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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 $40.00. 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 prescription drug deductible of $615. For Tier 1 preferred generics, 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 also highly affordable, with copays starting at just $2 for a one-month supply at preferred pharmacies and standard mail order. For higher-tier medications, the plan utilizes coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance across preferred, standard, and mail-order pharmacies. Utilizing preferred pharmacies or standard mail order services offers the greatest savings on your prescription copays under this plan.
Additional Benefits
The Tufts Medicare Preferred PPO RX (PPO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay or coinsurance for primary care visits and a $65 copay for specialist consultations. If you require hospital services, inpatient acute care has a $450 daily copay for the first six days and no copay for subsequent days up to 90 days. For emergencies, the plan charges a $130 copay for emergency room visits, which is waived if you are admitted, and a $50 copay for urgent care services. While routine dental, vision eyewear, and transportation services are not covered under this plan, it does offer ancillary benefits such as a routine eye exam ranging from no copay to a $65 copay and unlimited over-the-counter hearing aids with no copay. Additionally, you will pay no copay or coinsurance for home health services and the first 20 days of a skilled nursing facility stay, though durable medical equipment and dialysis services require a 20% coinsurance. Diagnostic laboratory tests and outpatient X-rays are also highly accessible with no copay or coinsurance.
Inpatient Hospital See details
Tufts Medicare Preferred PPO RX (PPO) partially covers inpatient hospital services with no coinsurance, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. For acute care, there is a $450 copay per day for days 1 through 6 and no copay for days 7 through 90, while psychiatric stays require a $400 copay per day for days 1 through 4 and no copay for days 5 through 90.
Outpatient Services See details
Tufts Medicare Preferred PPO RX (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $390 copay and observation services with a $390 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while individual and group outpatient substance abuse sessions require a $40 copay.
Partial Hospitalization See details
Tufts Medicare Preferred PPO RX (PPO) covers partial hospitalization services 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, although prior authorization is required. 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 are covered with a $50 copay and no coinsurance, while worldwide emergency services are covered with no coinsurance and copays of $50 for urgent care, $130 for emergency care, and $350 for emergency transportation.
Primary Care See details
Tufts Medicare Preferred PPO RX (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $65 copay and no coinsurance. Therapy services, including physical, occupational, and speech-language pathology, have a $30 copay and no coinsurance, though routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Tufts Medicare Preferred PPO RX (PPO) covers preventive services, including annual physicals and kidney disease education with no copay and no coinsurance, though an EKG requires a $30 copay and home safety devices require a 20% coinsurance. Additional preventive benefits are partially covered, excluding personal emergency response systems, post-discharge medication reconciliation, re-admission prevention, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
Tufts Medicare Preferred PPO RX (PPO) covers annual routine hearing 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 ranging from $250 to $1,150 and no coinsurance, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Tufts Medicare Preferred PPO RX (PPO) partially covers vision services, offering one routine eye exam per year with a copay of $0 to $65 and no coinsurance, though other eye exam services are not covered. Eyewear is not covered in practice, meaning there is no coverage for contact lenses, eyeglasses, lenses, frames, or upgrades.
Dental Services See details
Tufts Medicare Preferred PPO RX (PPO) partially covers dental services, with coverage limited to Medicare-covered dental care for a $65 copay and no coinsurance, requiring prior authorization. Preventive services such as oral exams, cleanings, and x-rays, as well as restorative, endodontic, and orthodontic treatments, are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Tufts Medicare Preferred PPO RX (PPO) with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs carry 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 medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays and prior authorization required. Covered durable medical equipment, prosthetics, and diabetic shoes carry a 20% coinsurance, while medical and diabetic supplies range from no coinsurance up to 20% coinsurance.
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. Outpatient X-rays and lab services feature no copay, while diagnostic tests range from a $0 to $65 copay, diagnostic radiological services require a minimum $100 copay, and therapeutic radiological services require a minimum $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 covered by Tufts Medicare Preferred PPO RX (PPO) with no coinsurance, but in practice only some services are covered and prior authorization is required. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation (which has a $15 copay), and Supervised Exercise Therapy (SET) for Peripheral Artery Disease (which has a $25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Tufts Medicare Preferred PPO RX (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required and no prior three-day hospital stay is needed, but additional days beyond the standard Medicare-covered limit 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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