0 2020 Tufts Medicare Preferred HMO Prime No Rx (HMO) H2256-016 By Tufts Health Plan.
2020 Tufts Medicare Preferred HMO Prime No Rx (HMO) H2256-016 By Tufts Health Plan.

2020 Medicare Advantage Plan Services for
Tufts Medicare Preferred HMO Prime No Rx (HMO)


Tufts Medicare Preferred HMO Prime No Rx (HMO) H2256-016 is a 2020 Medicare Advantage Plan or Medicare Part-C plan by Tufts Health Plan available to residents in Massachusetts. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The Tufts Medicare Preferred HMO Prime No Rx (HMO) has a monthly premium of $156.00 and has an in-network Maximum Out-of-Pocket limit of $3,400 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $3,400 out of pocket. This can be a extremely nice safety net.

Tufts Medicare Preferred HMO Prime No Rx (HMO) is a Local HMO *. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.

Tufts Health Plan works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Tufts Medicare Preferred HMO Prime No Rx (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Tufts Health Plan and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Tufts Health Plan except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.





2020 Tufts Health Plan Medicare Advantage Plan Details

Name:
Tufts Medicare Preferred HMO Prime No Rx (HMO)
ID:
H2256-016
Provider:Tufts Health Plan
Year:2020
Type: Local HMO *
Monthly Premium C+D: $156.00
Part C Premium:
MOOP: $3,400






2019 Plan Services

(*2020 Plan services will be added when available)




Health plan deductible


$0



Emergency care/Urgent care


Emergency $110 per visit (always covered)
Urgent care $10-15 per visit (always covered)



Diagnostic procedures/lab services/imaging


Diagnostic tests and procedures $0 copay
Lab services $0 copay
Diagnostic radiology services (e.g., MRI) 20%
Outpatient x-rays $0 copay



Hearing


Hearing exam $15
Fitting/evaluation $0 copay
Hearing aids $250-850



Preventive dental


Oral exam Not covered
Cleaning Not covered
Fluoride treatment Not covered
Dental x-ray(s) Not covered



Comprehensive dental


Non-routine services Not covered
Diagnostic services Not covered
Restorative services Not covered
Endodontics Not covered
Periodontics Not covered
Extractions Not covered
Prosthodontics, other oral/maxillofacial surgery, other services Not covered



Vision


Routine eye exam $15
Other Not covered
Contact lenses $0 copay
Eyeglasses (frames and lenses) $0 copay
Eyeglass frames $0 copay
Eyeglass lenses $0 copay
Upgrades Not covered



Mental health services


Inpatient hospital - psychiatric $300 per stay
Outpatient group therapy visit with a psychiatrist $15
Outpatient individual therapy visit with a psychiatrist $15
Outpatient group therapy visit $15
Outpatient individual therapy visit $15



Skilled Nursing Facility


$20 per day for days 1 through 20
$60 per day for days 21 through 44
$0 per day for days 4



Rehabilitation services


Occupational therapy visit $15
Physical therapy and speech and language therapy visit $15



Ground ambulance


$125



Other health plan deductibles?


In-Network No



Transportation


Not covered



Foot care (podiatry services)


Foot exams and treatment $15
Routine foot care Not covered



Medical equipment/supplies


Durable medical equipment (e.g., wheelchairs, oxygen) 10% per item
Prosthetics (e.g., braces, artificial limbs) 10% per item
Diabetes supplies $0 copay



Wellness programs (e.g., fitness, nursing hotline)


Covered



Medicare Part B drugs


Chemotherapy $0 copay
Other Part B drugs $0 copay



Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)


$3,400 In-network



Optional supplemental benefits


Yes



Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?


In-Network Yes, contact plan for further details



Inpatient hospital coverage


$300 per stay



Outpatient hospital coverage


$100 per visit



Doctor visits


Primary $10 per visit
Specialist $15 per visit



Preventive care


$0 copay


Ratings for Tufts Medicare Preferred HMO Prime No Rx (HMO) H2256

2019 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Plan All-Cause Readmissions
Statin Therapy


Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Timely Care and Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in Tufts Medicare Preferred HMO Prime No Rx (HMO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement


Health Plan Customer Service Rating for Tufts Medicare Preferred HMO Prime No Rx (HMO)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


Tufts Medicare Preferred HMO Prime No Rx (HMO) Drug Plan Customer Service ratings

Total Rating
Call Center, TTY, Foreign Language
Appeals Auto
Appeals Upheld


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes


Coverage Area for Tufts Medicare Preferred HMO Prime No Rx (HMO)

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Source: CMS.
Data as of September 4, 2019.
Star Rating as of October 10, 2019.
Plan Services are 2019 information as reference. 2020 information will be added when released.
Notes: Data are subject to change as contracts are finalized. For 2020, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit. Includes 2020 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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