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2023 Tufts Medicare Preferred
HMO Smart Saver Rx Plan

HMO
  • $0 Medical Deductible
  • Prescription Drug Coverage Included
  • $350 Annual Wellness Allowance
  • $150 Annual Eyewear Benefit
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Per Month
Enroll Now in 2023 Tufts Medicare Preferred HMO Smart Saver Rx Plan
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$0
Medical Deductible
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$0 per visit
Doctor Copay
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$45 per visit
Specialist Copay

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Drug Coverage

prescriptions

Tier 1 - Preferred Generic Drugs

Copays (30-day Retail / 90-day Mail Order)
$0 / $0
Deductible
$0
prescriptions

Tier 2 - Generic Drugs

Copays (30-day Retail / 90-day Mail Order)
$2 / $4
Deductible
$0
prescriptions

Tier 3 - Preferred Brand Drugs

Copays (30-day Retail / 90-day Mail Order)
$47 / $94
Deductible
$100 combined for Tiers 3-5
prescriptions

Tier 4 - Non-Preferred Drugs

Copays (30-day Retail / 90-day Mail Order)
$100 / $300
Deductible
$100 combined for Tiers 3-5
prescriptions

Tier 5 - Specialty Drugs

Copays (30-day Retail / 90-day Mail Order)
31% of cost / N/A
Deductible
$100 combined for Tiers 3-5
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Tier 6 - Vaccines

Copays (30-day Retail)
$0
Deductible
$0

Medical Coverage

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Out-of-Pocket Maximum

Your Annual Out-of-Pocket Maximum is $5,900. This is the most you will pay in a plan year for covered medical expenses. 

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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.

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Routine Vision Exam

Your Annual Routine Vision exam will cost $15. You are allowed one Annual Routine Vision exam each plan year.

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Routine Hearing Exam

Your Annual Routine Hearing Exam will cost $0. You are allowed one Annual Routine Hearing Exam each plan year.

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Laboratory Services

$0 per day for Lab Services, including certain blood, urinalysis and tissue tests. Copay will not apply in addition to office visit or urgent care copay.

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X-Rays

$20 per day. Copay will not apply in addition to office visit or urgent care copay.

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Diagnostic Procedures

$20 per day. Copay will not apply in addition to office visit or urgent care copay.

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Diagnostic Radiology Services

Ultrasound:  $100 per day. Others: $350 per day. These services generally include computed tomography (CT) and magnetic resonance imaging (MRI). 

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Outpatient Surgery

Colonoscopies: $0; Others (ASC): $270 per day; Others (Non-ASC): $370 -  for Outpatient Services, medical procedures or tests administered at a medical facility that don't require an overnight stay.

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Physical, Occupational, and Speech Therapy

$40 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.

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Cardiovascular Screening

$0 per visit. These screenings and tests help detect conditions that can lead to a heart attack or stroke.

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Cancer Screening (Colorectal, Prostate, Breast)

$0 per visit. These screenings are aimed at detecting cancer before symptoms appear, when treatment is more effective.

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Urgent Care

50 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.

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Emergency Room Visits

Emergency Room visits cost $90 per visit, and there is no limit to the number of visits in a plan year. 

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Inpatient Hospital Coverage

You will pay $380 per day for days 1-5. After day 5 you will pay $0 per day. 

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Ambulance Rides and Services

$350 per one-way trip for medically necessary Ambulance Services. This cost applies on a per day basis, regardless of the number of ambulance trips made. PA may be required for non-emergency transportation.

Dental Benefits

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Calendar Year Maximum

Included with Plan: $1,500 per calendar year

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Individual Annual Deductible

Included with Plan: $100 on Class 2 and 3 services

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Periodic Oral Evaluation

Included with Plan: $0. Covers two per calendar year.

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Comprehensive Oral Exam

Included with Plan: $0. Covers one every 36 months.

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Intra Oral Bitewing X-ray (X-rays of Crowns of Teeth)

Included with Plan: $0. Covers two per calendar year.

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Intra Oral X-ray - Entire Mouth (Panoramic & Full Mouth)

Included with Plan: 50% After Deductible. Covers one every 60 months.

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Single Tooth X-ray Images

Included with Plan: 50% After Deductible. Covered as needed.

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Silver Fillings and White Fillings (Front Teeth)

Included with Plan: 50% After Deductible. Covers one every 24 months per surface, per tooth; White filings on posterior teeth will be processed as a silver filling and the patient is responsible for up to the contracted fee.

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Periodontal Cleaning

Included with Plan: 50% After Deductible. Covers one every 6 months following active periodontal therapy; not to be combined with regular cleanings.

Additional Benefits

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Telehealth

Medicare-covered services plus additional telehealth services. $0 copay for e-visits and virtual visits; For all other telehealth visits, copay is the same as corresponding in-person visit copay.

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Acupuncture

$20 per visit. Covers up to 12 visits in 90 days for members with chronic lower back pain. 8 additional visits covered for those demonstrating an improvement. No more than 20 visits administered annually.

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Over the Counter (OTC)

$60 per calendar quarter. Members receive calendar quarter allowance to use towards covered OTC items. No rollover of unused quarterly balances.

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Hearing Aid Benefit

Up to 2 aids per year through Hearing Care Solutions: $250 copay for Standard level hearing aid; $475 copay for Superior level hearing aid; $650 copay for Advanced level hearing aid; $850 copay for Advanced Plus level hearing aid; $1,150 copay for Premier level hearing aid

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Eyewear Benefit

$150 per year to use at a participating EyeMed provider or $90 per year at a non-participating provider.

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Weight Management Programs

$150 reimbursement per year for fees related to weight management programs like WeightWatchers, Jenny Craig and hospital-based programs.

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Wellness Allowance

Choose how to stay fit with up to a $350 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.

Additional Information

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. Medicare Part D prescription drug coverage is also included as a part of this plan. 

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. 

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. 

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.  

The service area for this plan are: Barnstable, Bristol, Essex, Middlesex, Norfolk, Plymouth, Suffolk, Hampden, Worcester, or Hampshire Counties.