Tufts Medicare Preferred HMO Prime No Rx (HMO)

Massachusetts Medicare Advantage Plan (2024 Plan)


Monthly Premium

Your Cost
$133
by Tufts Health Plan

Additional Coverage

HearingVision

Overall Government Star Rating

 4.5
out of 5 stars

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Plan Name
Tufts Medicare Preferred HMO Prime No Rx (HMO)
Insurance Carrier
Tufts Health Plan
Plan Type
Medicare Advantage Plan Without Prescription Drugs
Network Type
HMO

Tufts Medicare Preferred HMO Prime No Rx (HMO) is a Medicare Advantage Plan Without Prescription Drugs, which is available in Massachusetts and offered by the health insurance company Tufts Health Plan. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$133
Annual Deductible
$0
Max Out-of-Pocket
$3,650
Primary doctor visit
$10 copay per visit
Specialist visit
$15 copay per visit
ER visit
$110 copay per visit (always covered)
Ambulance
$125 copay

Tufts Medicare Preferred HMO Prime No Rx (HMO) has a monthly premium cost of $133 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $3,650 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Tufts Medicare Preferred HMO Prime No Rx (HMO) are defined below.

No
Part D Prescription Drug Coverage
No
Dental
Yes
Vision
Yes
Hearing

Tufts Medicare Preferred HMO Prime No Rx (HMO) is a Medicare Advantage plan which does not include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Tufts Medicare Preferred HMO Prime No Rx (HMO) includes coverage for hearing, vision.

Medicare Advantage health plans can offer even more additional benefits. Tufts Medicare Preferred HMO Prime No Rx (HMO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Not covered
In-home support services
Not covered
Home and bathroom safety devices
Limited coverage
Meals for short duration
Limited coverage
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2024, Tufts Medicare Preferred HMO Prime No Rx (HMO) received an overall government quality rating of 4.5 stars out of 5 stars.

Tufts Medicare Preferred HMO Prime No Rx (HMO) performed better than Massachusetts’s State average overall quality score of 3.8 stars.

This Plan’s 5-star Gov’t Quality Score
Massachusetts State Average Score
Overall Government 5 Star Quality Rating
 4.5
 3.8
Summary rating of health plan quality
 4.5
 3.9
Staying healthy: screenings, tests, & vaccines
 5
 4.4
Managing chronic (long term) conditions
 3
 3.4
Member experience with health plan
 4
 3.5
Member complaints & changes in the health plan's performance
 4
 3.9
Health plan customer service
 5
 4.4

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

Tufts Medicare Preferred HMO Prime No Rx (HMO) received 4.5 stars for its health plan quality score which is better than the Massachusetts State average health plan quality score of 3.9 stars.


Monthly Premium
$133
Health Portion of Premium
$133
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$3,650 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
No

Doctor Services

Primary doctor visit
$10 copay per visit
Specialist visit
$15 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
$0-30 copay
Lab services
$0-30 copay
Diagnostic radiology services (like MRI)
20% coinsurance
Outpatient x-rays
$0-30 copay
Emergency care
$110 copay per visit (always covered)
Urgent care
$30 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
$300 per stay
Outpatient hospital coverage
$0-100 copay per visit

Skilled nursing facility

Skilled nursing facility
$20 per day for days 1 through 20
$80 per day for days 21 through 44
$0 per day for days 45 through 100

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
$125 copay

Therapy services

Occupational therapy visit
$15 copay
Physical therapy & speech & language therapy visit
$15 copay

Mental health services

Outpatient group therapy with a psychiatrist
$0-10 copay
Outpatient individual therapy with a psychiatrist
$0-10 copay
Outpatient group therapy visit
$0-10 copay
Outpatient individual therapy visit
$0-10 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
10% coinsurance per item
Prosthetics (like braces, artificial limbs)
10% coinsurance per item
Diabetes supplies
$0 copay

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

Part B Drugs

Chemotherapy drugs
$0 copay
Other Part B drugs
$0 copay

Hearing

Hearing exam
$15 copay
Fitting/evaluation
$0 copay
Hearing aids - All types
$250-1,150 copay

Preventive Dental

Oral exam
Not covered
Cleaning
Not covered
Fluoride treatment
Not covered
Dental x-rays
Not covered

Comprehensive dental

Non-routine services
Not covered
Diagnostic services
Not covered
Restorative services
Not covered
Endodontics
Not covered
Periodontics
Not covered
Extractions
Not covered
Prosthodontics, other oral/maxillofacial surgery, other services
Not covered

Vision

Routine eye exam
$15 copay
Contact lenses
$0 copay
Eyeglasses (frames & lenses)
$0 copay
Eyeglass frames (only)
$0 copay
Eyeglass lenses (only)
$0 copay
Upgrades
Not covered

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