Tufts Medicare Advantage Plans 2025

Are Medicare Advantage plans in 2025 right for you? This article cuts to the chase with direct comparisons of Tufts Medicare Advantage plans 2025, costs, and new offerings for the year ahead. Learn all you need to know about these plans with a focus on the updates that could impact your coverage choices and health management in 2025.


Key Takeaways

  • Tufts Medicare Advantage Plans for 2025 are comprehensive healthcare plans governed by Medicare Part C that bundle hospital, medical, and prescription drug coverage, emphasizing preventive healthcare and offering a variety of HMO and PPO options.


  • Additional benefits of Tufts plans include routine vision and hearing exams, wellness allowances, prescription drug coverage with a special tiered formulary system, and therapy services, all tailored to maximize members’ health and financial benefits.


  • Unique features of Tufts Medicare Advantage Plans include the Passport Program, Flex Advantage Spending Card for dental services, extensive coverage of home health services and community-based supports, and partnerships with PCPs for personalized care coordination.

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Understanding Tufts Medicare Advantage Plans


Tufts Medicare Advantage Plans 2025 Understanding Tufts Medicare Advantage Plans


The labyrinth of complex terms and choices in healthcare options can feel overwhelming. Yet, equipped with the right information, you’re capable of making decisions that best address your healthcare needs.

Enter Tufts Medicare Advantage Plans, a suite of Health Maintenance Organization (HMO) plans, Medicare Supplement plans, and a specialized HMO-SNP plan known as Tufts Health Plan Senior Care Options.

These designs have a unique feature where members choose a primary care physician who coordinates their care and provides necessary referrals for specialist consultations.


What is Medicare Advantage?

Medicare Advantage, alternatively known as Medicare Part C, serves as a comprehensive healthcare solution. It bundles hospital, medical, and often prescription drug coverage into one plan, offering an alternative to Original Medicare. These plans are provided by private insurers contracted with the federal government to deliver Medicare benefits.

Essentially, Medicare Advantage plans cover at least the same benefits as Original Medicare (Part A and Part B), with the potential for additional benefits. Coverage often includes:

  • doctors’ office visits


  • hospital stays


  • emergency room visits


  • preventive screenings


There is also the potential inclusion of prescription drugs.


The Role of Tufts Health Plan

Tufts Health Plan, as a Medicare Advantage plan provider, excels beyond just essential healthcare services by prioritizing preventative healthcare and wellness. It boasts an extensive network of healthcare providers, ensuring members have access to a wide range of physicians and specialists.

Tufts Health Plan’s commitment to quality service is evidenced by its high satisfaction ratings from its members and the range of plan options.


Variety of Plans Offered

The beauty of Tufts Health Plan lies in its diversity. It offers a range of Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans.

HMO plans require members to coordinate their healthcare through a primary care physician (PCP), which helps manage care and control costs. On the other hand, PPO plans offer flexibility to see any doctor or hospital, with incentives to use in-network providers, without requiring a PCP or referrals.

You can choose from a variety of plans based on your specific needs, some of which include plans with low or no monthly premiums and extra benefits like dental, vision, and hearing coverage.


Key Benefits of Enrolling in a Tufts Medicare Preferred Plan


Tufts Medicare Advantage Plans 2025 Key Benefits of Enrolling in a Tufts Medicare Preferred Plan


There are numerous benefits to enrolling in a 2025 Tufts Medicare Preferred plan. These plans include:


  • Offering additional benefits not covered by Original Medicare


  • Providing preventive services for vision and dental care


  • Including prescription drug coverage (Part D)


Moreover, many of these plans offer the added financial benefit of having low or even $0 premiums and provide discounts on fitness programs.


Enhanced Medical Coverage

Tufts Medicare Preferred HMO Basic Rx plan offers $0 copays for laboratory services, which include blood, urinalysis, and tissue tests. Advanced imaging services such as MRIs and CT scans are covered under the plan, subject to copays and prior authorization requirements.

Furthermore, diagnostic radiology services have varying copays, with ultrasounds costing $100 per day, while CT and MRI copays are $250 per day.


Prescription Drug Coverage


Tufts Medicare Advantage Plans 2025 Key Benefits of Enrolling in a Tufts Medicare Preferred Plan


Prescription drug coverage is a major advantage of Tufts Medicare Advantage plans. These plans feature prescription drug coverage with copays that range from $0 for preferred generic drugs to 29% for specialty drugs. The coverage includes a combined deductible of $225 for Tiers 3-5 drugs, with a special provision where the copay for covered insulin drugs will not exceed $35 per 30-day supply.

An extensive tiered formulary system ensures members have access to a broad selection of medications while providing lower copays for generic and preferred brand-name drugs.


Additional Wellness Benefits

Tufts Medicare Advantage plans provide the following benefits:

  • $150 annual wellness allowance for health club memberships, fitness classes, nutritional counseling sessions, and other wellness programs


  • Routine hearing exams included once per plan year with a $0 copay for members


  • Up to $150 per year reimbursement for weight management program fees


Nutritional counseling services are part of the additional wellness benefits, supporting members with dietary needs or health conditions.

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In-Depth Look at Covered Services


Tufts Medicare Advantage Plans 2025In-Depth Look at Covered Services


The range of services covered is a critical aspect to consider when choosing a healthcare plan. Members enrolled in Tufts Medicare Preferred plans can benefit from seeing a network of doctors and specialists without the requirement of a referral, enhancing the flexibility of healthcare decisions.


Preventative Services and Screenings

Preventative measures often outdo cures. This is why Tufts Medicare Advantage plans cover a wide range of preventive services and screenings, including cancer screening colorectal prostate breast. These preventive services and screenings are covered without a copay for HMO and PPO in-network members.

Screenings for cardiovascular disease, diabetes blood tests, and osteoporosis bone mass measurements are also provided without a copay.


Therapy Services

Managing health conditions often requires a holistic approach that includes various forms of therapy. Tufts Medicare Advantage plans cover physical, occupational, and speech therapy services.

These therapies are crucial for surgery and injury recovery, managing long-term health conditions like arthritis, and regaining necessary skills for daily life activities. Each visit for these therapy services requires a $30 copay, and the visits must be referred by the Primary Care Provider.


Emergency and Urgent Care

Emergencies are unpredictable, and having a plan that covers such occurrences is crucial. Each emergency room visit requires a copay of $90, and there is no limit on the number of visits permitted within a plan year. Urgent care visits have a copay of $45 per visit, whether in-network or out-of-network, for non-emergency medical issues that require immediate care.

Medically necessary ambulance rides and services are covered with a copay of $350 per one-way trip. The plan includes worldwide emergency transportation coverage to ensure beneficiaries have access to emergency care when traveling.


Understanding Your Costs with Tufts Medicare Advantage

Comprehending the associated costs is a vital aspect of any health plan. Tufts Medicare Advantage Plans offer an assortment of costs, including:

  • Premiums


  • Deductibles


  • Copays


  • Coinsurance options


This allows you to choose a plan that suits your budget.


Premiums and Deductibles

Premiums and deductibles are integral to understanding your health plan costs. The Tufts Medicare Preferred Supplement Core plan includes a $240 annual deductible for Medicare Part B. After meeting the Medicare Part B deductible, the plan covers all subsequent expenses for covered services.

Members are required to continue paying their Medicare Part B premium, which may be automatically deducted if they receive Social Security, Railroad Retirement Board (RRB) benefits, or Civil Service benefits.


Copays and Coinsurance

Copays and coinsurance are also essential to understand. Members enrolled in Tufts Medicare Preferred plans have the advantage of $0 copays for primary care visits, lab services, and preventive screenings. Telehealth services, including e-visits, virtual check-ins, and remote patient monitoring with a primary care provider or specialist, come with a $0 copay. This means that patients can access these services without any out-of-pocket expenses.

The Tufts Medicare Preferred Access PPO plan for 2025 has a $0 copay for primary care provider (PCP) visits both in-network and out-of-network. Specialist visits have a copay of $45 for both in-network and out-of-network services.


Out-of-Pocket Maximums

Out-of-pocket maximums provide financial protection by capping the total expenses a beneficiary must pay for covered services within a year. For instance, the Tufts Medicare Preferred Access PPO plan has an out-of-pocket maximum of $5,600 for in-network costs and $9,550 for a combination of in and out-of-network costs for the year 2025.

The annual out-of-pocket maximum for the Tufts Medicare Preferred HMO Prime Rx Plus plan is $3,650 for covered medical expenses.

Exclusive Features of Tufts Medicare Advantage Plans

Tufts Medicare Advantage Plans offer an array of unique features tailored to enhance members’ healthcare experience. These include:

  • The Passport Program, which allows plan members to get care across the United States from any provider that accepts Medicare


  • Acupuncture services


  • Yearly allowances for over-the-counter (OTC) items, which go above basic Medicare coverage.


Wellness programs, including weight management programs, routine physical exams, and a comprehensive fitness benefit, are also featured in these plans to encourage healthy living.


Flex Advantage Spending Card

One of the unique features of the Tufts Medicare Preferred Access (PPO) plan is the new Flex Advantage card, which offers the following benefits:

  • Embedded dental benefits starting in 2025


  • Ability to see any dentist across the country who accepts Visa, without any network restrictions


  • Allocation of funds towards non-cosmetic and non-Medicare-covered dental procedures


Each year, a benefit amount of $1,500 is reloaded onto the Flex Advantage spending card, and members must use these funds within the year as any unused balance does not roll over to the following year.


Hearing Aid Benefit and Vision Extras


Tufts Medicare Advantage Plans 2025 Exclusive Features of Tufts Medicare Advantage Plans


Hearing and vision are two key aspects of health that often get overlooked. Tufts Medicare Advantage plans provide hearing aid coverage, including routine hearing exam, an additional service not typically included in Original Medicare.

The vision extras include a $150 yearly allowance for eyewear when using participating EyeMed providers, or $90 for non-participating providers, following a routine vision exam.


Home Health Services and Support

The Tufts Health Plan Senior Care Options (HMO-SNP) plan is specially catered to individuals 65 or older with both Medicare and MassHealth Standard (Medicaid), delivering an integrated service experience. This plan emphasizes a team-based approach to care where a primary care team collaborates to develop a personalized care plan which may include:

  • the member


  • primary care provider


  • specialists


  • a geriatric support coordinator


Community-based services included in the Senior Care Options plan are:

  • Personal care


  • Social day care


  • Home-delivered meals


  • Medical visit transportation


These services are provided alongside traditional health care services.


Maximizing Your Tufts Medicare Advantage Plan

Maximizing your Tufts Medicare Advantage Plan requires comprehending how to use the wellness allowance, steer through additional benefits, and collaborate with your primary care provider.


Leveraging the Wellness Allowance

The wellness allowance covers health-related expenses such as:

  • Fitness programs


  • Gym memberships


  • Fitness classes like yoga and tai chi


  • Beginning January 1, 2025, pool-based classes and access to pool facilities


Members can claim reimbursements for expenses against the wellness allowance by submitting the Wellness Allowance Reimbursement Form.

There is a deadline of March 31, 2025, for members to submit reimbursement requests for wellness allowance expenses from the previous year.


Navigating Additional Benefits

In addition to the usual benefits, Tufts Medicare Advantage plans offer some additional perks. These include dental benefits, which can be accessed through embedded coverage in their HMO plans or through optional buy-up options for more comprehensive benefits.

The plans also provide hearing aid benefits which include a yearly $0 evaluation, a selection of five hearing aid levels with different copays, a 60-day trial period, a 3-year battery supply, and $0 copay follow-up visits with an audiologist.

Members enrolled in the Tufts Medicare Preferred HMO Value Rx plan benefit from an annual eyewear allowance of up to $150 at participating EyeMed providers or $90 at non-participating providers. Medication therapy management programs are available to assist in managing complex medication regimens effectively.


Partnering with Your Primary Care Provider (PCP)

Partnering with a Primary Care Provider (PCP) is crucial for personalized health management under the Tufts Medicare Advantage Plan. A referral from the PCP is necessary to access therapy services covered by the plan, highlighting the integral role of the PCP.

Working closely with a PCP allows beneficiaries to effectively utilize the full range of services covered under their Tufts Medicare Advantage Plan.



In conclusion, the 2025 Tufts Medicare Advantage Plans offer an integrated, comprehensive, and flexible approach to healthcare. Whether it’s the variety of plans offered, the enhanced coverage, the unique features, or the additional benefits, Tufts Medicare Advantage Plans are designed with the member’s healthcare needs at the forefront.

Remember, the key to maximizing your plan is understanding how to leverage the wellness allowance, navigate additional benefits, and partner with your primary care provider.

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Frequently Asked Questions


Does Tufts Medicare Preferred require prior authorization?

Yes, Tufts Medicare Preferred HMO requires prior authorization for certain drugs, so you or your physician will need to obtain approval before filling prescriptions. This helps ensure coverage for the medication you need.


What is the difference between Tufts HMO and PPO?

The difference between Tufts HMO and PPO plans comes down to how you see your doctor. An HMO plan will provide more of a partnership with your doctor, while a PPO plan will allow you to access any doctor or hospital.


Is Tufts Health Plan only in Massachusetts?

No, Tufts Health Plan offers health insurance plans in Massachusetts and Rhode Island, and their national CareLink product provides coverage for multi-state employers. So, Tufts Health Plan is not only in Massachusetts.


Is Tufts Medicare Preferred an advantage plan?

Yes, Tufts Medicare Preferred is an advantage plan that offers medical and prescription drug coverage beyond Original Medicare.


What types of plans are offered by Tufts Medicare Advantage?

Tufts Medicare Advantage offers a variety of plans, including Health Maintenance Organization (HMO) plans, Medicare Supplement plans, and a specialized HMO-SNP plan called Tufts Health Plan Senior Care Options. Choose the plan that best suits your needs.

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