Tufts Medicare Preferred HMO: Medical Benefit
Tufts Health Plan Medicare Preferred HMO offers different levels of coverage to meet your medical and prescription needs. With Tufts Medicare Preferred HMO you select a Primary Care Physician (PCP) from our network of participating physicians in your area. Your PCP will coordinate all of your routine care and refer you to plan specialists and other health care providers within his or her referral circle when needed. To be covered, you must receive all routine care from plan providers.
The chart below gives you a brief overview of our HMO Basic, Value, and Prime medical coverage options. For a more detailed description of plan benefits and costs, see the
Tufts Medicare Preferred HMO Summary of Benefits booklet.
Once you have compared the medical benefits below, compare your prescription drug options by clicking on 'Prescription Benefit' on the menu to the left.
| Plan Co-Payments* |
Basic |
Value |
Prime |
| Doctor’s Office Visits |
$25 |
$15 |
$10 |
| Specialist's Office Visits |
$25 |
$20 |
$15 |
| Inpatient General Hospital Coverage |
$200/day for day(s) 1-5
After day 5: $0 co-payment |
$100/day for day(s) 1-5
After day 5: $0 co-payment |
$200/year |
| Worldwide Emergency Coverage |
$50 |
$50 |
$50 |
| Maximum Out-of-Pocket Costs (per calendar year) |
$3,500 |
$3,000 |
$0 |
| Vision Services |
$25 co-payment for one routine eye exam per year; $69 toward eyewear every year |
$20 co-payment for one routine eye exam per year; $69 toward eyewear every year |
$15 co-payment for one routine eye exam per year; $69 toward eyewear every year |
| Hearing Services |
$25 co-payment for one routine hearing test per year |
$20 co-payment for one routine hearing test per year |
$15 co-payment for one routine hearing test per year |
Note:
To join Tufts Medicare Preferred HMO, you must live in Barnstable, Bristol*, Essex, Hampden, Hampshire, Middlesex, Norfolk, Plymouth*, Suffolk, or Worcester county.
*Partial counties: If you live in one of the following zip codes, you live outside the service area and are not eligible to enroll in our HMO plan: Bristol County - 02715, 02718, 02764, 02779, 02780, 02783. Plymouth County: 02344, 02346, 02347, 02348, 02349.
*Exclusions and limitations apply.
H2256-2008-56R1 9-28-07