Massachusetts-based Tufts Health Plan offer plans for Medicare Advantage enrollees, in addition to administering employer-sponsored plans and individual, small group, and Medicaid plans.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Tufts Health Plan are a nonprofit, Massachusetts-based insurer. The company — founded in 1979 and operating since 1981 — have 110 hospitals and more than 51,000 healthcare providers in their network. Plans are available to people in Massachusetts, New Hampshire, Connecticut, and Rhode Island.
The company’s healthcare plans include Medicare Advantage, prescription drug, and Medicare insurance supplement (Medigap) plans:
- Medicare Preferred: These Health Maintenance Organization (HMO) plans offer medical and prescription drug coverage.
- Health Plan Senior Care Options: These HMO Special Needs Plans (SNPs) are available to people who are eligible for both Medicare and MassHealth Standard (Medicaid) or just for MassHealth Standard.
- Preferred Supplement: Also known as Medigap, these plans provide additional insurance coverage for people enrolled in original Medicare (Part A and Part B). Learn more about Medigap plans here.
- Health Unify: This is a Medicare-Medicaid plan for people between the ages of 21 and 64 years.
For 2021, the Centers for Medicare & Medicaid Services (CMS) awarded Tufts Health Plan a 5-star rating. As the highest designation for a Medicare Advantage plan, this corresponds to an “Excellent” rating. The CMS have awarded Tufts Health Plan a 5-star rating every year since 2016.
Tufts Health Plan offer dental coverage with their Medicare Advantage HMO Dental Option plan and their Medicare Supplement Dental Option plan.
A plan may already include dental coverage, or this may be available as an add-on service. Dominion National administer the dental benefits.
HMO Preferred Dental Option
The HMO Preferred Dental Option plan offers the following benefits:
- $0 deductible
- $0 copay for preventive services, such as oral exams and routine cleanings
- 20% copay for restorative services, including fillings and simple extractions of noninfected teeth
- 50% coinsurance for major restorative services, such as crowns, dentures, and root canals
- annual maximum benefit of $1,000
Medigap Dental Option
A person enrolling in the company’s Medicare Supplement Dental Option plan can visit any licensed dentist, regardless of whether or not they are in-network. The plan offers several benefits, including:
- $0 deductible
- $0 copay for preventive services, such as oral exams and cleaning
- 20% coinsurance for services such as simple extractions and fillings
- 50% coinsurance for comprehensive services, including crowns, bridges, and dentures
- annual maximum benefit of $1,000
For the Medicare Supplement Dental Option plan, the monthly premium in 2021 is $48.
For HMO plans, the monthly premium varies between $17 and $30, depending on the plan and dental coverage. For example, the Tufts Medicare Preferred HMO Saver Rx and the Medicare Preferred HMO Basic Rx both include dental coverage for preventive and restorative services.
Some plans may not cover certain services. For example, Value and Prime plans do not offer coverage for a panoramic image X-ray of the entire mouth, and the plans’ dental option carries a 20% copay for this service.
For 2021, the following premiums are associated with these plans:
- Tufts Medicare Preferred HMO Basic RX: $17 per month
- Tufts Medicare Preferred HMO Saver Rx: $17 per month
- Tufts Medicare Preferred HMO Value Rx: $30 per month
- Tufts Medicare Preferred HMO Prime Rx: $30 per month
The price difference is due to the fact that the Basic and Saver plans include basic dental benefits. The other plans do not automatically include dental benefits, which a person must opt to add to their policy. Therefore, the monthly premium costs more than for the plans with integrated dental coverage.
Tufts Health Plan offer plans that are available to those who qualify for Medicare, live in the plan’s coverage area, and can pay the plan’s monthly premium.
A person aged 65 years or older can qualify for Medicare based on their age. Younger people may also qualify for Medicare if they have certain conditions or disabilities, including end stage renal disease and amyotrophic lateral sclerosis, which is also known as Lou Gehrig’s disease.
Tufts Health Plan’s Medicare Advantage plans are available in Massachusetts. However, the company may not offer all plans in each area. A person can check for available plans using this online tool or by searching by zip code on the Tufts Health Plan website.
Tufts Health Plan do not have a specific period during which a person can add a dental option to their plan. If a person is already enrolled in a Tufts Health Plan, they can contact their plan administrator and ask to add the dental option to their plan.
It is important to note that Tufts Health Plan provide the dental option as a Preferred Provider Organization (PPO) plan. With a PPO, a person will generally get the most significant cost savings when they choose in-network providers, although the plan will often reimburse at a lower rate for out-of-network providers.
Tufts Health Plan offers dental services as either an incorporated or add-on benefit of their Medicare Advantage plans. A person can also get a supplemental dental policy if they have original Medicare. Some plans require a person to use in-network healthcare providers.