Tufts Medicare Preferred HMO Value No Rx (HMO)
Medicare Advantage Plan H2256-019-1 • 2026
Tufts Medicare Preferred HMO Value No Rx (HMO) Medicare Advantage Plan H2256-019-1 • 2026
Tufts Medicare Preferred HMO Value No Rx is a Medicare Advantage HMO plan offered by Tufts Health Plan for the 2026 plan year. It uses a Health Maintenance Organization (HMO) provider network and comes without prescription drug coverage. CMS Plan ID H2256-019-1 identifies this plan.
Tufts Medicare Preferred HMO Value No Rx Overview
Plan Overview for H2256-019-1 |
|
|---|---|
| CMS Plan ID: | H2256-019-1 |
| Plan Type: | HMO |
| Plan Year: | 2026 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $3850.00 (In-Network) |
| Part B Give Back: | Not offered |
| Prescription Drug Coverage: | Not Included |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | See List |
| Enrollment (Nationwide) | 88 beneficiaries |
| Provided By: | Tufts Health Plan |
Plan Availability
Tufts Medicare Preferred HMO Value No Rx (H2256-019-1) is available in the following locations (click to open):
Plan Overview for Tufts Medicare Preferred HMO Value No Rx
This Medicare Advantage Health Maintenance Organization (HMO) plan provides Medicare Part A and Part B coverage through a network of participating providers. The monthly premium is $0.00, and services are generally covered when received from in-network providers, except in emergency situations.
Primary care visits have a $10 copay, specialist visits come with a $25 copay, lab services cost {lab_services_cost}, urgent care services carry a $30 copay, and ambulance transportation is $225 copay. These costs apply toward the annual out-of-pocket maximum (MOOP) of $3850.00. After this limit is reached, in-network services are fully covered for the remainder of the year.
This plan is listed by CMS under Plan ID {title_plan_id}. Cost-sharing details for key services are provided below.
Cost Sharing Expenses
Tufts Medicare Preferred HMO Value No Rx has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H2256-019-1.
This section outlines in-network costs for primary care and specialist office visits, along with related preventive services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: $10 copay |
| Specialist: | In-network: $25 copay |
This section outlines in-network costs for preventive and wellness services included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0-$150 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | In-network: $0 copay |
| Health education: | In-network: $0 copay |
| Counseling services: | Not covered |
| Over-the-counter drug benefits: | Not covered |
| Health transportation (non-emergency): | In-network: $0 copay |
This section outlines in-network costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Covered Service | In-Network Cost |
|---|---|
| Diagnostic radiology services: | In-network: $100 copay |
| Lab services: | In-network: $0-$30 copay |
| Outpatient x-rays: | In-network: $10-$30 copay |
| Diagnostic tests and procedures: | In-network: $10-$30 copay |
This section outlines in-network costs for emergency services, urgent care, ambulance transportation, inpatient hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | $125 copay |
| Worldwide emergency care: | $125 copay |
| Urgent care: | $30 copay |
| Inpatient hospital care: | Tier 1 | $200 per day for days 1-5 | $0 per day for days 6-90 | $0 per stay |
| Skilled Nursing Facility: | Tier 1 | $20 per day for days 1-20 | $120 per day for days 21-44 | $0 per day for days 45-100 |
| Ground ambulance: | In-network: $225 copay |
This section outlines in-network costs for mental health services, including outpatient therapy and inpatient psychiatric care.
| Covered Service | In-Network Cost |
|---|---|
| Outpatient individual therapy: | In-network: $0-$20 copay |
| Outpatient group therapy: | In-network: $0-$20 copay |
| Inpatient psychiatric hospital care: | Tier 1 | $200 per day for days 1-5 | $0 per day for days 6-90 | $0 per stay |
This section outlines in-network costs for rehabilitation services, including physical therapy, speech and language therapy, and occupational therapy.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $20 copay |
| Occupational therapy: | In-network: $20 copay |
This section outlines in-network costs for medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: $0 copay |
| Durable medical equipment: | In-network: 10% coinsurance |
| Prosthetics: | In-network: 10% coinsurance |
This section outlines in-network cost sharing for chemotherapy and other Medicare Part B-covered drugs.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | In-network: $0 copay |
| Other Part B drugs (Medicare-covered): | In-network: $0 copay |
This section outlines in-network cost sharing for dental services, including preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| Oral exam: | In-network: 0%-50% coinsurance |
| Dental x-rays: | In-network: 0%-50% coinsurance |
| Cleaning: | In-network: $0 copay |
| Periodontics: | In-network: 50% coinsurance |
| Endodontics: | Not covered |
| Restorative services: | In-network: 50% coinsurance |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | In-network: 50% coinsurance |
This section outlines in-network cost sharing for vision services, including eye exams, eyeglasses, and contact lenses.
| Covered Service | In-Network Cost |
|---|---|
| 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 |
This section outlines in-network cost sharing for hearing-related services, including exams, fittings, and hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| 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 |
This section outlines in-network cost sharing for additional and special needs services that may be included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Adult day health services: | Not covered |
| Home-based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | In-network: $0 copay |
| Wigs for chemotherapy-related hair loss: | In-network: $0 copay |
| 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 Value No Rx as a Part B benefit.
Prescription Drug Coverage
This plan does not include a Medicare Part D plan for prescriptions.
CMS Star Ratings
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 |
|---|---|
| 2026 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 |
How much does plan H2256-019-1 cost per month?
The plan’s monthly premium is $0.00 for 2026. The Part B premium is not included.
What is the MOOP for Tufts Medicare Preferred HMO Value No Rx in 2026?
The 2026 in-network MOOP is $3850.00. Once this limit is reached, covered in-network costs are fully covered.
How many beneficiaries are enrolled in this plan?
CMS reports 88 beneficiaries enrolled in this plan.
What is the prescription drug deductible for 2026?
For 2026, the prescription drug deductible is $0.00.
Contact Information for Tufts Health Plan
| Contact Type | Details |
|---|---|
| Website: | Tufts Health Plan Plan Page |
| New Members: | 1-877-218-4835 |
| Existing Members: | 1-800-701-9000 |
| Plan Address: | 1 Wellness Way | Canton, MA 02021 |
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed May 2, 2026
- CMS.gov, Medicare Part C & D Performance — Last accessed May 2, 2026
- CMS.gov, Plan Benefits Package — Last accessed May 2, 2026
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed May 2, 2026
Data sources and methodology documentation..
- Tufts Health Plan (official source), http://www.tuftsmedicarepreferred.org — Last accessed October 13, 2025
- Medicare.gov, "Understanding Medicare Advantage Plans" — Last accessed 25 May, 2025
- NCOA.org, "5 Steps to Choosing the Right Medicare Plan for You" — Last accessed 25 May, 2025
- Medicare.gov, "Compare Original Medicare & Medicare Advantage" — Last accessed 25 May, 2025
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