Tufts Medicare Preferred HMO Prime 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 Rx (HMO) H2256 – 015 – 1 available in Essex and Suffolk Counties.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Tufts Medicare Preferred HMO Prime Rx (HMO) is offered in the following locations.
Tufts Medicare Preferred HMO Prime 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: | Yes |
Ready to sign up for Tufts Medicare Preferred HMO Prime Rx (HMO) ?
Part B | Part C | Part D | Part B Give Back | Total |
---|---|---|---|---|
$174.70 | $156.00 | $60.00 | $0.00 | $390.70 |
Tufts Medicare Preferred HMO Prime Rx (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Deductible: | $0.00 |
Initial Coverage Limit: | $5,030.00 |
Catastrophic Coverage Limit: | $8,000.00 |
Drug Benefit Type: | Enhanced Alternative |
Additional Gap Coverage: | Yes |
Formulary Link: | Formulary Link |
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 Full |
---|---|
$60.00 | $ |
NOTE: The Inflation Reduction Act of 2022 has expanded full subsidy eligibility under the LIS program to individuals with incomes up to 150% of the Federal Poverty Level. People who qualify for Extra Help generally will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug.
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 $5,030.00. Once you reach that amount, you will enter the next coverage phase.
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $4.00 copay | $4.00 copay | ||
2 (Generic) | $8.00 copay | $8.00 copay | ||
3 (Preferred Brand) | $45.00 copay | $45.00 copay | ||
4 (Non-Preferred Drug) | $100.00 copay | $100.00 copay | ||
5 (Specialty Tier) | 33% | 33% | ||
6 (Vaccines ($0 cost sharing)) | $0.00 copay |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | ||||
2 (Generic) | ||||
3 (Preferred Brand) | ||||
4 (Non-Preferred Drug) | ||||
5 (Specialty Tier) | ||||
6 (Vaccines ($0 cost sharing)) |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $12.00 copay | $8.00 copay | ||
2 (Generic) | $24.00 copay | $16.00 copay | ||
3 (Preferred Brand) | $135.00 copay | $90.00 copay | ||
4 (Non-Preferred Drug) | $300.00 copay | $300.00 copay | ||
5 (Specialty Tier) | ||||
6 (Vaccines ($0 cost sharing)) | $0.00 copay |
After your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00, you will pay no more than the amounts below for any drug tier until you reach $8,000.00.
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
6 (Vaccines ($0 cost sharing)) | $0.00 copay | |||
Generic drugs | ||||
Brand-name drugs |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
6 (Vaccines ($0 cost sharing)) | $0.00 copay | |||
Generic drugs | ||||
Brand-name drugs |
Tier | Cost |
---|---|
All other tiers (Generic) | 25% |
All other tiers (Brand-name) | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, 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.
Tufts Medicare Preferred HMO Prime 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 |
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 Rx (HMO) ?
SMID: MULTIPLAN_HCIHNDOGMED01_M
Factsonmedicare.com is a free-to-use informational website by Dog Media Solutions LLC. All insurance agents and enrollment platforms linked to this site have their own terms and conditions.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B Premium give-back is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
All plan-related information on this site is from CMS.gov and Medicare.gov. We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do feature in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
HealthCompare Insurance Services does not offer every plan available in your area. Currently we represent 18 organizations, which offers 52,101 products in your area.
We do not feature every plan available in your area. Any information we provide is limited to those plans we do feature in your area. Enrollment is offered through our partners including HealthCompare Insurance Services Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
HealthCompare Insurance Services represents Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.
Medicare has neither approved nor endorsed any information on this site.