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Medicare Advantage · HMO
Tufts Health Plan
Plan year 2026

Tufts Medicare Preferred HMO Prime No Rx H2256-016 (HMO)

4.0 · 2026 Star Rating · source: CMS · Ratings are updated annually
Monthly premium
$176
+ your Part B premium
Max out-of-pocket
$3,850
in-network annual cap
Primary care
$10
per visit copay
Specialist
$15
per visit
This plan does not include Part D drug coverage
Before enrolling, confirm how your prescriptions will be covered. Whether you can add a standalone Part D plan depends on the Medicare Advantage plan type; pairing one with most MA HMO or PPO plans can disenroll you from Medicare Advantage. A gap in creditable drug coverage may lead to a Part D late enrollment penalty later.

Part D late enrollment penalty

If you go 63 days or more in a row after your Part D initial enrollment period without Part D or other creditable prescription drug coverage, you may owe a penalty if you join Part D later. The penalty is 1% of the national base beneficiary premium ($38.99 in 2026) for each full uncovered month. It is added to your monthly Part D premium for as long as you have Part D, and the base premium can change each year.

Who this type of plan may fit

MA-Only plans are generally considered by people who already have creditable prescription drug coverage, such as coverage from the VA, TRICARE, or a current or former employer or union. Your coverage provider—not this page—must tell you whether your current drug coverage is creditable.

Before you enroll
  • Find your current plan's annual Notice of Creditable Coverage or ask its benefits administrator.
  • Confirm in this plan's official documents whether adding a standalone drug plan is allowed.
  • Do not drop existing drug coverage until you understand how the change affects both coverages.
Review the creditable coverage checklist

Your costs at a glanceIn-network, for the 2026 plan year

Drug coverage
Not included
Inpatient hospital
$300
per stay
no limit on covered hospital days
Inpatient mental health
$300
per stay
Outpatient surgery
$100
Emergency room
$110
Urgent care
$30

What's included, and what it's actually worth4 benefits included. Tap any card for the detail

Hearing

$250–$1,150copay per hearing aid
Details$250–$1,150 copay per hearing aid
This is a supplemental benefit with plan-specific limits. See plan documents for details.

Vision

$150/yr eyewear allowance ($15 exam copay)
Eyewear allowance$150/yr eyewear allowance
Routine eye exam$15 copay
This is a supplemental benefit with plan-specific limits. See plan documents for details.
See more details about this plan
Doctor Visits: PCP$10 copay
In-network$10 copay per visit
Doctor Visits: Specialist$15 copay
In-network$15 copay per visit
Inpatient Hospital$300 per stay
In-network$300 per stay
Benefit limitNone — additional covered days are unlimited
Outpatient Surgery$100 copay
In-network$100 copay per procedure
Mental Health$300 per stay
Inpatient psychiatric$300 per stay
TransportationNon-emergency transportation benefit
DetailsNon-emergency transportation benefit
MealsMeal benefit

Your coverageCheck your coverageFrom the doctors you added

Our take

Where this plan shines

This plan’s out-of-pocket maximum ($3,850) is among the lowest available.
The specialist copay ($15) is among the more affordable options.
Highly rated by CMS (4 stars).

Things to know before you enroll

Network restriction — you’ll need to use in-network providers except in emergencies.
Limited coverage while traveling outside the plan’s service area.
Does not include prescription drug coverage — confirm whether you can keep other creditable coverage or pair this plan with a standalone Part D plan.
Late enrollment penalty risk if you go without creditable drug coverage for 63+ days.
Questions? Talk to a licensed agent at1-866-764-3312 (TTY: 711)

Plan documents

Summary of Benefits (PDF)
Download the plan's official Summary of Benefits document
Check Your Doctors
See if your doctors accept this plan
Documentos en español
Llame al (877)218-4835 (TTY: 711) para solicitar documentos en español

Helpful next steps

The Pocket Protector · NPN 21126942 · 1-866-764-3312 (TTY: 711) · thepocketprotector.com

Plan benefits, premiums, and copays may vary by county and plan. You must continue to pay your Medicare Part B premium. Benefits and costs may vary by service area. Contact the plan or CMS for complete details.

We do not offer every plan available in your area. Currently we represent a limited number of organizations which offer a limited number of products in your area. Please contact Medicare.gov, 1-800-MEDICARE (TTY: 1-877-486-2048), or your local State Health Insurance Program (SHIP) to get information on all of your options.

Every year, Medicare evaluates plans based on a 5-star rating system. Star ratings are based on 2026 data and may change annually.

Out-of-network/non-contracted providers are under no obligation to treat plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you to contact the plan.

Dental, hearing, vision, and other supplemental benefits may have limitations and restrictions. These benefits vary by plan. Please refer to the plan's Evidence of Coverage for details.

Benefits shown are based on CMS public plan data. Actual benefits vary by county. Not all plans available in all areas. Speak with a licensed agent before enrolling.

  1. The Pocket Protector represents Medicare Advantage HMO, PPO, and PFFS organizations and stand-alone PDP prescription drug plans that have a Medicare contract. Enrollment depends on the plan's contract renewal.
  2. The Pocket Protector is not connected with or endorsed by the United States government or the federal Medicare program.

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