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Medicare Advantage HMO Plans

Tufts Health Plan Medicare Preferred HMO member cards look like the samples below:

Prescription (Rx) and Pharmacy Documents

2018 Tufts Health Plan Medicare Preferred Step Therapy Prior Authorization Medical Necessity Guidelines

This document details drugs that may require prior authorization or Step Therapy to be covered by Tufts Health Plan Medicare Preferred HMO and PDP 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.

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2019 Tufts Health Plan Medicare Preferred Step Therapy Prior Authorization Medical Necessity Guidelines

This document details drugs that may require prior authorization or Step Therapy to be covered by Tufts Health Plan Medicare Preferred HMO and PDP 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.

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Provider Directories

2019 Tufts Medicare Preferred HMO Provider Directory

This directory provides a list of providers in the Tufts Medicare Preferred HMO network. Please note that this directory is for members in Barnstable, Bristol, Essex, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, and Worcester counties.

Plan Rating Documents

Appeals and Grievances Documents

Fraud, Waste & Abuse

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.

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Summary of Benefits

Evidence of Coverage

Annual Notice of Change

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Medicare Supplement Plans

Tufts Medicare Preferred Supplement member cards look like the sample below:

Policy Documents

Appeals and Grievances Documents

Fraud, Waste & Abuse

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.

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Senior Care Options Plan (HMO-SNP)

Tufts Medicare Preferred Senior Care Options member cards look like the samples below:
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Prescription (Rx) and Pharmacy Documents

2018 Tufts Health Plan Senior Care Options (HMO SNP) Step Therapy Prior Authorization Medical Necessity Guidelines

This document details drugs that may require prior authorization or Step Therapy to be covered by Tufts Health Plan Senior Care Options plan. 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.

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2019 Tufts Health Plan Senior Care Options (HMO SNP) Step Therapy Prior Authorization Medical Necessity Guidelines

This document details drugs that may require prior authorization or Step Therapy to be covered by Tufts Health Plan Senior Care Options plan. 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.

View Document

Provider Directories

Plan Rating Documents

Tufts Health Plan Senior Care Options Medicare Star Ratings

This document details the Star Rating given to Tufts Health Plan Senior Care Options plan. 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.

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Appeals and Grievances Documents

Fraud, Waste & Abuse

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.

View Document

Summary of Benefits

Evidence of Coverage

Annual Notice of Change

Back to Top
PDP

Prescription Drug Plan (PDP)

Tufts Medicare Preferred Prescription Drug Plan (PDP) member cards look like the sample below:

Prescription (Rx) and Pharmacy Documents

2018 Tufts Health Plan Medicare Preferred Step Therapy Prior Authorization Medical Necessity Guidelines

This document details drugs that may require prior authorization or Step Therapy to be covered by Tufts Health Plan Medicare Preferred HMO and PDP 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.

View Document

Provider Directories

Appeals and Grievances Documents

Fraud, Waste & Abuse

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.

View Document
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