PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Tufts Health Plan
CMS Rating
Plan Type
HMO
Annual Deductible
$0.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage
  • has been rated 5 stars by CMS

All cost-sharing assumes in-network healthcare providers.

Plan Details

Costs and Other Important Information

Plan Year:
2016
Monthly Drug Plan Premium
$24.40
Health Plan Deductible
$0
Choice of Doctors?
Plan Doctors for Most Services
Monthly Health Plan Premium
$154.00
Out-Of-Pocket Spending Limit
$3,400 In-network
Optional Supplemental Benefits?
Yes
Prescription Drugs Covered?
Yes
Other Health Plan Deductibles?
No

Benefits

Service
Cost
Ambulance
$75
Doctor's office visits
Primary Physician
$10 per visit
Specialist
$15 per visit
Durable medical equipment (wheelchairs, oxygen, etc.)
10% per item
Emergency care
$75 per visit (always covered)
Home health care
You pay nothing
Mental health care
$200 per stay
Outpatient hospital
$75 per visit
Renal dialysis
You pay nothing
Inpatient hospital care
$200 per stay
Skilled Nursing Facility (SNF)
$20 for days 1 through 20
$0 for days 21 through 100

Cost Sharing Information

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$4 copay$4 copay$3 copay
Tier 2: Non-Preferred Generic$8 copay$8 copay$7 copay
Tier 3: Preferred Brand Name$47 copay$47 copay$47 copay
Tier 4: Non-Preferred Brand Name$100 copay$100 copay$100 copay
Tier 5: Specialty Tier33% coinsurance33% coinsurance33% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$12 copay$12 copay$10 copay
Tier 2: Non-Preferred Generic$24 copay$24 copay$21 copay
Tier 3: Preferred Brand Name$141 copay$141 copay$141 copay
Tier 4: Non-Preferred Brand Name$300 copay$300 copay$300 copay
Tier 5: Specialty Tier33% coinsurance33% coinsurance33% coinsurance

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care management
Care for older adults – medication review
Care for older adults – functional status assessment
Care for older adults – Pain screening
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
Reducing the risk of falling
Plan all-cause readmissions

Member Experience with Health Plan

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan
Care Coordination

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Beneficiary access and performance problems
Health plan quality improvement

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability - Medical

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Beneficiary access and performance problems
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs

Drug Pricing and Patient Safety

MPF Price Accuracy
High risk medication
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate

Physician Finder

Physicians that accept Tufts Medicare Preferred HMO Prime Rx (HMO) for Massachusetts

/
DABORA, SANDRA
10 GOVE ST
EAST BOSTON, MA 02128
HUTNER, ALINE
10 GOVE ST
EAST BOSTON, MA 02128
BLEVINS, PENGWYNNE
10 GOVE ST
EAST BOSTON, MA 02128
DOHLMAN, JAN
10 GOVE ST
EAST BOSTON, MA 02128
CHEN, DOROTHY
10 GOVE ST
EAST BOSTON, MA 02128
CHUA, MARGARETH
10 GOVE ST
EAST BOSTON, MA 02128
KOSTICH, MIRJANA
10 GOVE ST
EAST BOSTON, MA 02128
SCHAPIRO, JEFFREY
10 GOVE ST
EAST BOSTON, MA 02128
WOODSON, JONATHAN
10 GOVE ST
EAST BOSTON, MA 02128
COSCIA, DIANNE
10 GOVE ST
EAST BOSTON, MA 02128
HELLER, CHARMALIE
10 GOVE ST
EAST BOSTON, MA 02128
BENTLEY, MARI
10 GOVE ST
EAST BOSTON, MA 02128
MANANDHAR, MONICA
10 GOVE ST
EAST BOSTON, MA 02128
KUEBLER, FRANCES
10 GOVE ST
EAST BOSTON, MA 02128
BROWN, ALLISON
10 GOVE ST
EAST BOSTON, MA 02128
CHOU, LORETTA
10 GOVE ST
EAST BOSTON, MA 02128
LAMBL, BARBARA
10 GOVE ST
EAST BOSTON, MA 02128
ZARRAGA, IDA
10 GOVE ST
EAST BOSTON, MA 02128
OAKLAND, MARGARET
10 GOVE ST
EAST BOSTON, MA 02128
LEWIS, VICTOR
151 EVERETT AVE
CHELSEA, MA 02150
NELSON, SARA
151 EVERETT AVENUE
CHELSEA, MA 02150
ARMAND, WYNNE
151 EVERETT AVE
CHELSEA, MA 02150
VOLOZHANINA, ELENA
1000 BROADWAY
CHELSEA, MA 02150
GONZALEZ, WANDA
151 EVERETT AVE
CHELSEA, MA 02150
GODOY, KAREN
1000 BROADWAY
CHELSEA, MA 02150
Details
SANDRA DABORA, MD, PHD
Phone Number
(617) 569-5800
Office Locations
10 GOVE ST
EAST BOSTON, MA 02128
10 GOVE ST EAST BOSTON MA, 02128

Similar Plans

PremiumPlan NameCMS Rating
from $0
Tufts Medicare Preferred HMO Saver Rx (HMO)
Details
from $49
Erickson Advantage Freedom (HMO-POS)
Details
from $24
SilverScript Choice (PDP)
Details
from $18
Humana Walmart Rx Plan (PDP)
Details
from $27
HNE Medicare Basic No Rx (HMO)
Details

Related Articles

Related Searches

{}