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Tufts Health Plan Medicare Review

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UPDATED: Nov 30, 2018

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Tufts Health Plan provides health insurance to over a million people in three New England states. They offer individual and group health insurance as well as Medicare Advantage and Supplement plans.

About Tufts

In 1979 Tufts Health Plan was founded by Dr. Morton Madoff of Tufts University Medical School, offering HMO health plans. The company remained solely in Massachusetts until 1995, when they began expanding into other New England states. They now have plan options in Rhode Island and New Hampshire.

The majority of Tufts plans are employee benefits, although individuals can also purchase coverage in Massachusetts (but not in any other state). In addition to those plans, Tufts has been offering Medicare plans since 1994 and is one of the top-rated Advantage providers in the country.

Tufts is headquartered in Watertown, MA with branch offices in the areas they serve. They offer a wide range of health insurance plans.

Tufts Medicare Plans

Medicare Advantage and Medicare Supplement plans are both available to residents of Massachusetts. For the purpose of this review, we used the zip code of the company’s headquarters to obtain product information.

Medicare Advantage

There are several Medicare Advantage plans available, most of which can be purchased with or without Part D prescription drug coverage. All of the plans have the option to add on dental coverage.

The Preferred Prime plan is available in three options: No Rx, With Rx, and With Rx Plus. Coverage under these plans is mainly the same with the exception of prescription drugs and a few other minor differences.

The plan has copays of $10 for primary care visits and $15 for specialist visits. Inpatient hospital coverage is $300 per day for the first five days, except with the Prime Rx Plus plan, which has a lower copay at $200 per day for the first five days. All three include hearing and vision coverage.

The Rx and Rx Plus plans both have no deductible for prescriptions but have different copays. Tier 1 drugs start at $2 on the Rx plan and at $4 on the Rx Plus plan, which has lower copays for prescriptions across the board.

Coverage on the HMO Value plan is exactly the same with or without Rx coverage – with the obvious exception that one has Part D coverage. Copays are $10 for primary care and $25 for specialist visits, and inpatient hospital coverage is $200 per day for the first five days. Both plans include vision and hearing coverage.

The prescription drug coverage starts at $4 for Tier 1 generic drugs. There is a $300 Rx deductible, but this only applies to Tiers 3 and up.

The Basic Rx plan has a primary care copay of $10 and a specialist copay of $40. The inpatient hospital copay is $275 a day for the first five days. Prescription coverage starts at $4 for Tier 1 drugs, with a $350 deductible applied to Tiers 3 and up. Hearing and vision are both included with this plan.

The final plan is the Saver Rx plan, which is the only $0 premium (above and beyond the regular Medicare premium) offered by Tufts. Copays on this plan are $10 for primary care and $45 for a specialist. The inpatient hospital deductible is $350 a day for the first five days. Prescriptions on this plan also start at $4 for Tier 1, and there is a $400 deductible on Tiers 3 and up. Hearing and vision are included.

Medicare Supplement

Tufts offers two Medicare Supplement plans in accordance with the Massachusetts state standards.

The Supplement One plan pays all Medicare Part A and B deductibles and coinsurance amounts. This plan also includes an eyewear benefit and a fitness benefit.

The Supplement Core plan covers copays and coinsurance but still has deductibles of $1,364 for Part A and $185 for Part B. It also offers a fitness benefit but does not have the eyewear benefit included.

SeniorCare Options

The SeniorCare Options plan is offered to those that have both Medicare and MassHealth Standard (Medicaid) and offers HMO SNP services along with a list of added benefits. These include free dental and vision exams, free routine hearing screenings, free access to things like orthopedic shoes and disposable medical products, and even free primary and specialist visits.

Rates

Rates are readily available on the Tufts site and vary by county. Our sample rates are for the same area again where the Tufts Health Plan headquarters is located.

As mentioned, the Saver Rx plans is a $0 premium plan. After this plan, the next most affordable option is Basic Rx at $40 a month. The Prime Rx Plus plan is the most expensive at $199 a month.

Dental care can be added to any of the Advantage plans for $54 a month.

On the Supplement side, the Core plan is priced at $114 a month, and the One plan at $212 a month.

These rates are only comparable to plans in the same area but, overall, they offer a good range of prices and good value for the dollar based on what we have seen elsewhere. This is particularly true of the Advantage plans; we did find the Supplement One plan to be on the pricey side. The dental coverage as well is more expensive than most such plans elsewhere.

Claims

Like most health insurance plans, Tufts does not have a section dedicated to claims, although they do have reimbursement forms available for those occasions when the insured must pay out of pocket and be reimbursed. This is a fairly rare occurrence since most claims are handled directly with providers.

Ratings and Consumer Reviews

Tufts has an A rating with the Better Business Bureau (BBB) and has 12 complaints on file in the past three years. Two of those were closed in the past 12 months. The BBB states that they have a slightly lower rating due to five complaints that were not resolved. There are six negative customer reviews on the BBB file page. The complaints are varied, with a few mentioning Medicare Advantage plan issues including unexpected cancellation of the policy.

Medicare gives Tufts Medicare Preferred Advantage plans a five out of five rating, which is the best possible rating and a rare occurrence.

Tufts Health Plan has 49 reviews on Yelp for an overall one-star rating. Most of the complaints appear to be in regards to problems with procedures being denied and increasing costs.

There are 19 reviews on Pissed Consumer for an overall 1.9-star rating. Complaints here are similar to those elsewhere – difficulty with prior authorizations for medications and procedures, increasing costs, and cancellation without notice.

For a company with well over a million members, the complaint volume here is not high, and the majority of the complaints do not refer to the Medicare plans specifically.

The Bottom Line

Tufts has a good range of Medicare plan options at various price points and an excellent rating from Medicare for their Advantage plans. They are a good pick for those in Massachusetts, but we do recommend checking your medications against the Tufts formulary before taking out a policy since this appears to be an issue in the complaints.

For a list of companies that we recommend, visit our Best Insurance Companies page.

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Review Information

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About Eric Stauffer

Author: Eric StaufferI am a former insurance agent and banker turned consumer advocate. My priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best place to get it.

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