Tufts Medicare Preferred HMO Basic No Rx (HMO) 2024 Benefit Details for Plan H2256-041-0 by Tufts Health Plan
Tufts Medicare Preferred HMO Basic No Rx is a 2024 HMO Medicare Advantage plan {with_without_pdp} Part D.
This Tufts Health Plan option offers the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may also include additional, valuable benefits not covered by Part A or Part B.
This plan is rated 4.5 (Good+) stars by CMS making it a top-rated plan.
Plan Basics | |
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Plan ID: | H2256 041 0 |
Plan Type: | Local HMO |
Plan Year: | 2024 |
Premium: | $20.00/mo Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Out-of-Pocket Maximum: | $3,650/yr |
Part B Reduction: | $0.00/mo |
Drug Plan Benefit: | Not Included |
Rx Gap Coverage: | No |
Supplemental Benefits: | Dental, Vision, Hearing |
Availability: | See List |
Insured By: | Tufts Health Plan |
Summary of Benefits |
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Health Plan Cost Sharing
This Tufts Health Plan Medicare Advantage plan has cost-sharing. These are costs you must pay out-of-pocket when you use approved health services.
NOTE: Most preventive services are covered 100% by the plan as a Part B benefit.
The following table summarizes the most common out-of-pocket costs you will incur if you join this plan unless you go out-of-network:
Healthcare Service | Member Cost |
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Doctor Visits (In-Network) | |
Primary: | $10 Copay |
Specialist: | $40 Copay Referral Required |
Wellness programs (e.g., fitness, nursing hotline): | None |
Preventive care: | $0 |
Foot Care (In-Network) | |
Foot exams and treatment (Medicare-covered): | $40 Copay Referral Required |
Routine foot care: | Not Covered |
Chiropractic Care (In-Network) | |
Medicare-covered chiropractic care: | $15 Copay Referral Required |
Routine chiropractic care: | Not Covered |
Emergency Care / Urgent Care | |
Emergency room care: | $110 Copay |
Urgent care: | $50 Copay |
Ground ambulance: | $325 Copay |
Inpatient hospital coverage: | $275.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Outpatient hospital coverage: | $170 Copay Authorization Required, Referral Required |
Skilled Nursing Facility: | $20.00 per day for days 1 through 20 $160.00 per day for days 21 through 44 $0.00 per day for days 45 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy visit with a psychiatrist: | $25 Copay |
Outpatient group therapy visit with a psychiatrist: | $25 Copay |
Inpatient hospital - psychiatric: | $275.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Outpatient group therapy visit: | $25 Copay |
Outpatient individual therapy visit: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy visit: | $30 Copay Referral Required |
Occupational therapy visit: | $30 Copay Referral Required |
Medical Equipment / Supplies (In-Network) | |
Diabetes supplies: | $0 |
Durable medical equipment (e.g., wheelchairs, oxygen): | 20% Coinsurance Authorization Required |
Prosthetics (e.g., braces, artificial limbs): | 20% Coinsurance |
Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
Diagnostic radiology services (e.g., MRI): | $250 Copay Authorization Required |
Lab services: | $50 Copay Authorization Required |
Outpatient x-rays: | $50 Copay Authorization Required |
Diagnostic tests and procedures: | $50 Copay Authorization Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Feel free to download our Tufts Medicare Preferred HMO Basic No Rx Summary of Benefits information.
Supplemental Benefits
The following is a summary of the supplemental benefits Tufts Health Plan includes with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | Maximum dental benefit: | $1,000.00 Every year |
Oral exam (In-Network) | Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Covered |
Cleaning (In-Network) | Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Covered |
Non-routine services (In-Network) | Covered |
Diagnostic services (In-Network) | Covered |
Extractions (In-Network) | Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | $0 Copay |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | $0 Copay |
Vision | Maximum vision benefit: | $150.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | Covered Limits may apply |
Routine eye exam (In-Network) | $15 Copay Referral Required |
Contact lenses (In-Network) | Covered Limits may apply |
Additional Benefits
None specified.
Prescription Drug Plan Costs & Benefits
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Rating Marks
The following table shows the quality ratings for this Tufts Health Plan plan. Each year CMS rates health plans (Part C) in five broad categories and drug plans (Part D) in four broad categories based on a 5-star rating system. Here are the most recent ratings for Tufts Medicare Preferred HMO Basic No Rx.
CMS Measure | Star Rating |
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2024 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | |
Drug Safety and Accuracy of Drug Pricing |
On its way to 5 stars, this Medicare Advantage HMO plan is worth considering. Here's why. Tufts Medicare Preferred HMO Basic No Rx does an excellent job keeping its members healthy through its preventive care program with proactive screenings, tests, and vaccines. When it comes to helping members manage their chronic health conditions, this plan does an average job.
Medicare beneficiaries enrolled in this Tufts Health Plan plan enjoy a good member experience. Complaints and changes in plan performance are one way we can measure quality, and this plan scores good at both. The plan shines at customer service with an overall excellent mark on this important metric.
Healthy people in this plan get extra savings with the availability of dental, vision, and hearing benefits (see Health Plan Costs & Benefits for details).
With an added premium of $20.00 dollars per month, prospective members are advised to carefully weigh the value of the plan's additional benefits. One of the most important considerations is a plan's maximum out-of-pocket (MOOP) limit. Tufts Medicare Preferred HMO Basic No Rx's annual MOOP is set at $3,650, which does not include prescriptions. This health plan does not have an annual deductible, making health care a little easier to budget.
Plan Availability
Tufts Medicare Preferred HMO Basic No Rx (H2256-041-0) is available in the following locations (click to open):
Additional Medicare Advantage Plan Options
The Medicare Advantage program offers a myriad of options, including these plans:
- H2256-015-2: Tufts Medicare Preferred HMO Prime Rx (HMO)
- H2256-040-0: Tufts Medicare Preferred HMO Value No Rx (HMO)
- H2256-026-1: Tufts Medicare Preferred HMO Basic Rx (HMO)
- H2256-018-7: Tufts Medicare Preferred HMO Value Rx (HMO)
- H2256-001-6: Tufts Medicare Preferred HMO Prime Rx Plus (HMO)
Contact Tufts Health Plan
Plan Website: | http://tuftsmedicarepreferred.org |
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Formulary Information: | http://www.thpmp.org/hmo-pharmacies |
Pharmacy Information: | Tufts Health Plan Pharmacy Page |
Prospective Members: | (877)218-4835 |
TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
Citations & References
- Tufts Health Plan, http://tuftsmedicarepreferred.org, Last Accessed February 20, 2024
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed January 21, 2024
- Medicare.gov, "Compare Original Medicare & Medicare Advantage", Last Accessed February 19, 2024
- Medicare.gov, "Medicare & You Handbook", Last Accessed February 19, 2024
- Medicare.gov, "Is Your Test, Item, or Service Covered?", Last Accessed June 3, 2023
- CMS.gov, Landscape Source Files, Last Accessed February 21, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed February 21, 2024
- CMS.gov, Plan Benefits Package, Last Accessed February 21, 2024
About This H2256-041-0 Plan Detail Page
The data on this Tufts Medicare Preferred HMO Basic No Rx plan detail page is derived from the 2024 Landscape Source Files, Plan Benefit Package, and Medicare Part C and Part D Performance Data published by CMS.
The author interprets these files, and their associated data dictionary, with great care, making every attempt to communicate the data submitted by Tufts Health Plan to CMS as clearly and accurately as possible. Given the complexity of the data, the author recommends that all potential enrollees request an official Summary of Benefits from Tufts Health Plan, at (877)218-4835, prior to enrollment.