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Tufts Medicare Preferred Access Rx (PPO)

H9907 - 001 - 0
3.5 out of 5 stars (3.5 / 5)

Tufts Medicare Preferred Access Rx (PPO) is a Medicare Advantage Plan by Tufts Health Plan.

This page features plan details for 2025 Tufts Medicare Preferred Access Rx (PPO) H9907 – 001 – 0 available in Most of Massachusetts.

Locations

Tufts Medicare Preferred Access Rx (PPO) is offered in the following locations.

Bristol County, Massachusetts
Essex County, Massachusetts
Hampden County, Massachusetts

Click to see more locations

Plan Overview

Tufts Medicare Preferred Access Rx (PPO) offers the following coverage and cost-sharing.

Insurer:Tufts Health Plan
Health Plan Deductible:$0
MOOP:$9,500 In and Out-of-network
$5,400 In-network
Drugs Covered:Yes

Ready to sign up for Tufts Medicare Preferred Access Rx (PPO) ?

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 Access Rx (PPO) 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
$185.00 $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 Medicare Preferred Access Rx (PPO) 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
$0.00$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 Access Rx (PPO) 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: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Endodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Implant Services
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Maxillofacial Prosthetics
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Maxillofacial Prosthetics
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Orthodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Periodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Prosthodontics, fixed
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Prosthodontics, removable
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Restorative Services
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Fluoride Treatment
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Oral Exams
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Other Diagnostic Dental Services
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Other Preventive Dental Services
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Prophylaxis (cleaning)
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)

Diagnostic procedures/lab services/imaging

  • Diagnostic radiology services (e.g., MRI)
    • Out-of-Network: 45% coinsurance (Authorization Required)
  • Outpatient x-rays
    • In-Network: $0-45 copay (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $100-140 copay (Authorization Required)
  • Lab services
    • Out-of-Network: 45% coinsurance (Authorization Required)
  • Outpatient x-rays
    • Out-of-Network: 45% coinsurance (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: $0-45 copay (Authorization Required)
    • Out-of-Network: 45% coinsurance (Authorization Required)
  • Lab services
    • In-Network: $0-45 copay (Authorization Required)

Doctor visits

  • Primary
    • In-Network: $0 copay
    • Out-of-Network: $0-40 copay per visit
  • Specialist
    • Out-of-Network: $0-40 copay per visit
    • In-Network: $40 copay per visit

Emergency care/Urgent care

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

Foot care (podiatry services)

  • Foot exams and treatment
    • Out-of-Network: $0-40 copay
    • In-Network: $40 copay
  • Routine foot care
    • Not covered

Ground ambulance

    • In-Network: $350 copay
    • Out-of-Network: $350 copay

Health plan deductible

    • $0

Hearing

  • Medicare-Covered Hearing Exam
    • Out-of-Network: $0-40 copay
  • Fitting/evaluation
    • Out-of-Network: 45% coinsurance (Limits Apply)
    • In-Network: $0 copay (Limits Apply)
  • Hearing aids
    • In-Network: $250-1,150 copay (Limits Apply)
    • Out-of-Network: $250-1,150 copay (Limits Apply)
  • Hearing aids OTC
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • In-Network: $40 copay

Inpatient hospital coverage

    • In-Network: $400 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
    • Out-of-Network: 45% per stay (Authorization Required)

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

    • $9,500 In and Out-of-network
      $5,400 In-network

Medical equipment/supplies

  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 50% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • Out-of-Network: 50% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • Out-of-Network: 0-50% coinsurance per item (Authorization Required)
    • In-Network: 0-20% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • Out-of-Network: $35 copay or 45-50% coinsurance (Authorization Required)
    • In-Network: 0-20% coinsurance (Authorization Required)
  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: $35 copay or 45-50% coinsurance (Authorization Required)

Mental health services

  • Outpatient group therapy visit
    • Out-of-Network: 45% coinsurance
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $0-25 copay
  • Inpatient hospital – psychiatric
    • In-Network: $400 per day for days 1 through 4
      $0 per day for days 5 through 90
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $0-25 copay
  • Outpatient individual therapy visit
    • Out-of-Network: 45% coinsurance
  • Outpatient group therapy visit
    • In-Network: $0-25 copay
  • Outpatient group therapy visit with a psychiatrist
    • Out-of-Network: 45% coinsurance
  • Inpatient hospital – psychiatric
    • Out-of-Network: 45% per stay
  • Outpatient individual therapy visit
    • In-Network: $0-25 copay
  • Outpatient individual therapy visit with a psychiatrist
    • Out-of-Network: 45% coinsurance

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • In-Network: $0-390 copay per visit (Authorization Required)
    • Out-of-Network: 45% coinsurance per visit (Authorization Required)

Preventive care

    • In-Network: $0 copay
    • Out-of-Network: 0-45% coinsurance

Rehabilitation services

  • Physical therapy and speech and language therapy visit
    • In-Network: $30 copay (Authorization Required)
    • Out-of-Network: 45% coinsurance (Authorization Required)
  • Occupational therapy visit
    • In-Network: $30 copay (Authorization Required)
    • Out-of-Network: 45% coinsurance (Authorization Required)

Skilled Nursing Facility

    • In-Network: $0 per day for days 1 through 20
      $190 per day for days 21 through 44
      $0 per day for days 45 through 100 (Authorization Required)
    • Out-of-Network: 45% per stay (Authorization Required)

Transportation

    • Out-of-Network: $0 copay
    • In-Network: $0 copay

Vision

  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglass frames
    • In-Network: $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • Out-of-Network: $0-40 copay (Limits Apply)
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply)
  • Contact lenses
    • Out-of-Network: $0-40 copay (Limits Apply)
  • Eyeglass lenses
    • Out-of-Network: $0-40 copay (Limits Apply)
  • Upgrades
    • Out-of-Network: $0-40 copay (Limits Apply)
  • Eyeglass frames
    • Out-of-Network: $0-40 copay (Limits Apply)
  • Eyeglass lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply)
  • Other
    • Not covered
  • Routine eye exam
    • Out-of-Network: $0-40 copay (Limits Apply)
  • Upgrades
    • In-Network: $0 copay (Limits Apply)

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

    • Covered

Ready to sign up for Tufts Medicare Preferred Access Rx (PPO) ?

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 Access Rx (PPO)? See 2025 Tufts Medicare Preferred Access Rx (PPO) at MedicareAdvantageRX.com.

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