How Our Different Plans Work

HMO Plans

With our HMO (Health Maintenance Organization) plans, you are covered for doctors’ office visits, hospital stays, emergency room visits, preventive screenings, and many more medical services. Depending on the plan you’ve chosen, you may also have coverage for prescription drugs. If the name of your plan ends in “No Rx”, this means that you do not have prescription drug coverage. Take a look in your Evidence of Coverage (EOC) booklet found on the Plan Documents page for more information on how your plan works. Use our drug search tool to check if your prescription drugs are covered by your plan.

With an HMO plan:

• You have a primary care physician (PCP) who provides and coordinates your care.
   
• You need to get referrals before you see specialists. Only your PCP can refer you to a specialist. In this way, your PCP can keep track of the care you receive and ensure that the care is right for you.
   
• You are covered anywhere in the world for emergency and urgently needed care.
   
• You are covered for preventive services such as annual physical, routine hearing and vision exams, and more.
   

Medicare Supplement Plans

Medicare Supplement plans[LINK] fill in the gaps that Original Medicare doesn’t cover. This may include deductibles or coinsurance. Our Medicare Supplement plans also offer additional benefits that Original Medicare does not offer, such as fitness and nutrition reimbursement. For more information on your Medicare Supplement plan, look at your plan policy document found on our Plan Documents page.

With a Medicare Supplement plan:

• Medicare is your primary insurer. Make sure you carry both your Tufts Health Plan Medicare Preferred ID card AND your red, white, and blue Medicare card. You will need to present both each time your receive care.
• You can see any doctor or go to any hospital, as long as they accept Original Medicare.
• There is no network of doctors, and you do not need a referral if you want to visit a specialist. This means that you can travel anywhere in the United States and visit any doctor as long as they accept Original Medicare.
• If you wish to have coverage for prescription drugs, you will need to purchase a separate Prescription Drug Plan (PDP).

Tufts Health Plan Senior Care Options (HMO-SNP) Plan

Tufts Health Plan Senior Care Options (HMO-SNP) plan is available to individuals who are at least 65 years old and have both Medicare and MassHealth Standard (Medicaid), or just MassHealth Standard coverage. Members receive health care coverage under a single plan that coordinates and integrates all the services covered by MassHealth Standard and Medicare.  

With Tufts Health Plan Senior Care Options:

• You are the center of a primary care team. This team meets with you to learn about your specific needs and works with you, your family, and your doctor to create an individualized plan of care. Your primary care team may include: you, your primary care physician (PCP), your Care Manager, a Care Coordinator, your specialists, a geriatric support services coordinator, and others depending on your specific needs.
• You have no out-of-pocket costs for covered services, prescription drugs in our formulary, or for select over-the-counter (OTC) drugs prescribed by your doctor.
• You are covered for community-based services such as personal care services, social day care, home-delivered meals, transportation to medical visits, and other services.
• For more complete details on how Tufts Health Plan Senior Care Options plan works and what is covered, take a look at your Evidence of Coverage (EOC) booklet on the Plan Documents page.

Learn More About How Medicare Works