Tufts Medicare Preferred HMO Prime No Rx (HMO)
H2256 - 016 - 1
(4.5 / 5)
Tufts Medicare Preferred HMO Prime 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 Prime No Rx (HMO) H2256 – 016 – 1 available in Essex and Suffolk Counties.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Locations
Tufts Medicare Preferred HMO Prime No Rx (HMO) is offered in the following locations.
Plan Overview
Tufts Medicare Preferred HMO Prime 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 Prime No Rx (HMO) ?
Premium Breakdown
Tufts Medicare Preferred HMO Prime No Rx (HMO) has a monthly premium of $156.00. 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 | $156.00 | $0.00 | $330.70 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
Tufts Medicare Preferred HMO Prime No Rx (HMO) also provides the following benefits.
| $0 |
| In-network | No |
| $3,650 In-network |
| Yes |
| In-network | No |
| $0-100 copay per visit (Authorization is required.) (Referral is required.) |
| Primary | $10 copay per visit (Not applicable.) (Not applicable.) |
| Specialist | $15 copay per visit (Authorization is not required.) (Referral is required.) |
| $0 copay (Authorization is not required.) (Referral is not required.) |
| Emergency | $110 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Urgent care | $30 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Diagnostic tests and procedures | $0-30 copay (Authorization is required.) (Referral is not required.) |
| Lab services | $0-30 copay (Authorization is required.) (Referral is not required.) |
| Diagnostic radiology services (e.g., MRI) | 20% coinsurance (Authorization is required.) (Referral is not required.) |
| Outpatient x-rays | $0-30 copay (Authorization is required.) (Referral is not required.) |
| Hearing exam | $15 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.) |
| Oral exam | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Cleaning | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Fluoride treatment | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Dental x-ray(s) | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Non-routine services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Diagnostic services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Restorative services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Endodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Periodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Extractions | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Routine eye exam | $15 copay (Limits may apply.) (Authorization is not required.) (Referral is required.) |
| Other | Not 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.) |
| Upgrades | Not covered (Not applicable.) (Not applicable.) |
| Occupational therapy visit | $15 copay (Authorization is not required.) (Referral is required.) |
| Physical therapy and speech and language therapy visit | $15 copay (Authorization is not required.) (Referral is required.) |
| $125 copay (Not applicable.) (Not applicable.) |
| $40 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
| Foot exams and treatment | $15 copay (Authorization is not required.) (Referral is required.) |
| Routine foot care | Not covered (Not applicable.) (Not applicable.) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | 10% coinsurance per item (Authorization is required.) (Not applicable.) |
| Prosthetics (e.g., braces, artificial limbs) | 10% coinsurance per item (Authorization is required.) (Not applicable.) |
| Diabetes supplies | $0 copay (Authorization is required.) (Not applicable.) |
| Covered (Authorization is not required.) (Referral is not required.) |
| Chemotherapy | $0 copay (Authorization is required.) (Not applicable.) |
| Other Part B drugs | $0 copay (Authorization is required.) (Not applicable.) |
| Part B Insulin drugs | $0 copay (Authorization is required.) (Not applicable.) |
| $300 per stay (Authorization is required.) (Referral is not required.) |
| Inpatient hospital – psychiatric | $300 per stay (Authorization is not required.) (Referral is not required.) |
| Outpatient group therapy visit with a psychiatrist | $0-10 copay (Authorization is not required.) (Referral is required.) |
| Outpatient individual therapy visit with a psychiatrist | $0-10 copay (Authorization is not required.) (Referral is required.) |
| Outpatient group therapy visit | $0-10 copay (Authorization is not required.) (Referral is not required.) |
| Outpatient individual therapy visit | $0-10 copay (Authorization is not required.) (Referral is not required.) |
| $20 per day for days 1 through 20 $80 per day for days 21 through 44 $0 per day for days 45 through 100 (Authorization is required.) (Referral is not required.) |
| Monthly Premium | $31.00 |
| Deductible | nan |
Optional Benefits
Package #1
| Preventive dental: | Monthly Premium: | $31.00 |
| Preventive dental: | Deductible: | N/A |
| Comprehensive dental: | Monthly Premium: | $31.00 |
| Comprehensive dental: | Deductible: | N/A |
Ready to sign up for Tufts Medicare Preferred HMO Prime No Rx (HMO) ?
Table of Contents
SMID: MULTIPLAN_HCIHNDOGMED01_M
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