Tufts Medicare Preferred HMO Prime Rx (HMO) Medicare Advantage Plan H2256-015-1 • 2027
- Monthly Premium
- $244.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $3850.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $0.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 9,127 beneficiaries
Tufts Medicare Preferred HMO Prime Rx (HMO) Introduction
Tufts Medicare Preferred HMO Prime Rx is a Medicare Advantage HMO plan offered by Tufts Health Plan. It uses a Health Maintenance Organization (HMO) provider network and comes with prescription drug coverage. For the 2027 plan year it has a $244.00 monthly premium, $0.00 medical deductible, and $3850.00 in-network maximum out-of-pocket. CMS Plan ID H2256-015-1 identifies this plan. The 2027 Part D prescription drug deductible is $0.00.
Plan Benefits
Tufts Medicare Preferred HMO Prime Rx has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H2256-015-1.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $10 copay | In-network: $10 copay |
| Specialist | In-network: $30 copay | In-network: $15 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay | In-network: $0 copay |
| Telehealth benefit | In-network: $0-$200 copay | In-network: $0-$100 copay |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay |
| Health education | In-network: $0 copay | In-network: $0 copay |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | Not covered | Not covered |
| Health transportation (non-emergency) | Coming soon | In-network: $0 copay |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: 20% coinsurance | In-network: 20% coinsurance |
| Lab services | In-network: $0-$30 copay | In-network: $0-$30 copay |
| Outpatient x-rays | In-network: $0-$30 copay | In-network: $0-$30 copay |
| Diagnostic tests and procedures | In-network: $0-$30 copay | In-network: $0-$30 copay |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $130 copay | $110 copay |
| Worldwide emergency care | Coming soon | $110 copay |
| Urgent care | $30 copay | $30 copay |
| Inpatient hospital care | Tier 1 $300 per stay |
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 |
Tier 1 $20 per day for days 1-20 $80 per day for days 21-44 $0 per day for days 45-100 |
| Ground ambulance | In-network: $175 copay | In-network: $175 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $0-$10 copay | In-network: $0-$10 copay |
| Outpatient group therapy | In-network: $0-$10 copay | In-network: $0-$10 copay |
| Inpatient psychiatric hospital care | Tier 1 $300 per stay |
Tier 1 $300 per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $15 copay | In-network: $15 copay |
| Occupational therapy | In-network: $15 copay | In-network: $15 copay |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay | In-network: $0 copay |
| Durable medical equipment | In-network: 10% coinsurance | In-network: 10% coinsurance |
| Prosthetics | In-network: 10% coinsurance | In-network: 10% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance | In-network: $0 copay |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance | In-network: $0 copay |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | Not covered | Not covered |
| Dental x-rays | Not covered | Not covered |
| Cleaning | Not covered | Not covered |
| Periodontics | Not covered | Not covered |
| Endodontics | Not covered | Not covered |
| Restorative services | Not covered | Not covered |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | Not covered | Not covered |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $15 copay | In-network: $15 copay |
| Contact lenses | In-network: $0 copay | In-network: $0 copay |
| Eyeglass frames only | In-network: $0 copay | In-network: $0 copay |
| Eyeglass lenses only | In-network: $0 copay | In-network: $0 copay |
| Eyeglasses (frames & lenses) | In-network: $0 copay | In-network: $0 copay |
| Upgrades | In-network: $0 copay | In-network: $0 copay |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay | In-network: $0 copay |
| Fitting/evaluation | In-network: $0 copay | In-network: $0 copay |
| Prescription hearing aids | In-network: $250-$1150 copay | In-network: $250-$1150 copay |
| OTC hearing aids | Not covered | Not covered |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | Not covered |
| Weight management programs | In-network: $0 copay | In-network: $0 copay |
| Wigs for chemotherapy-related hair loss | Coming soon | In-network: $0 copay |
| Alternative therapies | In-network: $0 copay | In-network: $0 copay |
| Massage therapy | In-network: $0 copay | In-network: $0 copay |
| Home/bathroom safety devices | In-network: 10% coinsurance | In-network: 10% coinsurance |
Certain preventive services are covered 100% by Tufts Medicare Preferred HMO Prime Rx as a Part B benefit.
Prescription Drug Coverage
Tufts Medicare Preferred HMO Prime Rx includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $40.70 |
| Supplemental Part D Premium: | $$15.20 |
| Total Part D Premium: | $55.90 |
| Low-Income Premium Subsidy: | $33.82 |
| Low-Income Premium Subsidy Paid by CMS: | $33.80 |
| Low-Income Subsidy Premium: | $22.10 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $0.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Tufts Health Plan starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Tufts Medicare Preferred HMO Prime Rx may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $4.00 copay | Coming soon |
| Generic | $8.00 copay | Coming soon |
| Preferred Brand | 20% coinsurance | Coming soon |
| Non-Preferred Drug | 40% coinsurance | Coming soon |
| Specialty Tier | 32% coinsurance | Coming soon |
| Vaccines | $0.00 copay | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H2256)
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, 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
- New Member Part D Help
- (877)218-4835
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
Tufts Medicare Preferred HMO Prime Rx (H2256-015-1) is available in the following locations:
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About Tufts Medicare Preferred HMO Prime Rx (HMO)
How much does plan H2256-015-1 cost per month?
The plan’s monthly premium is $244.00 for 2027. The Part B premium is not included.
What is the MOOP for Tufts Medicare Preferred HMO Prime Rx in 2027?
The 2027 in-network MOOP is $3850.00. Once this limit is reached, covered in-network costs are fully covered.
What is the CMS star rating for Tufts Medicare Preferred HMO Prime Rx?
The 2027 CMS star rating for Tufts Medicare Preferred HMO Prime Rx is ★0.0 out of 5.
How many beneficiaries are enrolled in this plan?
CMS reports 9,127 beneficiaries enrolled in this plan.
What is the prescription drug deductible for 2027?
For 2027, the prescription drug deductible is $0.00.
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 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
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