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Tufts Medicare Preferred HMO Basic Rx (HMO)

H2256 - 026 - 1
4 out of 5 stars (4 / 5)

Tufts Medicare Preferred HMO Basic Rx (HMO) is a Medicare Advantage Plan by Tufts Health Plan.

This page features plan details for 2025 Tufts Medicare Preferred HMO Basic Rx (HMO) H2256 – 026 – 1 available in Most of Massachusetts.

Locations

Tufts Medicare Preferred HMO Basic Rx (HMO) is offered in the following locations.

Essex County, Massachusetts
Massachusetts
Suffolk County, Massachusetts

Click to see more locations

Plan Overview

Tufts Medicare Preferred HMO Basic Rx (HMO) offers the following coverage and cost-sharing.

Insurer:Tufts Health Plan
Health Plan Deductible:$0
MOOP:$3,650 In-network
Drugs Covered:Yes

Ready to sign up for Tufts Medicare Preferred HMO Basic Rx (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

Tufts Medicare Preferred HMO Basic Rx (HMO) has a monthly premium of $58.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $36.10 $21.90 $ $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Tufts Medicare Preferred HMO Basic Rx (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $0.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$21.90$0.00

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

Tufts Medicare Preferred HMO Basic Rx (HMO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Comprehensive Dental

  • Adjunctive General Services
    • In-Network: 50 Coins – No Co pay
  • Oral and Maxillofacial Surgery
    • In-Network: 50 Coins – No Co pay
  • Periodontics
    • In-Network: 50 Coins – No Co pay
  • Restorative Services
    • In-Network: 50 Coins – No Co pay

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: 0-50 Coins – No Copay
  • Oral Exams
    • In-Network: 0-50 Coins – No Copay
  • Prophylaxis (cleaning)
    • In-Network: No Coins – No Copay

Diagnostic procedures/lab services/imaging

  • Diagnostic radiology services (e.g., MRI)
    • $100-250 copay (Authorization Required)
  • Diagnostic tests and procedures
    • $10-45 copay (Authorization Required)
  • Lab services
    • $0-45 copay (Authorization Required)
  • Outpatient x-rays
    • $10-45 copay (Authorization Required)

Doctor visits

  • Primary
    • $10 copay per visit
  • Specialist
    • $40 copay per visit (Referral Required)

Emergency care/Urgent care

  • Urgent care
    • $45 copay per visit (always covered)
  • Emergency
    • $125 copay per visit (always covered)

Foot care (podiatry services)

  • Routine foot care
    • Not covered
  • Foot exams and treatment
    • $40 copay (Referral Required)

Ground ambulance

    • $325 copay

Health plan deductible

    • $0

Hearing

  • Fitting/evaluation
    • $0 copay (Limits Apply)
  • Hearing aids
    • $250-1,150 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • $40 copay
  • Hearing aids OTC
    • Not covered

Inpatient hospital coverage

    • $275 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $3,650 In-network

Medical equipment/supplies

  • Diabetes supplies
    • $0 copay (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • 20% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Other Part B drugs
    • 0-20% coinsurance (Authorization Required)
  • Chemotherapy
    • 0-20% coinsurance (Authorization Required)

Mental health services

  • Inpatient hospital – psychiatric
    • $275 per day for days 1 through 5
      $0 per day for days 6 through 90
  • Outpatient individual therapy visit
    • $0-25 copay
  • Outpatient individual therapy visit with a psychiatrist
    • $0-25 copay
  • Outpatient group therapy visit
    • $0-25 copay
  • Outpatient group therapy visit with a psychiatrist
    • $0-25 copay

Optional supplemental benefits

    • Yes

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • $0-270 copay per visit (Authorization Required, Referral Required)

Preventive care

    • $0 copay

Rehabilitation services

  • Physical therapy and speech and language therapy visit
    • $30 copay (Authorization Required, Referral Required)
  • Occupational therapy visit
    • $30 copay (Authorization Required, Referral Required)

Skilled Nursing Facility

    • $20 per day for days 1 through 20
      $160 per day for days 21 through 44
      $0 per day for days 45 through 100 (Authorization Required)

Transportation

    • $0 copay

Vision

  • Eyeglasses (frames and lenses)
    • $0 copay (Limits Apply)
  • Routine eye exam
    • $15 copay (Limits Apply, Referral Required)
  • Eyeglass lenses
    • $0 copay (Limits Apply)
  • Upgrades
    • $0 copay (Limits Apply)
  • Contact lenses
    • $0 copay (Limits Apply)
  • Eyeglass frames
    • $0 copay (Limits Apply)
  • Other
    • Not covered

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Tufts Health Plan Medicare Preferred Dental Option

Comprehensive Dental

  • Restorative Services, Endodontics, Periodontics, Prosthodontics, removable, Prosthodontics, fixed, Oral and Maxillofacial Surgery, Adjunctive General Services
    • Monthly Premium: $37.00
    • Max Coverage: $1000.00
    • Coverage Periodicity: Every year

Diagnostic and Preventive Dental

  • Oral Exams, Dental X-Rays, Prophylaxis (Cleaning)
    • Monthly Premium: $37.00
    • Max Coverage: $1000.00
    • Coverage Periodicity: Every year

Ready to sign up for Tufts Medicare Preferred HMO Basic Rx (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Need more information on Tufts Medicare Preferred HMO Basic Rx (HMO)? See 2025 Tufts Medicare Preferred HMO Basic Rx (HMO) at MedicareAdvantageRX.com.

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