Tufts Medicare Preferred HMO Basic No Rx (HMO)

H2256 - 042 - 0
4.5 out of 5 stars (4.5 / 5)

Tufts Medicare Preferred HMO Basic No Rx (HMO) is a Medicare Advantage (Part C) Plan by Tufts Health Plan.

This page features plan details for 2024 Tufts Medicare Preferred HMO Basic No Rx (HMO) H2256 – 042 – 0 available in Essex and Suffolk Counties.

IMPORTANT: This page has been updated with plan and premium data for 2024.

Locations

Tufts Medicare Preferred HMO Basic No Rx (HMO) is offered in the following locations.

Plan Overview

Tufts Medicare Preferred HMO Basic No Rx (HMO) offers the following coverage and cost-sharing.

Insurer:Tufts Health Plan
Health Plan Deductible:$0.00
MOOP:$3,650 In-network
Drugs Covered:No

Ready to sign up for Tufts Medicare Preferred HMO Basic No Rx (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

Premium Breakdown

Tufts Medicare Preferred HMO Basic No Rx (HMO) has a monthly premium of $28.00. This amount includes your Part C premium but does not include your Part B premium.
Part B Part C Part B Give Back Total
$174.70 $28.00 $0.00 $202.70
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

Tufts Medicare Preferred HMO Basic No Rx (HMO) also provides the following benefits.

Health plan deductible

$0

Other health plan deductibles?

In-network No

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

$3,650 In-network

Optional supplemental benefits

Yes

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

In-network No

Outpatient hospital coverage

$0-270 copay per visit (Authorization is required.) (Referral is required.)

Doctor visits

Primary$10 copay per visit (Not applicable.) (Not applicable.)
Specialist$40 copay per visit (Authorization is not required.) (Referral is required.)

Preventive care

$0 copay (Authorization is not required.) (Referral is not required.)

Emergency care/Urgent care

Emergency$110 copay per visit (always covered) (Not applicable.) (Not applicable.)
Urgent care$50 copay per visit (always covered) (Not applicable.) (Not applicable.)

Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures$10-50 copay (Authorization is required.) (Referral is not required.)
Lab services$0-50 copay (Authorization is required.) (Referral is not required.)
Diagnostic radiology services (e.g., MRI)$100-250 copay (Authorization is required.) (Referral is not required.)
Outpatient x-rays$10-50 copay (Authorization is required.) (Referral is not required.)

Hearing

Hearing exam$40 copay (Authorization is not required.) (Referral is not required.)
Fitting/evaluation$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Hearing aids$250-1,150 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Preventive dental

Oral exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Cleaning$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Fluoride treatmentNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Dental x-ray(s)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Comprehensive dental

Non-routine services50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Diagnostic services50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Restorative services50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
EndodonticsNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Periodontics50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Extractions50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Prosthodontics, other oral/maxillofacial surgery, other services50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Vision

Routine eye exam$15 copay (Limits may apply.) (Authorization is not required.) (Referral is required.)
OtherNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Contact lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Eyeglasses (frames and lenses)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Eyeglass frames$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Eyeglass lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
UpgradesNot covered (Not applicable.) (Not applicable.)

Rehabilitation services

Occupational therapy visit$30 copay (Authorization is not required.) (Referral is required.)
Physical therapy and speech and language therapy visit$30 copay (Authorization is not required.) (Referral is required.)

Ground ambulance

$325 copay (Not applicable.) (Not applicable.)

Transportation

$40 copay (There are no limits.) (Authorization is not required.) (Referral is not required.)

Foot care (podiatry services)

Foot exams and treatment$40 copay (Authorization is not required.) (Referral is required.)
Routine foot careNot covered (Not applicable.) (Not applicable.)

Medical equipment/supplies

Durable medical equipment (e.g., wheelchairs, oxygen)20% coinsurance per item (Authorization is required.) (Not applicable.)
Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item (Authorization is required.) (Not applicable.)
Diabetes supplies$0 copay (Authorization is required.) (Not applicable.)

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

Covered (Authorization is not required.) (Referral is not required.)

Medicare Part B drugs

Chemotherapy0-20% coinsurance (Authorization is required.) (Not applicable.)
Other Part B drugs0-20% coinsurance (Authorization is required.) (Not applicable.)
Part B Insulin drugs$35 copay (Authorization is required.) (Not applicable.)

Inpatient hospital coverage

$275 per day for days 1 through 5
$0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.)

Mental health services

Inpatient hospital – psychiatric$275 per day for days 1 through 5
$0 per day for days 6 through 90 (Authorization is not required.) (Referral is not required.)
Outpatient group therapy visit with a psychiatrist$0-25 copay (Authorization is not required.) (Referral is required.)
Outpatient individual therapy visit with a psychiatrist$0-25 copay (Authorization is not required.) (Referral is required.)
Outpatient group therapy visit$0-25 copay (Authorization is not required.) (Referral is not required.)
Outpatient individual therapy visit$0-25 copay (Authorization is not required.) (Referral is not 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 is required.) (Referral is not required.)

Package #1

Monthly Premium$21.50
Deductiblenan

Optional Benefits

Package #1

Comprehensive dental:Monthly Premium:$19.50
Comprehensive dental:Deductible:N/A

Ready to sign up for Tufts Medicare Preferred HMO Basic No Rx (HMO) ?

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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