2025 Tufts Health Plan
Senior Care Options (HMO-SNP)
Covered Insulin Drugs
Part B: $0
Part D: $0
Prior authorization may be required.
Out-of-Pocket Maximum
Your Annual Out-of-Pocket Maximum is $9,350. This is the most you or others who pay on your behalf will pay in a plan year for covered medical expenses. Because you get assistance from MassHealth (Medicaid), you have no out-of-pocket costs for covered services. You pay nothing for medical services covered by Tufts Health Plan Senior Care Options.
Annual Physical Visit
Your Annual Physical visit will cost you $0 per year.
Annual Wellness Visit
Your Annual Wellness visit will cost you $0 per year.
Primary Care Provider (PCP)
$0 per visit.
Specialist Copay
$0 per visit.
Routine Vision Exam
$0 per year
Routine Hearing Exam
$0 per year
Laboratory Services
$0 per visit. Prior Authorization may be required.
X-Rays
$0 per visit. Prior Authorization may be required.
Diagnostic Procedures
$0 per visit. Prior Authorization may be required.
Diagnostic Radiology Services
$0 per visit. Prior Authorization may be required.
Outpatient Surgery
$0 per visit. Prior Authorization may be required.
Physical, Occupational, and Speech Therapy
$0 per visit. Referral from your Primary Care Provider (PCP) is required. Prior authorization may be required.
Cardiovascular Screening
$0 per visit
Cancer Screening (Colorectal, Prostate, Breast)
$0 per visit
Urgent Care
$0 per visit
Emergency Room Visits
$0 per visit.
Inpatient Hospital Coverage
$0 per visit. Prior Authorization may be required.
Ambulance Rides and Services
$0 per service. Prior authorization may be required for non-emergency transportation.
Embedded Dental Benefit
Free dental benefits, including coverage for exams, dentures, root canals, crowns, implants, and more.
Telehealth
$0 Medicare-covered services plus additional telehealth services expansion. The same referral rules apply to additional telehealth services as corresponding in-person visits. Prior authorization may be required for Remote Patient Monitoring services.
Over the Counter (OTC)
Instant Savings Card: $425 per calendar quarter. Members receive an OTC card loaded quarterly with credit to use towards covered OTC items, personal and hygiene items, and healthy food and groceries at participating retailers and plan approved online stores. No rollover of unused quarterly balances. See Evidence of Coverage (EOC) for more information
Over-The-Counter (OTC) Prescription Medicines: $0
Eyewear Benefit
$300 allowance at EyeMed providers; $180 allowance at non-participating providers. Use for routine eyeglasses (prescription lenses, frames, a combination of lenses and frames) and/or contact lenses. The annual allowance may be used to purchase upgrades for Medicare-covered and/or therapeutic eyewear as well as routine/corrective eyewear.
Weight Management Programs
$200 allowance per year; covers program fees for weight loss programs such as WeightWatchers or a hospital-based weight loss program.
Wellness Allowance
Free membership to your local participating YMCA facility; and $200 allowance per year to spend on fitness classes, an activity tracker and more.