Medicare Advantage plans include all the benefits of original Medicare as well as cover for prescription drugs and more. Tufts Medicare Advantage plans are only available in Massachusetts.
Medicare is a federal insurance plan for people aged 65 and older. Original Medicare has parts A and B.
Medicare Part A pays for hospital, hospice, and skilled nursing facility care, while Part B pays for medically necessary care to diagnose and treat conditions. It also pays for some preventive services, such as the flu shot.
Medicare Part C is also known as Medicare Advantage. These plans incorporate the benefits of original Medicare under one policy. Private insurance companies that Medicare approves, such as Tufts, can administer these plans.
This article will discuss Tufts Medicare Advantage plans, where they are available, and how to get one.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Tufts Health Plan is a nonprofit group that began life in 1979. The company offers different insurance policies, including:
- employer-backed plans in Massachusetts, Rhode Island, and New Hampshire
- individual health plans in Massachusetts (sold through brokers)
- Medicaid plans in Massachusetts and Rhode Island
- dual eligibility plans for people aged 21–64 who qualify for Medicare and Medicaid in Massachusetts
- senior care options for people aged 65 and over with Medicare and Medicaid in Massachusetts
- Tufts Medicare Advantage, Medicare supplement, and Medicare prescription drug plans
Tufts Health Plan offer two Medicare Advantage products: Tufts Medicare Advantage preferred Health Maintenance Organization (HMO) plans (which are for individuals to purchase) and Tufts Health Plan Medicare Preferred Group plans (which are available through employers and can include Advantage plans, Medicare supplement plans, and prescription plans).
The company offers products in Massachusetts, Rhode Island, and New Hampshire, but they only provide Tufts Medicare Advantage plans to people living in 10 Massachusetts counties. These are:
A person can check whether or not a Tufts Medicare Advantage plan is available in their area by using this tool.
The tool uses a zip code to search for Medicare Advantage plans available.
People can filter search results depending on their individual needs. The available filters include:
- lowest yearly prescription drug deductible
- lowest health plan deductible
- lowest prescription drug and premium costs
- lowest monthly premium
A person can also see and compare plan benefits, including:
- monthly premiums
- estimated yearly costs
- preventive services
- therapy services
- mental health services
- extra benefits included in the plan
Many plans have an option to enroll online.
An individual may need to answer several questions during this process, and they can speak with a person from the company if they choose to.
In some cases, people may prefer to enroll using a paper form and returning it by mail. Usually, the insurance company will be happy to send a paper form if a person requests one by email or phone.
Medicare has specific times that enrollment and plan changes can take place. To enroll, a person must have original Medicare.
When a person first qualifies for Medicare parts A and B, they may enroll in a Medicare Advantage plan.
The benefits do not start before an individual’s 65th birth month, but when the policy begins will depend on when enrollment takes place.
For example, if a person delays enrollment for original Medicare, they must wait for the Medicare general enrollment period, which runs from January 1 to March 31 every year.
If a person signs up during this period, the policy start date would be July 1.
Enrollment in a Medicare Advantage plan can then take place between April 1 and June 30 each year.
The Tufts Medicare Advantage plans offer people two options to reduce their costs: higher premium/lower copay or lower premium/higher copay.
The first option could be beneficial for people who see their doctor frequently. It can help lower copayments and other medical costs.
The second option may better suit those who do not visit the doctor often, and there are plans with a $0 premium.
Some Tufts Medicare Advantage plans limit annual out-of-pocket expenses to $3,450. After a person meets this limit, the plan will pay 100% of medically necessary charges.
Costs can vary depending on the policy a person buys, the benefits included, and the county they live in.
The Tufts Medicare Advantage plans provide all parts A and B benefits, and may also include the prescription drug coverage found in Medicare Part D.
The program also includes a benefit that reimburses wellness care. A person can claim $150 or $300, depending on the policy, for benefits such as:
- fitness program memberships or classes
- nutritional programs and counseling
- AAA driving program
- diabetes workshops
- prescription eyeglasses or contact lenses
Tufts Medicare Advantage beneficiaries may also get discounts on services to help them stay healthy. These can include massage therapy, laser eye care, and mental health programs.
There are some rules and exclusions that apply to HMO plans. The sections below will cover these in more detail.
Healthcare provider networks
In an HMO, a person will receive services from providers in a specified network, except when emergency and urgent care are necessary out-of-area and when out-of-area dialysis is necessary.
In all other instances, a person will pay the full charge for out-of-network care.
Some HMO plans allow a person to use providers outside of their network. These are called HMO Point of Service plans.
Primary care and referrals
A person usually needs to choose a primary care doctor to coordinate their care. A referral is often necessary to see a specialist.
If the primary care doctor ends their participation with Medicare, a person can choose another doctor.
A plan may require prior approval for certain services.
To help manage costs, a person may wish to contact their plan provider before booking a particular service to ensure that cover is available.
The nonprofit group Tufts Health Plan administer Tufts Medicare Advantage policies. These are available in a limited number of counties in Massachusetts.
The policies are HMO plans, meaning that a person must usually use providers within the plan’s network.
A person can enroll at the same time they sign up with original Medicare.
The costs will vary depending on the benefits included and the area in which the person lives.
The company offers plan options to suit an individual’s needs, including higher or lower premiums and copayments.
People can compare Medicare Advantage plans by using Medicare’s online plan finder tool.