Tufts Medicare Preferred HMO Saver Rx Middlesex County, MA Medicare Advantage Plan

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Tufts Medicare Preferred HMO Saver Rx by Tufts Health Plan, a 2016 Medicare Advantage plan available in Middlesex County, MA Tufts Medicare Preferred HMO Saver Rx is a Medicare Advantage plan, from Tufts Health Plan, that's available in Middlesex County, Massachusetts. This is a Health Maintenance Organization (HMO) option, with a prescription drug plan, for people with Medicare Part A and Part B benefits. It gives you all of the same health insurance benefits as Original Medicare and offers extras that Medicare does not cover.

You can reach Tufts Health Plan directly at (877)218-4835 or (888)899-8978 for TTY users.

About Medicare Advantage HMO Plans

The benefit of an HMO plan is lower, predictable out-of-pocket expenses. Although more restrictive than Original Medicare, a HMO plan limits your annual out-of-pocket costs. With Medicare Parts A and B, there's no cap, leaving you vulnerable to excessive medical bills.

IMPORTANT: With an HMO you are required to use healthcare providers in the plan's network. If you don't you will incur additional costs. Also, be aware that your primary care physician must refer you before you can see a specialist.

CRITICAL: The prescription drug coverage included with Tufts Medicare Preferred HMO Saver Rx has its own deductible and co-pays. If you have prescriptions, make sure your drugs are covered at a favorable price before you join this plan.

Monthly Premium and Deductibles

The premium on this plan is $0.00 per month. That includes your prescription drugs, as well. Plus, you must continue to pay your monthly Medicare Part B premium. Co-payments and/or co-insurances also apply with most healthcare services, except preventive care mandated by CMS (see H2256-028 Summary of Benefits below).

Although the health plan itself does not have a deductible, the prescription drug plan does. It's $300.00 per year. That means you pay 100% of your prescription costs until you've spent $300.00, then the plan will begin paying it's share.

IMPORTANT: When evaluating this plan, look past the monthly premium. Identify the costs of the healthcare services you use most. Only then will you uncover the plan's value for your personal situation.

Maximum Out-of-Pocket (MOOP) Limit for Parts A & B

Unlike Original Medicare, Medicare Advantage plans must set an annual Maximum Out-of-Pocket limit on inpatient and outpatient healthcare services. The Tufts Medicare Preferred HMO Saver Rx plan MOOP is $3,400 . Once you reach this amount of spending on your co-payments, all of your Medicare Part A and Part B services will be covered at no additional charge.

Plans can set their MOOP at a voluntary level of $0 to $3,400 (for in-network services) or a mandatory $3,401 to $6,700 (in-network). Combined totals for in-network and out-of-network are generally higher.

NOTE: MOOP does not include what you spend on monthly premiums. It also does not apply to your prescription drugs or Part D deductible.

CRITICAL: It is important to evaluate the combined annual MA/MAPD premiums and MOOP versus what you might expect to pay for a Medigap plan in Middlesex County. Some Medicare Supplements offer less overall financial risk than Medicare Advantage.

Plan Ratings

In this section we show you the quality rating for this plan. Each year the Centers for Medicare and Medicaid Services (CMS) rates health plans (Part C) in five broad categories and drug plans (Part D) in four broad categories. We do not recommend joining a plan with an overall rating less than 3.0. The following marks will give you an idea of the level of care you will receive if you join this Tufts Health Plan plan.

2016 Overall RatingTufts Medicare Preferred HMO Saver Rx Overall Rating
Part C Summary RatingTufts Medicare Preferred HMO Saver Rx Medicare Part C Rating
Part D Summary RatingTufts Medicare Preferred HMO Saver Rx Medicare Part D Rating
Staying Healthy: Screenings, Tests, VaccinesTufts Medicare Preferred HMO Saver Rx Staying Healthy Rating
Managing Chronic (Long Term) ConditionsTufts Medicare Preferred HMO Saver Rx Managing Chronic Conditions Rating
Member Experience with Health PlanTufts Medicare Preferred HMO Saver Rx Member Experience with Health Plan Rating
Complaints and Changes in Plans PerformanceTufts Medicare Preferred HMO Saver Rx Complaints Rating
Health Plan Customer ServiceTufts Medicare Preferred HMO Saver Rx Health Plan Customer Service Rating
Drug Plan Customer ServiceTufts Medicare Preferred HMO Saver Rx Drug Plan Customer Service Rating
Complaints and Changes in the Drug PlanTufts Medicare Preferred HMO Saver Rx Drug Plan Member Complaints Rating
Member Experience with the Drug PlanTufts Medicare Preferred HMO Saver Rx Drug Plan Member Experience Rating
Drug Safety and Accuracy of Drug PricingTufts Medicare Preferred HMO Saver Rx Drug Safety and Accuracy of Drug Pricing Rating

Part D Prescription Drug Benefits

This plan includes Medicare Part D prescription drug benefits. If you have regular prescriptions, it's critical that you evaluate your costs using the plan's formulary.

Annual Rx Deductible:300.00
Initial Coverage Limit (ICL):$3,310
Gap Coverage:No
Plan's Pharmacy Page:http://tuftsmedicarepreferred.org/drug-coverage
Plan's Formulary Page:http://tuftsmedicarepreferred.org
Plan Offers an Online Pharmacy:No

Here's what you'll pay at the pharmacy if you join this plan:

TierDrug ClassCopay
1Preferred Generic$6
2Generic$12
3Preferred Brand$47
4Non-Preferred Drug$100
5Specialty Tier26%

IMPORTANT: Once you and your plan provider have spent $3,310 on covered drugs (combined amount plus your deductible), you will be in the donut hole coverage gap. In this phase, unless the plan offers additional coverage, you will pay 45% for brand-name drugs and 58% on generic drugs. This Tufts Health Plan plan does not provide additional coverage through the gap.

NOTE: Medicare Advantage plans that include prescription drug coverage (MAPDs) are treated like Medicare Part D plans. Members at higher income levels are subject to the Income Related Monthly Adjustment Amount (IRMAA). In some situations, IRMAA can be appealed. You will need to show SSA evidence of a qualifying event and provide proof of your lower income.

Summary of Benefits (H2256-028)

In this section we outline high-level information about the plan's co-payment and co-insurance costs for inpatient, outpatient, preventive care, transportation and other healthcare services. For complete details, download the Tufts Medicare Preferred HMO Saver Rx Summary of Benefits.

Outpatient Care and Services

All outpatient health care services (Medicare Part B benefits) have their own co-payment or co-insurance costs. Here's how this plan charges for the basics.

Primary Care Doctor:20% co-insurance
Physician Specialist:$40 co-payment
Chiropractor:$15 co-payment
Occupational Therapist:$40 co-payment
Physical Therapist:$40 co-payment
Speech Terapist:$40 co-payment
Psychotherapist:$40 co-payment
Psychiatrist:$40 co-payment
Podiatrist:$40 co-payment

Lab and Diagnostic Services

Lab and diagnostic services have co-payment or co-insurance costs. Some plans offer these services at no cost, but most do not.

Medicare-covered Diagnostic Procedures/Tests:
Medicare-covered Lab Services:
Medicare-covered Diagnostic Radiological Services:$200 co-payment
Medicare-covered Therapeutic Radiological Services
Medicare-covered X-Ray Services

Urgent Care and Emergency Services

Urgent care and emergency room services (Medicare Part B benefits) have co-payment or co-insurance costs. Some plans waive these costs if you are admitted as an inpatient within a specified amount of time. Also, plans are not required to offer emergency care worldwide.

Urgent Care:$20 to $40 co-payment
Emergency Care:$75 co-payment
Co-insurance waived if admitted within 24 Hours
Worldwide Coverage:Yes
Ambulance:$225 co-payment

Medicare Preventive Care

Tufts Medicare Preferred HMO Saver Rx covers preventive services, as required by law under Medicare Part B, including:

  • Abdominal aortic aneurysm screening
  • Alcohol misuse counseling
  • Bone mass measurement
  • Breast cancer screening (mammogram)
  • Cardiovascular disease (behavioral therapy)
  • Cardiovascular screenings
  • Cervical and vaginal cancer screening
  • Colorectal cancer screenings
  • Depression screening
  • Diabetes screenings
  • HIV screening
  • Medical nutrition therapy services
  • Obesity screening and counseling
  • Prostate cancer screenings (PSA)
  • Sexually transmitted infections screening and counseling
  • Tobacco use cessation counseling
  • Vaccines including Flu shots Hepatitis B shots Pneumococcal shots
  • "Welcome to Medicare" preventive visit
  • Yearly "Wellness" visit

All preventive healthcare services are provided at no cost to the beneficiary. Any additional preventative services approved by Medicare during the contract year will be covered.

Inpatient Care and Services

When you are admitted into a hospital or skilled nursing facility you will make copayments based on benefit periods. A benefit period begins when you are admitted and ends after not receiving inpatient care for 60 days in a row. If you are admitted again after a benefit period has ended a new benefit period begins.

You are required to pay an inpatient deductible for each benefit period. There are no limits on the the number of benefit periods. Here's how this plan charges:

  • Day 1 to 5 you pay $350 per day
  • See the Summary of Benefits for additional copayment periods.
The hospital benefit period is Copay Of $350/day For Days 1-5 Applies Per Admission.

Hospice

You pay nothing for hospice care from a Medicare-approved (certified) hospice facility. You may have to pay some of the cost for drugs and respite care.

Plan Availability

Tufts Medicare Preferred HMO Saver Rx is available to beneficiaries living in Ashby, Ayer, Devens, Groton, Littleton, Pepperell, Shirley, Townsend, West Groton, West Townsend, Framingham, Village Of Nagog Woods, Boxborough, Acton, Ashland, Bedford, Hanscom AFB, Carlisle, Concord, Holliston, Hopkinton, Hudson, Marlborough, Maynard, Natick, Sherborn, Lincoln, Stow, Sudbury, Wayland, Woodville, Woburn, Burlington, Billerica, Chelmsford, Dracut, Dunstable, Lowell, North Billerica, North Chelmsford, North Reading, Nutting Lake, Pinehurst, Reading, Tewksbury, Tyngsboro, Wakefield, Westford, Wilmington, Winchester, Cambridge, Somerville, Malden, Everett, Medford, West Medford, Melrose, Stoneham, Lexington, Waltham, North Waltham, New Town, Newton, Newton Center, Newtonville, Newton Highlands, Newton Lower Falls, Newton Upper Falls, West Newton, Auburndale, Chestnut Hill, Waban, Watertown, Arlington, Arlington Heights, Belmont, Waverley, Weston, Nonantum, and all other areas of Middlesex County, Massachusetts.

For assistance 24 hours a day, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048 or visit www.medicare.gov

Tips and Disclaimers

The Medicare Advantage plan data on MedicareWire.com comes directly from Medicare.gov and CMS.gov and is subject to change. The Centers for Medicare and Medicaid Services has neither reviewed nor endorsed the information on this site.

The benefit information provided on this page is a brief summary only, not a complete description. Limitations, co-payments, and restrictions may apply. For more information contact the plan directly at (877)218-4835 or (888)899-8978 for TTY users.

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