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Tufts Health Plan Review

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Eric Stauffer is a former insurance agent and banker turned consumer advocate. His priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best...

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UPDATED: Apr 10, 2020

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Tufts Health Plan is a nonprofit operating mainly in Massachusetts and Rhode Island, with coverage extended to nearly one million members. They offer a range of health insurance plans for individuals and families as well as group plans for employers.

About Tufts Health Plan

Tufts Health Plan came out of Tufts University Medical School in 1979 when Dr. Morton Madoff founded an HMO health plan connected to the school. Shortly thereafter the plan added the option of a POS format, leading the way for other similar companies to do the same, although today most plans offered are HMO plans. Coverage was extended to New Hampshire in 1995, and later to Rhode Island and a few counties in Connecticut as well.

Tufts offers individual health plans on two different networks as well as Medicare and Medicaid options. You can read our full review of Tufts Medicare plans here. The majority of Tufts’ 1 million plus members receive their insurance through group plans provided by employers. Currently, individual and family plans are only offered in Massachusetts, with other states offering group health plans.

Tufts headquarters is located in Watertown, MA, with branches throughout the service area.

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Tufts Health Plans

Tufts offers two families of plans, Direct and Premier. Direct is a more low-cost option while Premier offers a larger range of in-network providers. The two networks include different providers, but both are HMOs, which means the networks are limited.

Tufts Health Direct

There are several levels of Tufts Health Direct plans, ranging from catastrophic to platinum levels, along with the ConnectorCare plans. Some plans are specifically for low-income families and have income qualifications. Out-of-network care coverage is not offered for any plans offered from Tufts.

The Catastrophic Plan has a $7,150 individual deductible and $14,300 family. Primary care visits have a 50% coinsurance, and other visits are not covered until the deductible is met. The deductible with this plan is also the out of pocket limit. Prescription drugs are not covered until after the deductible.

The Direct Bronze Plan has a $2,500 individual and $5,000 family deductible. There is a separate pharmacy deductible of $250 individual and $500 family. Primary care visits have a $25 copay while specialist visits have a $50 copay. After the deductible, prescriptions start at a $25 copay.

Direct Silver 2200 has a $2,200 individual deductible and a $4,400 family deductible. Primary care visits have a $50 copay while specialist visits have a $75 co pay. Prescription drugs start at a $35 copay.

Direct Silver 2000 has a $2,000 individual and $4,000 family deductible. There is a $30 copay for primary care visits and a $50 copay for specialists. Prescription drugs start at $20.

Direct Gold 1000 has a $1,000 individual deductible and a $2,000 family deductible. Primary care visits are a $20 copay while specialist visits have a $45 copay. Generic drugs start at a $20 copay.

Direct Gold 500 is a low deductible plan with a $500 individual and $1,000 family deductible. Primary care visits have a $20 copay and specialist visits have a $35 copay. Prescription drug coverage starts at $15 for generic Tier 1 drugs.

Direct Platinum is a $0-deductible plan with a $25 copay for primary care visits and a $40 copay for specialist visits. Generic drugs start at $15.

There are three Direct ConnectorCare plans, all of which have income requirements to qualify. Type I is a $0 deductible plan with no copays whatsoever for any office visits. Generic drugs start at $1 and there is a low out of pocket limit of $250 individual and $500 family on prescriptions.

Type II is a similar $0-deductible plan with slightly higher out of pocket limits. Copays are $10 for primary care and $18 for specialist visits. Prescription drug coverage starts at $10.

Like the others, Type III has no deductible, but again the out of pocket limits are higher. Copays are $15 for primary care and $22 for specialists. Prescription drugs start at $12.50 for Tier 1 drugs.

Tufts Health Premier

There is one Premier plan at each metallic level. These plans offer a wider network than the Direct plans, but there is still no out-of-network coverage.

The Bronze Saver 3300 has an individual deductible of $3,300 and a family deductible of $6,600. Copays are $40 for a primary care visits and $65 for specialist visits. Tier 1 drugs start at a $35 copay.

Premier Silver 2000 has an individual deductible of $2,000 and a family deductible of $4,000. Copays are $30 for a primary care visit and $50 for a specialist visit. Generic drug coverage starts at $20.

The Premier Gold 1000 plan has a $1,000 individual deductible and a $2,000 family deductible, with copays of $30 for primary care and $45 for specialist visits. Prescription drugs start at a $20 copay.

Finally, the Premier Platinum plan is a $0-deductible plan that has a $25 copay for primary care visits and a $45 copay for specialists. Tier 1 drugs start at a $15 copay.

Tufts Rates

Tufts offers a quick rate chart on their website that outlines plan costs based on income level for the Direct plans. ConnectorCare Level 1 is offered with no monthly premium at the lowest income level, and rates rise from there. Prices are not given for the catastrophic or metallic level plans, which vary based on plan level and income.

Since Tufts is a regional HMO, it is difficult to compare their rates to other companies. They do appear to have plans available at all income levels, right down to a $0-premium option for low-income individuals and families.

Claims

Tufts is an HMO and handles all claims and payments directly. Since the provider and the insurer are directly connected, claims can be expected to be paid swiftly and without much difficulty.

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Ratings and Consumer Reviews

Tufts Health Plans has an A rating with the Better Business Bureau (BBB), and there have been 11 complaints against them in the past three years. This is a change from our attempt to retrieve a BBB rating on Tufts when we reviewed their Medicare plans – at the time the company returned a “Not Rated” on the file. That has been updated, and now the file lists three complaints that have not been resolved among the 11 as the reason for the slightly lowered rating.

Tufts has an overall rating of 5.0 from the National Committee for Quality Assurance. Their rating in the area of consumer satisfaction, however, is a 3.5 with lower rankings in the areas of getting care quickly and easily. Tufts does rank quite high though overall in most of the other rankings.

There are currently seven reviews on Pissed Consumer, with two company responses to the issues. Complaints typically surround customer service issues and billing errors.

Tufts overall has a low complaint volume that does not seem to raise any major red flags, although they could be more responsive to complaints online. Overall, they have a good reputation.

The Bottom Line

Tufts is a good choice for anyone in their service area looking for an HMO plan at a relatively low cost. Provider networks are limited, particularly in the Direct plans, but this may not be a problem for those who rarely travel and do not have complex health needs. The company has a solid reputation with generally high ratings and a low complaint volume.

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

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Review Information

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Tufts Health Plan
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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.

3 Comments

  1. Premier Bronze Saver 3300 – Tufts Health Plan
    prescriptions/copay covered after $3300 deductible is met! WATCH OUT!

    Reply
  2. They typically give you a run-around, invent fictional ways they can magically help you get that appointment covered, and outright lie to their members. I was with them for six months and despite telling them again and again who my PCP was, they believed I had the same one as my mother.
    The people on the phone are kind and professional, but I can’t stand being lied to. I can’t wait to change insurance.

    Reply
    • About the being lied to, Victoria is right…

      They really do “pat you on the head” and send you away with a promise that doesn’t occur.

      Seems like 1980’s style silos inside of the place.

      We spent tons of time managing them and their network.

      Thank God we are capable to do so. Too much BS with them.

      Reply

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