Tufts Health Plan Medicare Review & Complaints: Health Insurance (2023)

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.

In this Tufts Health Plan Medicare review, we’ll focus on the Medicare plans available, including Advantage and Medicare Supplement (MediGap) plans. We’ll also look at Tufts Health Plan Medicare quotes and company ratings.

After reading this review, you might decide to buy Tufts Health Plan Medicare insurance. But before you make the final choice, compare your options. Enter your ZIP code now for free Medicare quotes.

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 Health Plan 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.

Tufts Health Plan Medicare Advantage

Tufts Health Plan Medicare Preferred is the company’s line of Medicare Advantage plans.

There are several of these 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.

The Tufts Health Plan Medicare Preferred formulary is available online for you to check your prescriptions.

Tufts Health Plan Medicare Supplement

Tufts offers three Medicare Supplement plans in accordance with the Massachusetts state standards, sometimes called Tufts Health Plan Medicare complement plans.

The Supplement 1 plan pays all Medicare Part A and B deductibles and coinsurance amounts. This plan also includes an eyewear benefit and a fitness benefit. There is also a Supplement 1A plan that does have a Part B deductible in return for a lower rate.

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.

Tufts Health Care 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.

Tufts Health Plan Medicare 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 $46 a month. The Prime Rx Plus plan is the most expensive at $214 a month.

The Tufts Health Plan Medicare Preferred dental plan can be added to any of the Advantage plans for $either $17 or $30 a month, depending on the plan you select.

On the Supplement side, the Core plan is priced at $129 a month, the 1 plan at $228.50 a month, and the 1A plan falls in between at $195.50 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.

Tufts Health Plan Medicare 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.

Tufts Health Plan Medicare 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 stars, 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.

Tufts Health Plan Medicare: 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.

Even if you have found an affordable Tufts Health Plan Medicare option, it’s always good to compare options to be sure you have the best plan. For free Medicare quotes, enter your ZIP code below.