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Tufts Medicare Preferred HMO: Prescription Benefit
Tufts Medicare Preferred offers two prescription drug options. By selecting either one of these options, you are automatically enrolled in a qualified Medicare Part D prescription drug plan. Please compare the two prescription drug options below. If you enroll in the Tufts Medicare Preferred HMO and you want the Medicare prescription benefit, you must purchase it through our plan.
( | Rx Option | Rx Plus Option | |
| Description | You pay NO upfront deductible | You pay NO upfront deductible |
| Yearly drug costs paid by both you and Tufts Medicare Preferred | Covered up to $2,510 | Covered up to $2,510 |
| Copays for up to a 30-day supply at a retail pharmacy | Tier 1: $10 Tier 2: $30 Tier 3: $55 |
Tier 1: $10 Tier 2: $25 Tier 3: $50 |
| Copays for up to a 90-day supply through mail order | Tier 1: $20 Tier 2: $60 Tier 3: $110 |
Tier 1: $20 Tier 2: $50 Tier 3: $100 |
| "Donut Hole Coverage" After yearly drug costs paid by you and tufts Medicare Preferred reach $2,510 but before your yearly out-of-pocket costs reach $4,050 | You pay 100% of the Tufts Medicare Preferred negotiated price for your prescription drug costs. | You are covered for Tier 1 (member pays 100% for Tier 2 and 3): |
| Copays for up to a 30-day supply at a retail pharmacy | Tier 1: $10 | |
| Copays for up to a 90-day supply through mail order | Tier 1: $20 | |
| After the "Donut Hole" Copays for retail and mail order |
Tier 1: $2 Tier 2: $8 Tier 3: $14 |
Tier 1: $2 Tier 2: $8 Tier 3: $14 |
Note:
See the list of covered drugs (formulary) and directory of participating pharmacies for locations where you can get your prescriptions filled. Some medications require prior authorization or dispensing limits. For more information, see the Summary of Benefits booklet.
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.
H2256-2008-56R1 9-28-07
See the list of covered drugs (formulary) and directory of participating pharmacies for locations where you can get your prescriptions filled. Some medications require prior authorization or dispensing limits. For more information, see the Summary of Benefits booklet.
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.
H2256-2008-56R1 9-28-07
