Plan Documentation

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Basic No Rx, in Essex and Suffolk counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Basic No Rx in Worcester county. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Basic Rx in Hampden and Hampshire counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Basic Rx in Barstable, Bristol, Middlesex, Norfolk, and Plymouth counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Basic Rx in Worcester county. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Employer Group Custom Prime Rx II plan. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Employer Group Custom Prime Rx Plus plan. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Employer Group Harvard University No Rx plan. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Employer Group Prime Fit Rx plan. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Employer Group Prime No Rx plan. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Employer Group Prime Rx plan. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Employer Group Prime Rx BOS plan. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Employer Group Prime Rx Custom plan. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Employer Group Prime Rx HP Inc. plan. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Employer Group Prime Rx Plus plan. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Employer Group Prime Rx Standard plan. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Employer Group Value Rx plan. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Prime No Rx plan in Essex and Suffolk counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Prime No Rx plan in Barstable, Bristol, Middlesex, Norfolk, and Plymouth counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Prime No Rx plan in Worcester county. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Prime Rx plan in Essex and Suffolk counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Prime Rx plan in Hampden and Hampshire counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Prime Rx plan in Barstable, Bristol, Middlesex, Norfolk, and Plymouth counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Prime Rx plan in Worcester county. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Prime Rx Plus plan in Essex and Suffolk counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Prime Rx Plus plan in Hampden and Hampshire counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Prime Rx Plus plan in Barstable, Bristol, Middlesex, Norfolk, and Plymouth counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Saver Rx plan in Barstable, Bristol, Middlesex, Norfolk, Plymouth, Worcester, Essex, Suffolk, Hampden and Hampshire counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Smart Saver Rx plan in Barstable, Bristol, Middlesex, Norfolk, Plymouth, Worcester, Essex, Suffolk, Hampden and Hampshire counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Value No Rx in Essex and Suffolk counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Value No Rx in Barstable, Bristol, Middlesex, Norfolk, and Plymouth counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Value No Rx in Worcester county. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Value Rx in Essex and Suffolk counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Value Rx in Hampden and Hampshire counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Value Rx in Barstable, Bristol, Middlesex, Norfolk, and Plymouth counties. It outlines how the costs and coverages for this plan have changed compared to the previous year.

This documents details the year-over-year changes to the Tufts Health Plan Medicare Preferred HMO Value Rx in Worcester county. It outlines how the costs and coverages for this plan have changed compared to the previous year.

Dominion National’s Utilization Review (UR) Guidelines explain the criteria used to review pre-treatment estimates, pre-authorization requests and/or claims, whenever clinical review is performed. The Guidelines were formulated based on generally accepted dental standards and information gathered from practicing dentists, dental schools, insurance companies, as well as other dental related organizations.

This document provides detailed coverage information for the Tufts Medicare Preferred HMO Basic No Rx plan.

This document provides detailed coverage information for the Tufts Medicare Preferred HMO Basic Rx plan.

This document provides detailed coverage information for the Tufts Medicare Preferred HMO Basic Rx Custom (HMO) Employer Group plan. 

This document provides detailed coverage information for the Tufts Medicare Preferred HMO Custom Prime Rx (HMO) Employer Group plan. 

This document provides detailed coverage information for the Tufts Medicare Preferred HMO Custom Prime Rx II (HMO) Employer Group plan. 

This document provides detailed coverage information for the Tufts Medicare Preferred HMO Custom Prime Rx Plus (HMO) Employer Group plan. 

This document provides detailed coverage information for the Tufts Medicare Preferred HMO Harvard University (HMO) Employer Group.

This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Fit Rx (HMO) Employer Group plan.

This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime No Rx plan.

This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime No Rx (HMO) Employer Group plan. 

This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx plan.

This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx (HMO) Employer Group plan.

This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx BOS (HMO) Employer Group plan.

This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx Custom (HMO) Employer Group plan.

This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx HP Inc. (HMO) Employer Group plan.

This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx Plus plan.

This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) Employer Group plan.

This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx Standard (HMO) Employer Group plan.

This document provides detailed coverage information for the Tufts Medicare Preferred HMO Saver Rx plan.

This document provides detailed coverage information for the Tufts Medicare Preferred HMO Smart Saver Rx plan.

This document provides detailed coverage information for the Tufts Medicare Preferred HMO Value No Rx plan.

This document provides detailed coverage information for the Tufts Medicare Preferred HMO Value Rx plan.

This document provides detailed coverage information for the Tufts Medicare Preferred HMO Value Rx (HMO) Employer Group plan.

This document is a comprehensive formulary containing the prescription drugs covered by Tufts Health Plan Medicare Preferred Medicare Advantage HMO Group Plans. 

This document is a comprehensive formulary containing the prescription drugs covered by Tufts Health Plan Medicare Preferred Medicare Preferred individual HMO plans. 

This document details the Tufts Health Plan Medicare Preferred Medical Necessity Guidelines. These guidelines are used by Tufts Health Plan to determine medical necessity and appropriateness of health care services for the purpose of determining coverage under the applicable health benefit plan. 

This document details drugs that may require prior authorization or Step Therapy to be covered by Tufts Health Plan Medicare Preferred Medicare Advantage Plans. Prior Authorization means that your doctor, or prescriber, must first show that you have a medically necessary need for the drug before Tufts Health Plan will cover the drug cost. Step Therapy is a type of prior authorization that in most cases requires a less expensive drug, that has been proven effective for your condition, is prescribed before moving up a "step" to a more expensive drug. 

Use the link below to determine if a pharmacy is within the preferred pharmacy network.

Use the link below to determine if a pharmacy is within the preferred pharmacy network.

This fact sheet outlines information regarding the Medicare Prescription Payment Plan which is a new payment option in the prescription drug law that works with your current drug coverage to help you manage your out-of-pocket Medicare Part D drug costs by spreading them across the calendar year (January-December). Starting in 2025, anyone with a Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage) can use this payment option. All plans offer this payment option and participation is voluntary. This payment option might help you manage your expenses, but it doesn’t save you money or lower your drug costs.

This document allows you to learn about your right to ask Medicare to review your Medicare Part D late enrollment penalty. 

This document details what to do if your current prescription drugs are not included in the Tufts Health Plan Medicare Preferred formulary, or drug list, or are restricted in some way.

This document details the Star Rating given to Tufts Health Plan Medicare Preferred HMO plans. Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. For more information on plan ratings, go to www.medicare.gov. 

This document provides a summary of the coverage and costs associated with Tufts Health Plan Medicare Preferred HMO plans in the following Massachusetts counties: Barstable, Bristol, Essex, Hampden, Hamshire, Middlesex, Norfolk, Plymouth, Suffolk and Worcester. 

The document provides details around how Tufts Health Plan members can contact the Tufts Health Plan Fraud Hotline with questions, concerns and/or complaints related to possible wasteful, fraudulent, or abusive activity.

This document explains how to submit a complaint to Tufts Medicare Preferred in the form of an appeal or grievance.

This document details the legal, security, and privacy practices related to the Tufts Health Plan website. 

CMS National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), Local Coverage Articles (LCAs) and documentation included in the Medicare manuals and MassHealth Medical Necessity Determinations are used to support the determination that something is investigational and not medically necessary. When CMS and MassHealth do not provide guidance, or evidence supports non coverage, the Plan may elect to not cover a service that it deems as investigational and not medically necessary.

Tufts Health Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

We have free interpreter services to answer any questions you may have about our health or drug plan. To get an interpreter, just call us at the number included in this document. Someone who speaks your language can help you. This is a free service. 

These directories provide a full list of providers and pharmacies in the Tufts Medicare Preferred network. These directories are updated daily and are current as of the date located in the footer on each page.

These directories provide a full list of providers and pharmacies in the Tufts Medicare Preferred network. These directories are updated daily and are current as of the date located in the footer on each page.

These directories provide a full list of providers and pharmacies in the Tufts Medicare Preferred network. These directories are updated daily and are current as of the date located in the footer on each page.