Tufts Health Unify (Medicare-Medicaid Plan)

H7419 - 001 - 0
Plan Not Rated

Tufts Health Unify (Medicare-Medicaid Plan) is a Medicare Advantage (Part C) Medicare-Medicaid Plan by Tufts Health Plan.

This page features plan details for 2023 Tufts Health Unify (Medicare-Medicaid Plan) H7419 – 001 – 0 available in Counties: NOR, PLY, BRI, MID, SUF, WOR, ESS, BAR.

IMPORTANT: This page features the 2023 version of this plan. See the 2024 version using the link below:

Locations

Tufts Health Unify (Medicare-Medicaid Plan) is offered in the following locations.

Plan Overview

Tufts Health Unify (Medicare-Medicaid Plan) offers the following coverage and cost-sharing.

Insurer:Tufts Health Plan
Health Plan Deductible:$0.00
MOOP:
Drugs Covered:Yes
Please Note:
  • This is a Medicare-Medicaid plan for people with both Medicare and Medicaid. Contact the plan for details.

Ready to sign up for Tufts Health Unify (Medicare-Medicaid Plan) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

Premium Breakdown

Tufts Health Unify (Medicare-Medicaid Plan) has a monthly premium of $0.00. 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
$164.90 $0.00 $0.00 $0.00 $0.00
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 Health Unify (Medicare-Medicaid Plan) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $0.00
Initial Coverage Limit: $
Catastrophic Coverage Limit: $7,400.00
Drug Benefit Type: Enhanced
Gap Coverage: All Generics and All Brands
Formulary Link: Formulary Link

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 D LIS 25% LIS 50% LIS 75% LIS Full
$0.00 $43.40 $34.80 $26.30 $17.70

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 $. Once you reach that amount, you will enter the next coverage phase.

Gap Coverage Phase

After your total drug costs (including what this plan has paid and what you have paid) reach $, you will pay no more than the amounts below for any drug tier until you reach $7,400.00.

Tier Cost
All other tiers (Generic)25%
All other tiers (Brand-name)25%

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.

Drug TypeCost Share
1 ($0 Drugs)$0.00 copay
2 (Generic Drugs)$0.00 copay
3 (Brand Drugs)$0.00 copay
4 (Non-Medicare Rx/OTC Drugs)$0.00 copay

Additional Benefits

Tufts Health Unify (Medicare-Medicaid Plan) also provides the following benefits.

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

In-Network: No

Dental (comprehensive)

Diagnostic services: $0 copay (limits may apply) (authorization required) (referral not required)
Endodontics: $0 copay (limits may apply) (authorization required) (referral not required)
Extractions: $0 copay (limits may apply) (authorization required) (referral not required)
Non-routine services: $0 copay (limits may apply) (authorization required) (referral not required)
Periodontics: $0 copay (limits may apply) (authorization required) (referral not required)
Prosthodontics, other oral/maxillofacial surgery, other services: $0 copay (limits may apply) (authorization required) (referral not required)
Restorative services: $0 copay (limits may apply) (authorization required) (referral not required)

Dental (preventive)

Cleaning: $0 copay (limits may apply) (authorization required) (referral not required)
Dental x-ray(s): $0 copay (limits may apply) (authorization required) (referral not required)
Fluoride treatment: $0 copay (limits may apply) (authorization required) (referral not required)
Oral exam: $0 copay (limits may apply) (authorization required) (referral not required)

Diagnostic procedures/lab services/imaging

Diagnostic radiology services (e.g., MRI): $0 copay (authorization required) (referral not required)
Diagnostic tests and procedures: $0 copay (authorization required) (referral not required)
Lab services: $0 copay (authorization required) (referral not required)
Outpatient x-rays: $0 copay (authorization required) (referral not required)

Doctor visits

Primary: $0 copay
Specialist: $0 copay (authorization required) (referral not required)

Emergency care/Urgent care

Emergency: $0 copay
Urgent care: $0 copay

Foot care (podiatry services)

Foot exams and treatment: $0 copay (authorization not required) (referral not required)
Routine foot care: $0 copay (no limits) (authorization not required) (referral not required)

Ground ambulance

$0 copay

Health plan deductible

$0.00

Health plan deductibles (other)

In-Network: No

Hearing

Fitting/evaluation: $0 copay (limits may apply) (authorization not required) (referral not required)
Hearing aids – inner ear: $0 copay (limits may apply) (authorization required) (referral not required)
Hearing aids – outer ear: $0 copay (limits may apply) (authorization required) (referral not required)
Hearing aids – over the ear: $0 copay (limits may apply) (authorization required) (referral not required)
Hearing exam: $0 copay (authorization not required) (referral not required)

Hospital coverage (inpatient)

$0 copay (authorization required) (referral not required)

Hospital coverage (outpatient)

$0 copay (authorization required) (referral not required)

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

Not Applicable

Medical equipment/supplies

Diabetes supplies: $0 copay (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen): $0 copay (authorization required)
Prosthetics (e.g., braces, artificial limbs): $0 copay (authorization required)

Medicare Part B drugs

Chemotherapy: $0 copay (authorization required)
Other Part B drugs: $0 copay (authorization required)

Mental health services

Inpatient hospital – psychiatric: $0 copay (authorization required) (referral not required)
Outpatient group therapy visit: $0 copay (authorization required) (referral not required)
Outpatient group therapy visit with a psychiatrist: $0 copay (authorization required) (referral not required)
Outpatient individual therapy visit: $0 copay (authorization required) (referral not required)
Outpatient individual therapy visit with a psychiatrist: $0 copay (authorization required) (referral not required)

Optional supplemental benefits

No

Preventive care

$0 copay (authorization required) (referral not required)

Rehabilitation services

Occupational therapy visit: $0 copay (authorization required) (referral not required)
Physical therapy and speech and language therapy visit: $0 copay (authorization required) (referral not required)

Skilled Nursing Facility

$0 copay (authorization required) (referral not required)

Transportation

$0 copay (no limits) (authorization not required) (referral not required)

Vision

Contact lenses: $0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglass frames: $0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglass lenses: $0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglasses (frames and lenses): $0 copay (limits may apply) (authorization not required) (referral not required)
Other: Not covered (no limits)
Routine eye exam: $0 copay (limits may apply) (authorization not required) (referral not required)
Upgrades: Not covered

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

Covered (authorization not required) (referral not required)

Ready to sign up for Tufts Health Unify (Medicare-Medicaid Plan) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

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