Tufts Medicare Preferred HMO Prime No Rx (HMO) Medicare Advantage Plan H2256-016-1 • 2027 • Suffolk County, MA
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $3850.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Not Included
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Suffolk County, MA
- Local Enrollment
- 0 beneficiaries in Suffolk County
Tufts Medicare Preferred HMO Prime No Rx (HMO) Introduction
This Medicare Advantage HMO plan, Tufts Medicare Preferred HMO Prime No Rx, is offered by Tufts Health Plan and uses a Health Maintenance Organization (HMO) provider network. It comes without prescription drug coverage. For the 2027 plan year, the monthly premium is $0.00, the medical deductible is $0.00, and the in-network maximum out-of-pocket is $3850.00. The plan is identified by CMS Plan ID H2256-016-1.
Enrollment in this plan requires residence in Suffolk County, Massachusetts. CMS enrollment data reports 0 plan members in Suffolk County. New members can call the plan directly at (877)218-4835 (TTY 711) for assistance.
Compare Similar Plans in Suffolk County
Compare this plan with the two most-enrolled HMO plans available in Suffolk County, Massachusetts. Enrollment is based on CMS local enrollment data.
| Plan Detail | Tufts Medicare Preferred HMO Prime No Rx | Tufts Medicare Preferred HMO Basic Rx | Tufts Medicare Preferred HMO Prime Rx |
|---|---|---|---|
| CMS Plan ID | H2256-016-1 |
H2256-026-1 |
H2256-015-1 |
| Local Enrollment | 0 | 855 | 407 |
| Monthly Premium | $0.00 | $88.00 | $244.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $3,850.00 | $4,500.00 | $3,850.00 |
| Part B Giveback | Not offered | Not offered | Not offered |
| Primary Care | $10 copay | $10 copay | $10 copay |
| Specialist | $20 copay | $45 copay | $30 copay |
| Part D Deductible | Not Applicable | $200.00 | $0.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | Not covered | 0%-50% coinsurance | Not covered |
| Vision | $15 copay | $15 copay | $15 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Plan Benefits
Cost-sharing for Tufts Medicare Preferred HMO Prime No Rx includes out-of-pocket expenses for covered healthcare services. The following tables provide a summary of typical in-network out-of-pocket costs for plan H2256-016-1.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H2256-016-1 Cost Compare.
Office Visits
- Primary care
- In-network: $10 copay
- Specialist
- In-network: $20 copay
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
- Telehealth benefit
- In-network: $0-$200 copay
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- In-network: $0 copay
- Counseling services
- Not covered
- Over-the-counter drug benefits
- Not covered
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: 20% coinsurance
- Lab services
- In-network: $0-$30 copay
- Outpatient x-rays
- In-network: $0-$30 copay
- Diagnostic tests and procedures
- In-network: $0-$30 copay
Emergency and Urgent Care Services
- Emergency room care
- $130 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $30 copay
- Inpatient hospital care
- Tier 1
$300 per stay - Skilled Nursing Facility
- Tier 1
$0 per day for days 1-20
$110 per day for days 21-44
$0 per day for days 45-100 - Ground ambulance
- In-network: $175 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $0-$10 copay
- Outpatient group therapy
- In-network: $0-$10 copay
- Inpatient psychiatric hospital care
- Tier 1
$300 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $15 copay
- Occupational therapy
- In-network: $15 copay
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
- Durable medical equipment
- In-network: 10% coinsurance
- Prosthetics
- In-network: 10% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: $0 copay
- Other Part B drugs (Medicare-covered)
- In-network: $0 copay
Dental Services
- Oral exam
- Not covered
- Dental x-rays
- Not covered
- Cleaning
- Not covered
- Periodontics
- Not covered
- Endodontics
- Not covered
- Restorative services
- Not covered
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- Not covered
Vision Services
- Routine eye exam
- In-network: $15 copay
- Contact lenses
- In-network: $0 copay
- Eyeglass frames only
- In-network: $0 copay
- Eyeglass lenses only
- In-network: $0 copay
- Eyeglasses (frames & lenses)
- In-network: $0 copay
- Upgrades
- In-network: $0 copay
Hearing Services
- Hearing exam
- In-network: $0 copay
- Fitting/evaluation
- In-network: $0 copay
- Prescription hearing aids
- In-network: $250-$1150 copay
- OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- In-network: $0 copay
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- In-network: $0 copay
- Massage therapy
- In-network: $0 copay
- Home/bathroom safety devices
- In-network: 10% coinsurance
Certain preventive services are covered 100% by Tufts Medicare Preferred HMO Prime No Rx as a Part B benefit.
Prescription Drug Coverage
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Performance Ratings (Contract ID: H2256)
CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall 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 |
Contact Information for Tufts Health Plan
- Website
- Tufts Health Plan Plan Page
- Providers
- Tufts Health Plan Providers Page
- Formulary
- Tufts Health Plan Formulary Page
- Pharmacy
- Tufts Health Plan Pharmacy Page
- New Member Health Plan Help
- (877)218-4835
- New Member Health Plan TTY
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Tufts Health Plan (official source) | http://www.tuftsmedicarepreferred.org | October 4, 2026 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | 25 May, 2025 |
| AARP.org | The Big Choice: Original Medicare vs. Medicare Advantage | 25 May, 2025 |
| Medicare.gov | Your coverage options | 25 May, 2025 |
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