tufts preferred medicare in network where is it accepted

by Dr. Colby Goyette II Published 3 years ago Updated 2 years ago

What states does Tufts Health Plan cover?

Tufts Health Plan offers health insurance plans for employers of all sizes in Massachusetts and Rhode Island. Our national CareLink product, in collaboration with Cigna, provides coverage for multi-state employers.

Is Tufts Health Plan only in Massachusetts?

Members seeking health care services in Massachusetts, Rhode Island or New Hampshire can use providers within the Tufts Health Plan network at an in-network cost share. Members seeking health care services in all other states can use providers within the Cigna PPO network at an in-network cost share.

Is Tufts Health Plan Nationwide?

Tufts Health Plan contracts with other provider networks to provide coverage for health care services to its members nationwide.

Can I use Tufts Health Plan in Florida?

You can be outside our service area¹ for up to six consecutive months and still be covered for emergency or urgent care. (For example, if you go to Florida for the winter, you could stay there for up to six consecutive months and be covered).Feb 10, 2022

Is Tufts Health Plan HMO or PPO?

Tufts Health Plan currently offers two Advantage plans: Advantage HMO and Advantage PPO. The Advantage plans require members to pay an upfront deductible for most authorized services, which differentiate these plans from the standard HMO and PPO options.

Is Tufts Navigator a PPO or HMO?

Navigator by Tufts Health Plan is a Preferred Provider Organization (PPO) plan. Members do not need to designate a primary care physician (PCP) or obtain referrals for covered services.

Is Tufts under Cigna?

Cigna has a strategic alliance with Tufts Health Plan to offer CareLink®, an Open Access Plan (OAP). Your patients who have ID cards that display the CareLink logo are able to access care through the Tufts Health Plan network of providers in Massachusetts and Rhode Island.

Who owns Tufts Health Plan?

Point32Health Plan Holdings, Inc.

Tufts Health Plan / Parent organization

What is the federal ID number for Tufts Health Plan?

04-2985923

The Employer Identification Number (EIN) for Tufts Associated Health Plans, Inc. is 04-2985923.

Does Beth Israel accept Tufts Health Plan?

Trusted Providers Help You Feel Your Best

Tufts Health Plan and Beth Israel Deaconess Care Organization (BIDCO) are partners in a MassHealth accountable care organization (ACO) called Tufts Health Together with BIDCO. In an ACO, you receive more coordinated care.

Does Tufts have a PPO plan?

The PPO plan provides a higher level of benefits (in-network) if you use health care providers in Tufts Health Plan's network, and a lower level of benefits if you use non-network providers. You do not need to name a primary care provider (PCP) or receive referrals for specialist visits.

What is Tufts famous for?

Founded in 1852, Tufts University is recognized among the premier universities in the United States, known for its rigorous and innovative research and educational programs. Tufts enjoys a global reputation for academic excellence and for the preparation of students as leaders in a wide range of professions.

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Prior Authorization and Step Therapy Guidelines

Tufts Medicare Preferred HMO requires prior authorization and/or step therapy guidelines for selected drug products that have a specific indication for use, are expensive, or pose significant safety concerns.

Forms

For requests regarding prescription medications that have coverage limitations, the provider may submit clinical documentation using one of the forms listed below:

Is Tufts Health Plan Medicare preferred?

Tufts Health Plan Medicare Preferred is dedicated to providing its members with comprehensive health care coverage. However, there may be times when you have concerns or problems related to your coverage or care. In these instances, you have the right to make formal complaints to Tufts Health Plan Medicare Preferred.

How long do you have to appeal a denied Tufts medical plan?

You have 60 days from the date of our Notice of Denial of Medicare Prescription Drug Coverage to ask for a redetermination. By fax: 1-617-972-9516.

What is a PCP?

Your PCP will provide your routine care, preventive care, and treatment for common illnesses. Your PCP is also responsible for coordinating or overseeing your care. An important part of coordinating your care is when your PCP “refers” you to a specialist for services he/she isn’t able to provide.

What is EOC in insurance?

Your Evidence of Coverage (EOC) document tells you when you can end your membership in the plan. The process for voluntarily ending your membership varies depending on what type of new coverage you are choosing. See your Evidence of Coverage (EOC) document for additional details.

Co-payments

Please Note: Starting November 1, 2018, we can no longer accept cash as a form of payment for deductibles, co-payments or co-insurance at Tufts Medical Center and Tufts Children's Hospital outpatient clinics. We accept all forms of credit cards, debit cards and personal checks. This change allows us to ensure proper documentation of your payment.

Insurance payers and plans

The level of coverage you receive is determined by your health insurance provider. Some health insurance companies may use other companies to cover certain services such as mental health or transplant-related services. Some services may not be covered by your insurance plan.

What are the benefits of Tufts Health Plan?

Tufts Health Plan Medicare Advantage (HMO) (Part C) plans provide all the coverage of Original Medicare (Part A and Part B) plus coverage for important additional benefits: 1 Out-of-pocket limit to the amount you would have to pay for medical expenses in a year. 2 Available with prescription drug coverage so you can have your medical and prescription drug coverage all in one plan. 3 Coverage for routine vision and hearing exams, fitness reimbursements, worldwide travel coverage, and more. 4 You choose a primary care physician to help coordinate the care you need and make informed decisions about your health. 5 We have thousands of PCPs in our network to choose from and can help you select a PCP if you don’t currently have one. 6 Monthly premiums for our Medicare Advantage plans start as low as $0.

Why do people sign up for Medicare Advantage?

Many people choose to sign up for a Medicare Advantage plan in addition to Original Medicare because it covers everything Original Medicare covers plus additional benefits. Medicare Advantage plans are available with prescription drug coverage, so you can have medical and drug coverage in one plan.

What is a private fee for service?

Private Fee-for-Service. The plan determines how much it will pay and how much you must pay for care. Not all providers may accept the plan's payment terms. Also, if your plan has a network, you may pay more to see an out-of-network provider.

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