2021 Tufts Medicare Preferred HMO Basic No Rx Plan
- Monthly Dental Premium
- Deductible for Diagnostic and Preventive Services
- Maximum benefit per year
Drug Copays and Deductibles
Drugs Not Covered
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About the Plan
This is a Medicare Advantage plan, also known as Medicare Part C. It provides you with all of your Medicare Part A and B benefits, as well as additional coverage not included in Parts A and B. By paying a monthly premium, you gain consistent co-payments and deductibles and a yearly out-of-pocket spending maximum.
You must continue to pay your Medicare Part B premium. If you receive Social Security, Railroad Retirement Board (RRB) benefits, or Civil Service benefits, your Medicare Part B (Medical Insurance) premium is already automatically deducted from your benefit payment.
What is an HMO plan?
An HMO plan requires you to choose a Primary Care Physician (PCP) who provides all of your routine treatment for common ailments and illnesses, while also coordinating your overall care. In most cases your PCP will work with a Referral Circle to coordinate your care. A Referral Circle is a network of specialists your PCP has selected to work with due to their expertise in their respective fields. This means that in most cases, you will not have access to the entire Tufts Medicare Preferred HMO network, except in emergency or urgent care situations, or for out-of-area renal dialysis. When your PCP can’t treat a specific illness or condition he or she will refer you to a specialist within this referral circle who can. Your specialists will communicate with your PCP to ensure you receive the right care at the right time.
What does RX mean?
Rx is an abbreviation for a drug prescription. Plans with "Rx" in their names include prescription drug coverage, plans with "No Rx" in their names do not.
Massachusetts Plan Service Area
To join a Tufts Medicare Preferred HMO Basic No Rx plan, you must live in Essex, Worcester, or Suffolk Counties.
Your Annual Out-of-Pocket Maximum is $3,450. This is the most you will pay in a plan year for covered medical expenses.
Physical and Wellness Visit
Your Annual Physical, or Wellness Visit, will cost $0. You are allowed one Annual Physical and one Wellness Visit each plan year.
Routine Vision Exam
Your Annual Routine Vision exam will cost $15. You are allowed one Annual Routine Vision exam each plan year.
Routine Hearing Exam
Your Annual Routine Hearing Exam will cost $40. You are allowed one Annual Routine Hearing Exam each plan year.
FIT Tests: $0; Others: $10 per day Lab Services, including certain blood, urinalysis and tissue tests. Co-pay will not apply in addition to OV copay.
FIT Tests: $0; Others: $10 per day for X-rays. Co-pay will not apply in addition to OV copay.
FIT Tests: $0; Others: $10 per day for Diagnostic Procedures. Co-pay will not apply in addition to OV copay.
Diagnostic Radiology Services
Ultrasounds: $100 per day; Others: $250 per day. These services generally include computed tomography (CT) magnetic resonance imaging (MRI) and ultrasound.
Colonoscopies: $0; Others: $250 a day for Outpatient Services, medical procedures or tests administered at a medical facility that don't require an overnight stay.
Physical, Occupational, and Speech Therapy
$30 per visit. Physical Therapy often helps in recovering from surgery or injury and can help manage long-term health issues like arthritis. Occupational Therapy helps develop, recover, and improve the skills needed for daily living and working after an injury or disability. Speech Therapy generally helps manage speech, language, communication and swallowing disorders.
$0 per visit. These screenings and tests help detect conditions that can lead to a heart attack or stroke.
Cancer Screening (Colorectal, Prostate, Breast)
$0 per visit. These screenings are aimed at detecting cancer before symptoms appear, when treatment is more effective.
PCP: $10 per visit; Specialists: $40 per visit. Urgently needed care covers you when you need immediate medical care due to an unanticipated illness, injury, or condition but your health is not in serious danger.
Emergency Room Visits
Emergency Room visits cost $110 per visit, and there is no limit to the number of visits in a plan year.
Inpatient Hospital Coverage
You will pay $275 per day for days 1-5. After day 5 you will pay $0 per day.
Ambulance Rides and Services
$325 per trip for medically necessary Ambulance Services. Prior authrorization may be required for non-emergency transportation.
Embedded Dental Benefit
0$ Preventive Copay. 50% Restorative and $1,000 maximum coverage per year, no waiting period. For additional coverage members may purchase the dental rider.
Hearing Aid Benefit
Through Hearing Care Solutions, up to 2 aids per year.
$150 per year to use at a participating EyeMed provider or $90 per year at a non-participating provider.
Weight Management Programs
$150 reimbursement per year for fees related to weight management programs like WeightWatchers, Jenny Craig and hospital-based programs.
Choose how to stay fit with up to a $150 reimbursement for fees you pay toward joining a health club, fitness class (such as aerobics, Pilates, Tai Chi, or yoga), nutritional counseling sessions and other wellness programs like memory fitness activities.