2026 Tufts Health Plan
Senior Care Options (HMO-SNP)
Beginning January 1, 2026, all SCO enrollees must be enrolled in both Medicare Parts A and B, as well as MassHealth Standard (Medicaid), to remain in a SCO plan. For more information on this change, please click here:
Covered Insulin Drugs
Part B: $0. Prior Authorization may be required.
Part D: $0
Out-of-Pocket Maximum
Because you get assistance from MassHealth (Medicaid), you have no out-of-pocket costs for covered services. You pay nothing for medical services covered by Tufts Health Plan Senior Care Options.
Annual Physical Visit
Your Annual Physical visit will cost you $0 per year.
Annual Wellness Visit
Your Annual Wellness visit will cost you $0 per year.
Primary Care Provider (PCP)
$0 per visit.
Specialist Copay
$0 per visit. Referral from your Primary Care Provider (PCP) may be required.
Routine Vision Exam
$0 per year
Routine Hearing Exam
$0 per year
Laboratory Services
$0 per visit. Prior Authorization may be required.
X-Rays
$0 per visit. Prior Authorization may be required.
Diagnostic Procedures
$0 per visit. Prior Authorization may be required.
Diagnostic Radiology Services
$0 per visit. Prior Authorization may be required.
Outpatient Surgery
$0 per visit. Prior Authorization may be required.
Physical, Occupational, and Speech Therapy
$0 per visit. Referral from your Primary Care Provider (PCP) may be required. Prior authorization may be required.
Outpatient Observation Services
$0 per stay. Copay is waived if admitted inpatient within 1 day for the same condition. Prior authorization may be required.
Cardiovascular Screening
$0 per visit
Cancer Screening (Colorectal, Prostate, Breast)
$0 per visit
Urgent Care
$0 per visit
Emergency Room Visits
$0 per visit.
Inpatient Hospital Coverage
$0 per visit. Prior Authorization may be required.
Ambulance Rides and Services
$0 per service. Prior authorization may be required for non-emergency transportation.
Embedded Dental Benefit
Free dental benefits, including coverage for exams, dentures, root canals, crowns, and more.
Telehealth
$0 Medicare-covered services plus additional telehealth service. The same referral and prior authorization rules apply to additional telehealth services as corresponding in-person visits. Prior authorization may be required for Remote Patient Monitoring services.
Over the Counter (OTC)
Instant Savings Card:
$115 per calendar quarter for Medicare-approved OTC items (covered under Medicare)
$235 per calendar quarter for Food & Beverages and other personal items (covered under MassHealth/Medicaid)
*Members receive a single OTC card loaded quarterly with two separate credits to use as described above for purchases at participating retailers and plan approved online stores. The two credit amounts are separate and can't be combined, which means that the amount designated for Medicare-approved OTC items cannot be used to purchase food and beverages and other personal items, and vice versa. No rollover of unused quarterly balances. See Evidence of Coverage (EOC) for more information.
Non-VBID benefit: single card with two separate wallets.
Over-The-Counter (OTC) Prescription Medicines: $0 for additional OTC prescription medicines not covered by Medicare or MassHealth/Medicaid
Eyewear Benefit
$300 allowance at EyeMed providers; $180 allowance at non-participating providers. Use for routine eyeglasses (prescription lenses, frames, a combination of lenses and frames) and/or contact lenses. Note: Only one purchase is allowed per calendar year up to the benefit amount; any unused amount after the single purchase will expire and cannot be applied toward another purchase during the calendar year.
Weight Management Programs
$200 allowance per year; covers program fees for weight loss programs such as WeightWatchers or a hospital-based weight loss program.
Wellness Allowance
Free membership to your local participating YMCA facility; plus $200 allowance per year to spend on fitness classes, an activity tracker and more.