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Morton Madoff, M.D. of Tufts University Medical School founded Tufts Health Plan in 1979. The original plan was founded as an HMO, but quickly added a POS option to their plans a few years later, one of the first such companies to make this move. Initially offering coverage only in Massachusetts, Tufts Health Plan expanded to New Hampshire in 1995 and to Rhode Island in 2008, although offerings in those states are limited. Today, they have expanded to cover a handful of counties in Connecticut.
The company began offering Medicare plans in 1994 and has since become one of the top rated Medicare providers in the country. As of June 2016 the company had 1,085,000 members in total, with the majority of those carrying plans offered through an employer.
Tufts is headquartered in Watertown, MA but has offices in all of the states it serves. In Rhode Island and New Hampshire, the only plans offered are through employers, although individuals and families can purchase coverage within the state of Massachusetts. As a result, this review will focus mainly on the products offered in that state.
Tufts offers both Medicare Advantage plans and Medicare Supplement, as well as a combined Medicare/Medicaid plan as well for those who qualify. We used the county where the company is headquartered for the sample plans and rates.
Tufts has a multitude of Medicare Preferred HMO plans to choose from, with a wide price range and differing coverage. Dental coverage can be added to any of the plans for an added premium.
The $0 premium (on top of regular Part B premiums) base plan is the Preferred HMO Saver Rx Plan. This plan has no deductible, a $20 office visit co pay, and a $40 specialist visit co pay. Urgent care has a $20-40 co pay, with no explanation as to when each price point would apply. Emergency room visits are the standard $75 co pay seen elsewhere. Inpatient hospital has a $350 per day co pay for the first five days.
This plan also includes Part D Prescription Drug coverage. Drug co pays start at $6 for Tier 1 drugs. There is not a deductible for Tiers 1 and 2, but a $350 deductible for Tiers 3-5. Hearing and vision screening benefits are also included with this plan.
The Preferred HMO Basic Rx Plan has a slightly higher cost but lower co pays overall, and no medical deductible. Office visits have a $10 co pay and specialists $30. Urgent care ranges form $10-30 per visit, with ER visits at the same rate. Inpatient hospital care has a $295 per day co pay for the first five days.
Part D Prescription Drug Coverage is included with slightly lower co pays, starting at $4 for Tier 1. Tiers 3-5 have a $300 deductible before co pays kick in. This plan includes benefits for hearing and vision, and as with all of the plans, dental can be added at an extra cost.
The next step up premium-wise is the Preferred HMO Value No Rx plan. As the name implies, this plan does not include Part D coverage for prescriptions. Primary care office visits have a $10 co pay, and specialists have a $20 co pay. Urgent care co pays are $10-20 while ER services are the standard $75. Inpatient hospital care is covered with a $200 per day co pay for the first five days. Overall, co pays are lower for this plan, including for vision and hearing benefits.
The more expensive Preferred HMO Value Rx Plan has the same coverage and co pay amounts as the No Rx plan, with Part D coverage included. The drug coverage starts at $4 co pays for Tier 1 drugs, and as with the previous plans there is a deductible for Tiers 3-5, in this case $250.
The final set of plan options is the Prime Plan, which has three levels of coverage. These are the Prime No Rx, the Prime Rx and the Prime Rx Plus. All three plans have a $10 office visit co pay and a $15 specialist visit co pay. Vision and hearing benefits are the same, with low co pays at $15, and Urgent Care co pays are $10-20 for all three plans.
The Rx Plus plan has a lower inpatient hospital co pay than the other two, at $200 per day for the first five days versus $300 per day for the first five days.
The No Rx plan, as the name implies, does not include Part D coverage, while the other two plans include it. For the Prime Rx plan, drug co pays start at $4 for Tier 1, while the Rx Plus plan co pays start at $2 with lower co pay amounts across the board. Neither plan has a Part D deductible.
Tufts also writes Medicare Supplement Plans. These are designed to pay the out of pocket expenses that are not covered under Original Medicare. In most states, Medicare Supplement plans are offered as a series of lettered plan levels, and companies can choose which of these plans to offer. In Massachusetts, however, the standards are different. Tufts does not offer its Medicare plans in Rhode Island or New Hampshire so the only plans listed on the site follow the Massachusetts system.
There are two Medicare Supplement plans offered. The first is the Medicare Preferred Supplement Core plan. This plan covers the co pays and coinsurance not paid for by Original Medicare, but still requires you to pay deductibles. This plan is similar to the Plan A offered in states that follow the lettered system, and is the most basic Supplement plan available.
The second is the Medicare Preferred Supplement One Plan. This plan covers all of the co pays and coinsurance as well as the Part A and Part B deductibles. Also included with this plan are routine vision screening and an eyewear benefit.
Due to the fact that Tufts is a regional insurer in a relatively small area, we are unable to compare their rates to other nationwide companies. They do not provide coverage in our usual sample area, which again makes it difficult to provide a rate comparison.
Rates are readily available on the Tufts website, however, and accompany each of the basic plan descriptions. Medicare Advantage plans start at the $0 premium Saver Rx Plan, and increase in price steadily from there. The most expensive plan available is the Prime Rx Plus Plan, which comes in at $193 per month.
All of the plans appear to be fairly reasonably priced, and there is such a good selection of options that one of them is likely to meet any budget. None of the plans include dental, but it can be added to any selection for an additional $54 per month.
For Medicare Supplement, the Core Plan is priced at $110 per month, while the One Plan is $204 per month. These are very similar to the prices we have seen from similar Massachusetts-based companies.
Ratings and Reviews
The Better Business Bureau gives Tufts Health Plan an A rating, with a total of 10 complaints, 4 of those closed in the last 12 months. The bulk of the complaints regard billing/collection issues. The BBB also lists two reviews, both of which are negative.
Tufts boasts a 5.0 rating from NCQA, although the breakdown shows that they don’t rank as well in customer satisfaction as they do in other areas. They ranked particularly low in the areas of ease and speed of getting care, and in claims handling, which may carry more weight with potential customers than some of the other ranking factors even though they do not appear to greatly impact the overall score.
Pissed Consumer has 6 reviews of Tufts, and a few of them actually related directly to Medicare plans. The content of the complaints isn’t anything unusual for a good-sized insurance company, and Tufts appears to have responded to several of the complaints, which is a good sign.
Medicare gives Tufts a top 5-star rating for their Advantage plans, which reflects a number of factors including member satisfaction and complaint volume.
Overall, Tufts appears to have a fairly solid reputation, although there are a few areas where the overall rating might not reflect what is important to those shopping for insurance. There does not seem to be major red flags in any of the reviews.
The Bottom Line
Tufts is a choice worth considering for those who live in the coverage area and who are not concerned with the limitations of an HMO plan. They have a great selection to choose from – one of the best we have seen – with a variety of premiums that are easy to compare, and they have a good reputation. Overall, they appear to be a solid choice.
For a list of companies that we recommend, visit our Best Insurance Companies page.