, while emergency room visits carry a $130 copay that is waived upon admission. Outpatient hospital services and diagnostic lab tests are highly accessible, featuring no coinsurance and copays ranging from no copay up to $390. Specialist visits require a $65 copay, and routine eye exams range from no copay to $65. While routine dental care is not covered, members benefit from acupuncture, over-the-counter items, and unlimited OTC hearing aids with no copays or coinsurance. Additionally, skilled nursing facility stays feature no copay for the first 20 days, while durable medical equipment and dialysis services require a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by Tufts Medicare Preferred PPO RX (PPO) with no coinsurance, requiring a $450 daily copay for days 1 to 6 of an acute stay and a $400 daily copay for days 1 to 4 of a psychiatric stay, followed by no copay for remaining days. Non-Medicare-covered stays, room upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Tufts Medicare Preferred PPO RX (PPO) covers outpatient services with no coinsurance, featuring a $0 to $390 copay for outpatient hospital services and a $390 copay per stay for observation services. Ambulatory surgical center and 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) covers ground and air ambulance services with a $350 copay and no coinsurance, subject to prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Tufts Medicare Preferred PPO RX (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within one day. Urgently needed services require a $50 copay with no coinsurance, and worldwide emergency, urgent, and transportation services are 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 covered services like mental health and physical therapy feature copays ranging from $0 to $65 with no coinsurance, though podiatry and routine chiropractic care are not covered.
Preventive Services See details
Tufts Medicare Preferred PPO RX (PPO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered, excluding personal emergency response systems, adult day health, home-based palliative care, and caregiver support. While most covered services have no cost, some require cost-sharing, such as a 20% coinsurance for home safety devices and a $30 copay for post-welcome visit EKGs.
Hearing Services See details
Hearing services are covered by Tufts Medicare Preferred PPO RX (PPO), featuring annual routine exams and evaluations for a $65 copay and no coinsurance, plus 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
Vision services are covered by Tufts Medicare Preferred PPO RX (PPO), featuring partially covered eye exams where routine exams are covered once yearly for a $0 to $65 copay and no coinsurance, but other exam services are not covered. For eyewear, some services are covered with no copay or coinsurance, but contact lenses, eyeglasses, lenses, frames, and upgrades are not covered.
Dental Services See details
Tufts Medicare Preferred PPO RX (PPO) partially covers dental services, with coverage limited to Medicare-covered dental benefits that require prior authorization and have a $65.00 copay and no coinsurance. Other preventive and comprehensive dental services, such as exams, cleanings, x-rays, and restorative treatments, are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under Tufts Medicare Preferred PPO RX (PPO) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy and other drugs require no copay and a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under Tufts Medicare Preferred PPO RX (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Tufts Medicare Preferred PPO RX (PPO) covers medical equipment, prosthetics, and diabetic supplies with no copays, though prior authorization is required. Members will pay a 20% coinsurance for durable medical equipment, prosthetics, and therapeutic shoes, while medical and diabetic supplies carry a coinsurance ranging from no coinsurance to 20%.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Tufts Medicare Preferred PPO RX (PPO) with no coinsurance, though prior authorization is required. There is no copay for lab services and outpatient X-rays, while diagnostic procedures carry a $0 to $65 copay, diagnostic radiology starts at a $100 copay, and therapeutic radiology starts at a $60 copay.
Home Health Services See details
Home health services are covered by Tufts Medicare Preferred PPO RX (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered under the Tufts Medicare Preferred PPO RX (PPO) plan, requiring prior authorization with no coinsurance and copayments between $15 and $25. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Tufts Medicare Preferred PPO RX (PPO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, prior hospital stays of less than three days are allowed, and additional days beyond the standard 100 days are not covered.
Other Services See details
Tufts Medicare Preferred PPO RX (PPO) partially covers other services, offering acupuncture and over-the-counter (OTC) items with no copay and no coinsurance. Meal benefits and other additional services are not covered under this plan.
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