Tufts Medicare Preferred HMO covers both brand name drugs and generic drugs. A generic drug is approved by the FDA as having the same active ingredient as the brand name drug. Generally, generic drugs cost less than brand name drugs.
Full Answer
What is Tufts Health Plan's policy number?
If you have questions about your plan, visit Tufts Health Plan or call 844-516-5790 . If you have questions about a Health Savings Account, visit HealthEquity or call 866-346-5800. For questions regarding your Tufts University benefits, contact Tufts Support Services at [email protected] or 617-627-7000.
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Which is the best Medicare plan, Aetna or Humana?
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What is the best supplemental insurance to have with Medicare?
- You must have Medicare Part A and Part B.
- A Medigap policy is different from a Medicare Advantage Plan. ...
- You pay the private insurance company a monthly premium The periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage. ...
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What is the difference between Tufts Medicare complement and Tufts Medicare Preferred?
Members enrolled in the Tufts Health Plan Medicare Complement Plan may utilize any provider that accepts Medicare. Tufts Health Plan Medicare Preferred is an HMO plan with a Medicare contract. Enrollment in Tufts Health Plan Medicare Preferred depends on contract renewal.
Is Tufts Medicare Preferred an HMO?
HMO Plans. Our Tufts Health Plan Medicare Preferred HMO plans are Medicare Advantage plans (also known as Medicare Part C) that offer comprehensive medical coverage beyond Original Medicare (Medicare Parts A & B).
Does Tufts Medicare Preferred cover physical therapy?
Tufts Health Plan covers medically necessary physical therapy (PT), occupational therapy (OT) and speech therapy (ST) services, in accordance with the member's benefit. Services and subsequent payment are pursuant to the member's benefit plan document.
Does Tufts Medicare Preferred cover eye exams?
Our plan pays up to $150 every year for contact lenses and eyeglasses (frames and lenses). Copay applies per visit. You must use an EyeMed Vision Care provider in order to receive the covered Routine Eye Exam benefit.
What is Medicare preferred?
A Preferred Provider Organization (PPO) plan is a Medicare Advantage Plan that has a network of doctors, specialists, hospitals, and other health care providers you can use, but you can also use out-of-network providers for covered services, usually for a higher cost.
Is Tufts Health Plan Medicare or Medicaid?
Tufts Health Plan is one of the few health plans in Massachusetts to participate in the commercial, Medicare and Medicaid/subsidized markets, offering coverage across the life span regardless of age or circumstance.
Does Tufts cover cataract surgery?
Tufts Health Plan may authorize the coverage of Laser-in-situ keratomileusis and photorefractive keratectomy for Members with documented intolerance to contact lens and one of the following conditions: • Anisometropia resulting in a 2 diopter difference following conventional cataract surgery, anterior segment glaucoma ...
Does Tufts Medicare Preferred require prior authorization?
Plan providers are responsible to obtain prior authorization for durable medical equipment (DME) and certain procedures. This list does not include drugs that require prior authorization as part of the Tufts Medicare Preferred HMO Pharmacy Management Program.
Does Tufts cover ambulance service?
S0208 applies to hospital-based ambulance services only. Tufts Health Plan does not routinely compensate for non-ambulance transportation services, if the billing provider's specialty is ambulance.
Is EyeMed part of Tufts?
Besides routine eye exams, providers in the EyeMed network are able to meet certain medical optometry needs. However, if you need to see an ophthalmologist to treat or monitor an eye disease or condition, be sure to confirm that the ophthalmologist participates in the Tufts Health Plan network.
Does medical include vision?
Medi-Cal Vision Benefits Vision benefits are covered for those with full-scope Medi-Cal benefits. For questions regarding your Medi-Cal eligibility, please contact your county social services office.
How do you get reimbursed from EyeMed?
You can now submit your form online or by mail. Don't wait to submit your claim - forms must typically be submitted within 15 months of the date of service to receive reimbursement*. To access the out-of-network form or to check the status of a claim, log in to your Member Web account and navigate to the Claims tab.
Part A: Hospital visits
Part A covers hospital stays, nursing home stays, some home care, and hospice care. Most people don’t pay a monthly premium for Part A, but there is a deductible.
What's covered
Hospital expenses for inpatient hospital stays (e.g. meals, supplies, tests, accommodations)
What does Part A cost?
If you or your spouse paid Medicare taxes while employed, like most people, Part A is premium-free.
What is a medical emergency?
A medical emergency is when you believe your health is in serious danger.
What is urgently needed care?
Urgently needed care is when you need medical care right away because of an illness, injury, or condition that you did not anticipate, but your health is not in serious danger.
You can be away for up to 6 months
You can be outside our service area 1 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).
No referral needed
You do not need a referral from your primary care physician (PCP) before getting emergency or urgent care. Routine care, such as a physical, is not covered outside our service area, so remember to schedule routine care before or after your travel plans.
How to get reimbursed
If you receive emergency care outside our service area, you may need to pay out-of-pocket. Simply save the paperwork for any services you have, and fill out a member reimbursement form or call Customer Relations for reimbursement details 2.
Remember your medication
If you take any medications, make sure you have enough before leaving for a trip. In certain situations, you can request a “vacation override” for a larger supply if you need it. Just call Customer Relations at least 14 business days before leaving for your trip. Be sure to have your prescription and pharmacy information handy.
What if you lose your medication?
If you lose or run out of your medication when traveling, we will cover prescriptions filled at an out-of-network pharmacy if a network pharmacy is unavailable 3.
Step Therapy and Prior Authorization Guidelines
Tufts Health Plan SCO 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:
