Plan Documentation
Medicare Advantage HMO Plans
Tufts Health Plan Medicare Preferred HMO member cards look like the samples below:
Prescription (Rx) and Pharmacy Documents
2025 Tufts Health Plan Medicare Preferred HMO Employer Group Formulary (List of Covered Drugs)
This document is a comprehensive formulary containing the prescription drugs covered by Tufts Health Plan Medicare Preferred Medicare Advantage HMO Group Plans.
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View Document called 2025 Tufts Health Plan Medicare Preferred HMO Employer Group Formulary (List of Covered Drugs)2025 Tufts Health Plan Medicare Preferred HMO Individual Formulary (List of Covered Drugs)
This document is a comprehensive formulary containing the prescription drugs covered by Tufts Health Plan Medicare Preferred Medicare Preferred individual HMO plans.
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View Document called 2025 Tufts Health Plan Medicare Preferred HMO Individual Formulary (List of Covered Drugs)2025 Tufts Health Plan Medicare Preferred Prior Authorization Medical Necessity Guidelines
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.
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View Document called 2025 Tufts Health Plan Medicare Preferred Prior Authorization Medical Necessity Guidelines2025 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 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.
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View Document called 2025 Tufts Health Plan Medicare Preferred Step Therapy Prior Authorization Medical Necessity GuidelinesHMO Employer Group Plans Pharmacy Locator Search
Use the link below to determine if a pharmacy is within the preferred pharmacy network.
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View Document called HMO Employer Group Plans Pharmacy Locator SearchHMO Pharmacy Locator Search
Use the link below to determine if a pharmacy is within the preferred pharmacy network.
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View Document called HMO Pharmacy Locator SearchMedicare Prescription Payment Plan Fact Sheet
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.
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View Document called Medicare Prescription Payment Plan Fact SheetPart D Late Enrollment Penalty (LEP) Right to Review Reconsideration Notice
This document allows you to learn about your right to ask Medicare to review your Medicare Part D late enrollment penalty.
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View Document called Part D Late Enrollment Penalty (LEP) Right to Review Reconsideration NoticeTufts Health Plan Medicare Preferred HMO Transition Process
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.
View Document called Tufts Health Plan Medicare Preferred HMO Transition ProcessDental Coverage Documents
2025 Dominion National Utilization Review Guidelines
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.
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View Document called 2025 Dominion National Utilization Review GuidelinesProvider Directories
Tufts Health Plan Medicare Advantage HMO Prime Rx, Prime Rx Plus, and Group Retiree Provider & Pharmacy Directory
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.
View Document called Tufts Health Plan Medicare Advantage HMO Prime Rx, Prime Rx Plus, and Group Retiree Provider & Pharmacy DirectoryTufts Health Plan Medicare Advantage HMO Provider & Pharmacy Directory (Other)
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.
View Document called Tufts Health Plan Medicare Advantage HMO Provider & Pharmacy Directory (Other)Tufts Health Plan Medicare Advantage HMO Saver Rx, Smart Saver Rx, Basic Rx, and Value Rx Provider & Pharmacy Directory
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.
View Document called Tufts Health Plan Medicare Advantage HMO Saver Rx, Smart Saver Rx, Basic Rx, and Value Rx Provider & Pharmacy DirectoryPlan Rating Documents
2025 Tufts Medicare Preferred HMO Medicare Star Rating
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.
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View Document called 2025 Tufts Medicare Preferred HMO Medicare Star RatingAppeals 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 called Fraud, Waste & AbuseTufts Health Plan Medicare Preferred HMO Appeals and Grievances Document
This document explains how to submit a complaint to Tufts Medicare Preferred in the form of an appeal or grievance.
View Document called Tufts Health Plan Medicare Preferred HMO Appeals and Grievances DocumentSummary of Benefits
2025 Tufts Medicare Preferred HMO Plans | Summary of Benefits (All Counties)
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.
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View Document called 2025 Tufts Medicare Preferred HMO Plans | Summary of Benefits (All Counties)Legal Documents
Legal, Security, and Privacy Practices
This document details the legal, security, and privacy practices related to the Tufts Health Plan website.
View Document called Legal, Security, and Privacy PracticesMember Medicare Noncovered Investigational Services Document
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.
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View Document called Member Medicare Noncovered Investigational Services DocumentNotice of Non-Discrimination - Tufts Health Plan Medicare Preferred
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.
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View Document called Notice of Non-Discrimination - Tufts Health Plan Medicare PreferredTufts Medicare Preferred Multi-Language Interpreter Services
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.
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View Document called Tufts Medicare Preferred Multi-Language Interpreter ServicesEvidence of Coverage
2025 Evidence of Coverage | Tufts Medicare Preferred HMO Basic No Rx
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Basic No Rx plan.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred HMO Basic No Rx2025 Evidence of Coverage | Tufts Medicare Preferred HMO Basic Rx
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Basic Rx plan.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred HMO Basic Rx2025 Evidence of Coverage | Tufts Medicare Preferred HMO Basic Rx Custom (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Basic Rx Custom (HMO) Employer Group plan.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred HMO Basic Rx Custom (HMO) Employer Group2025 Evidence of Coverage | Tufts Medicare Preferred HMO Custom Prime Rx (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Custom Prime Rx (HMO) Employer Group plan.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred HMO Custom Prime Rx (HMO) Employer Group2025 Evidence of Coverage | Tufts Medicare Preferred HMO Custom Prime Rx II (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Custom Prime Rx II (HMO) Employer Group plan.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred HMO Custom Prime Rx II (HMO) Employer Group2025 Evidence of Coverage | Tufts Medicare Preferred HMO Custom Prime Rx Plus (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Custom Prime Rx Plus (HMO) Employer Group plan.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred HMO Custom Prime Rx Plus (HMO) Employer Group2025 Evidence of Coverage | Tufts Medicare Preferred HMO Harvard University (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Harvard University (HMO) Employer Group.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred HMO Harvard University (HMO) Employer Group2025 Evidence of Coverage | Tufts Medicare Preferred HMO Prime Fit Rx (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Fit Rx (HMO) Employer Group plan.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred HMO Prime Fit Rx (HMO) Employer Group2025 Evidence of Coverage | Tufts Medicare Preferred HMO Prime No Rx
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime No Rx plan.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred HMO Prime No Rx2025 Evidence of Coverage | Tufts Medicare Preferred HMO Prime No Rx (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime No Rx (HMO) Employer Group plan.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred HMO Prime No Rx (HMO) Employer Group2025 Evidence of Coverage | Tufts Medicare Preferred HMO Prime Rx
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx plan.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred HMO Prime Rx2025 Evidence of Coverage | Tufts Medicare Preferred HMO Prime Rx (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx (HMO) Employer Group plan.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred HMO Prime Rx (HMO) Employer Group2025 Evidence of Coverage | Tufts Medicare Preferred HMO Prime Rx BOS (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx BOS (HMO) Employer Group plan.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred HMO Prime Rx BOS (HMO) Employer Group2025 Evidence of Coverage | Tufts Medicare Preferred HMO Prime Rx Custom (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx Custom (HMO) Employer Group plan.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred HMO Prime Rx Custom (HMO) Employer Group2025 Evidence of Coverage | Tufts Medicare Preferred HMO Prime Rx HP Inc. (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx HP Inc. (HMO) Employer Group plan.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred HMO Prime Rx HP Inc. (HMO) Employer Group2025 Evidence of Coverage | Tufts Medicare Preferred HMO Prime Rx Plus
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx Plus plan.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred HMO Prime Rx Plus2025 Evidence of Coverage | Tufts Medicare Preferred HMO Prime Rx Plus (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx Plus (HMO) Employer Group plan.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred HMO Prime Rx Plus (HMO) Employer Group2025 Evidence of Coverage | Tufts Medicare Preferred HMO Prime Rx Standard (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Prime Rx Standard (HMO) Employer Group plan.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred HMO Prime Rx Standard (HMO) Employer Group2025 Evidence of Coverage | Tufts Medicare Preferred HMO Saver Rx
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Saver Rx plan.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred HMO Saver Rx2025 Evidence of Coverage | Tufts Medicare Preferred HMO Smart Saver Rx
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Smart Saver Rx plan.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred HMO Smart Saver Rx2025 Evidence of Coverage | Tufts Medicare Preferred HMO Value No Rx
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Value No Rx plan.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred HMO Value No Rx2025 Evidence of Coverage | Tufts Medicare Preferred HMO Value Rx
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Value Rx plan.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred HMO Value Rx2025 Evidence of Coverage | Tufts Medicare Preferred HMO Value Rx (HMO) Employer Group
This document provides detailed coverage information for the Tufts Medicare Preferred HMO Value Rx (HMO) Employer Group plan.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred HMO Value Rx (HMO) Employer GroupAnnual Notice of Change
2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Basic No Rx (Essex, Suffolk)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Basic No Rx (Essex, Suffolk)2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Basic No Rx (Worcester)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Basic No Rx (Worcester)2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Basic Rx (Hampden, Hampshire)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Basic Rx (Hampden, Hampshire)2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Basic Rx (Other Counties)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Basic Rx (Other Counties)2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Basic Rx (Worcester)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Basic Rx (Worcester)2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Basic Rx Custom
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Basic Rx Custom2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Custom Prime Rx
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Custom Prime Rx2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Custom Prime Rx II
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Custom Prime Rx II2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Custom Prime Rx Plus
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Custom Prime Rx Plus2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Harvard University No Rx
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Harvard University No Rx2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Prime Fit Rx
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Prime Fit Rx2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Prime No Rx
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Prime No Rx2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Prime Rx
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Prime Rx2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Prime Rx BOS
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Prime Rx BOS2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Prime Rx Custom
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Prime Rx Custom2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Prime Rx HP Inc.
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Prime Rx HP Inc.2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Prime Rx Plus
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Prime Rx Plus2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Prime Rx Standard
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Prime Rx Standard2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Value Rx
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Employer Group Value Rx2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime No Rx (Essex, Suffolk)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime No Rx (Essex, Suffolk)2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime No Rx (Other Counties)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime No Rx (Other Counties)2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime No Rx (Worcester)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime No Rx (Worcester)2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime Rx (Essex, Suffolk)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime Rx (Essex, Suffolk)2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime Rx (Hampden, Hampshire)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime Rx (Hampden, Hampshire)2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime Rx (Other Counties)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime Rx (Other Counties)2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime Rx (Worcester)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime Rx (Worcester)2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime Rx Plus (Essex, Suffolk)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime Rx Plus (Essex, Suffolk)2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime Rx Plus (Hampden, Hampshire)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime Rx Plus (Hampden, Hampshire)2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime Rx Plus (Other Counties)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Prime Rx Plus (Other Counties)2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Saver Rx (All Counties)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Saver Rx (All Counties)2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Smart Saver Rx (All Counties)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Smart Saver Rx (All Counties)2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Value No Rx (Essex, Suffolk)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Value No Rx (Essex, Suffolk)2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Value No Rx (Other Counties)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Value No Rx (Other Counties)2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Value No Rx (Worcester)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Value No Rx (Worcester)2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Value Rx (Essex, Suffolk)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Value Rx (Essex, Suffolk)2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Value Rx (Hampden, Hampshire)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Value Rx (Hampden, Hampshire)2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Value Rx (Other Counties)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Value Rx (Other Counties)2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Value Rx (Worcester)
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.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Medicare Preferred HMO Value Rx (Worcester)PPO Access Plan
Tufts Health Plan Medicare PPO Access member cards look like the sample below:
Prescription (Rx) and Pharmacy Documents
2025 Tufts Health Plan Medicare Preferred Access (PPO) Formulary (List of Covered Drugs)
This document is a comprehensive formulary containing the prescription drugs covered by Tufts Health Plan Medicare Preferred Medicare Preferred Access (PPO) plan.
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View Document called 2025 Tufts Health Plan Medicare Preferred Access (PPO) Formulary (List of Covered Drugs)2025 Tufts Health Plan Medicare Preferred Prior Authorization Medical Necessity Guidelines
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.
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View Document called 2025 Tufts Health Plan Medicare Preferred Prior Authorization Medical Necessity Guidelines2025 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 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.
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View Document called 2025 Tufts Health Plan Medicare Preferred Step Therapy Prior Authorization Medical Necessity GuidelinesMedicare Prescription Payment Plan Fact Sheet
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.
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View Document called Medicare Prescription Payment Plan Fact SheetPPO Pharmacy Locator Search
Use the link below to determine if a pharmacy is within the preferred pharmacy network.
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View Document called PPO Pharmacy Locator SearchProvider Directories
Tufts Health Plan Medicare Advantage Access (PPO) Provider & Pharmacy Directory
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.
View Document called Tufts Health Plan Medicare Advantage Access (PPO) Provider & Pharmacy DirectoryPlan Rating Documents
2025 Tufts Medicare Preferred PPO Medicare Star Rating
This document details the Star Rating given to Tufts Health Plan Medicare Preferred Access (PPO) 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.
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View Document called 2025 Tufts Medicare Preferred PPO Medicare Star RatingAppeals 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 called Fraud, Waste & AbuseSummary of Benefits
2025 Tufts Medicare Preferred PPO Plans | Summary of Benefits (All Counties)
This document provides a summary of the coverage and costs associated with Tufts Health Plan Medicare Preferred PPO plans in the following Massachusetts counties: Barstable, Bristol, Essex, Hampden, Hamshire, Middlesex, Norfolk, Plymouth, Suffolk and Worcester.
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View Document called 2025 Tufts Medicare Preferred PPO Plans | Summary of Benefits (All Counties)Legal Documents
Legal, Security, and Privacy Practices
This document details the legal, security, and privacy practices related to the Tufts Health Plan website.
View Document called Legal, Security, and Privacy PracticesMember Medicare Noncovered Investigational Services Document
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.
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View Document called Member Medicare Noncovered Investigational Services DocumentNotice of Non-Discrimination - Tufts Health Plan Medicare Preferred
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.
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View Document called Notice of Non-Discrimination - Tufts Health Plan Medicare PreferredTufts Medicare Preferred Multi-Language Interpreter Services
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.
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View Document called Tufts Medicare Preferred Multi-Language Interpreter ServicesEvidence of Coverage
2025 Evidence of Coverage | Tufts Medicare Preferred Access (PPO)
This document provides detailed coverage information for the Tufts Medicare Preferred Access (PPO) plan.
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View Document called 2025 Evidence of Coverage | Tufts Medicare Preferred Access (PPO)Annual Notice of Change
2025 Annual Notice of Change | Tufts Health Plan Access (PPO) Plan
This documents details the year-over-year changes to the Tufts Health Plan Senior Care Options. It outlines how the costs and coverages for this plan have changed compared to the previous year.
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View Document called 2025 Annual Notice of Change | Tufts Health Plan Access (PPO) PlanMedicare Supplement Plans
Tufts Medicare Preferred Supplement member cards look like the sample below:
Policy Documents
2025 Tufts Health Plan Medicare Preferred Medicare Supplement Dental Option Policy Addendum
This document provides detailed coverage information for the Tufts Health Plan Medicare Preferred Supplement Dental Option.
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View Document called 2025 Tufts Health Plan Medicare Preferred Medicare Supplement Dental Option Policy Addendum2025 Tufts Health Plan Medicare Preferred Medicare Supplement Policy - Tufts Medicare Preferred Supplement Core Plan
This document provides detailed coverage information for the Tufts Health Plan Medicare Preferred Supplement Core plan.
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View Document called 2025 Tufts Health Plan Medicare Preferred Medicare Supplement Policy - Tufts Medicare Preferred Supplement Core Plan2025 Tufts Health Plan Medicare Preferred Medicare Supplement Policy - Tufts Medicare Preferred Supplement One A Plan
This document provides detailed coverage information for the Tufts Health Plan Medicare Preferred Supplement 1A plan.
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View Document called 2025 Tufts Health Plan Medicare Preferred Medicare Supplement Policy - Tufts Medicare Preferred Supplement One A Plan2025 Tufts Health Plan Medicare Preferred Medicare Supplement Policy - Tufts Medicare Preferred Supplement One Plan
This document provides detailed coverage information for the Tufts Health Plan Medicare Preferred Supplement 1 plan.
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View Document called 2025 Tufts Health Plan Medicare Preferred Medicare Supplement Policy - Tufts Medicare Preferred Supplement One PlanLegal Documents
Legal, Security, and Privacy Practices
This document details the legal, security, and privacy practices related to the Tufts Health Plan website.
View Document called Legal, Security, and Privacy PracticesAppeals 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 called Fraud, Waste & AbuseTufts Health Plan Senior Care Options (HMO-SNP)
Tufts Health Plan Senior Care Options member cards look like the samples below:
Prescription (Rx) and Pharmacy Documents
2025 Tufts Health Plan Senior Care Options (HMO-SNP) Formulary (List of Covered Drugs)
This document is a comprehensive formulary containing the prescription drugs covered by Tufts Health Plan Senior Care Options plan.
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View Document called 2025 Tufts Health Plan Senior Care Options (HMO-SNP) Formulary (List of Covered Drugs)2025 Tufts Health Plan Senior Care Options (HMO-SNP) Prior Authorization Medical Necessity Guidelines
This document details the Tufts Health Plan Senior Care Options 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.
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View Document called 2025 Tufts Health Plan Senior Care Options (HMO-SNP) Prior Authorization Medical Necessity Guidelines2025 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 the 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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View Document called 2025 Tufts Health Plan Senior Care Options (HMO-SNP) Step Therapy Prior Authorization Medical Necessity GuidelinesMassHealth Over-the-Counter Drug List
This document lists the only over-the-counter (OTC) drugs that are covered by MassHealth without prior authorization (PA).
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View Document called MassHealth Over-the-Counter Drug ListSenior Care Options (HMO-SNP) Pharmacy Locator Search
Use the link below to determine if a pharmacy is within the preferred pharmacy network.
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View Document called Senior Care Options (HMO-SNP) Pharmacy Locator SearchTufts Health Plan Senior Care Options (HMO-SNP) Transition Process
This document details certain circumstances in which the plan can offer a temporary supply of a drug when your drug is not included in the Tufts Health Plan Senior Care Options formulary, or drug list, or is restricted in some way.
View Document called Tufts Health Plan Senior Care Options (HMO-SNP) Transition ProcessProvider Directories
Tufts Health Plan Medicare Advantage Senior Care Options (HMO-SNP) Provider & Pharmacy Directory
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.
View Document called Tufts Health Plan Medicare Advantage Senior Care Options (HMO-SNP) Provider & Pharmacy DirectoryPlan Rating Documents
2025 Tufts Health Plan Senior Care Options (HMO-SNP) Medicare Star Rating
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.
Last Updated:
View Document called 2025 Tufts Health Plan Senior Care Options (HMO-SNP) Medicare Star RatingAppeals 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 called Fraud, Waste & AbuseTufts Health Plan Senior Care Options (HMO-SNP) Appeals and Grievances
This document explains how to submit a complaint to Tufts Health Plan Senior Care Options (HMO-SNP) in the form of an appeal or grievance.
View Document called Tufts Health Plan Senior Care Options (HMO-SNP) Appeals and GrievancesSummary of Benefits
2025 Tufts Health Plan Senior Care Options (HMO-SNP) | Summary of Benefits
This document provides a summary of the coverage and costs associated with the Tufts Health Plan Senior Care Options Plan.
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View Document called 2025 Tufts Health Plan Senior Care Options (HMO-SNP) | Summary of BenefitsLegal Documents
Legal, Security, and Privacy Practices
This document details the legal, security, and privacy practices related to the Tufts Health Plan website.
View Document called Legal, Security, and Privacy PracticesMember Medicare Noncovered Investigational Services Document
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.
Last Updated:
View Document called Member Medicare Noncovered Investigational Services DocumentNotice of Non-Discrimination - Tufts Health Plan Senior Care Options (HMO-SNP)
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.
Last Updated:
View Document called Notice of Non-Discrimination - Tufts Health Plan Senior Care Options (HMO-SNP)Tufts Health Plan Senior Care Options (HMO-SNP) Multi-Language Interpreter Services
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.
Last Updated:
View Document called Tufts Health Plan Senior Care Options (HMO-SNP) Multi-Language Interpreter ServicesTufts Health Plan Senior Care Options (HMO-SNP) Notice of Privacy Practices
This notice describes how health information about you may be used and disclosed, and how you can get access to this information.
View Document called Tufts Health Plan Senior Care Options (HMO-SNP) Notice of Privacy PracticesEvidence of Coverage
2025 Evidence of Coverage | Tufts Health Plan Senior Care Options (HMO-SNP)
This document provides detailed coverage information for the Tufts Health Plan Senior Care Options (HMO-SNP) plan.
Last Updated:
View Document called 2025 Evidence of Coverage | Tufts Health Plan Senior Care Options (HMO-SNP)Annual Notice of Change
2025 Annual Notice of Change | Tufts Health Plan Senior Care Options (HMO-SNP)
This documents details the year-over-year changes to the Tufts Health Plan Senior Care Options. It outlines how the costs and coverages for this plan have changed compared to the previous year.
Last Updated:
View Document called 2025 Annual Notice of Change | Tufts Health Plan Senior Care Options (HMO-SNP)