Benefits & costs

You pay no premiums or copayments!

With Tufts Health One Care, you get all the benefits that you currently receive through Medicare and MassHealth (Medicaid) and much more, at no cost to you.

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Benefits

Your Tufts Health One Care benefits cover these services:

Medical

  • Visits to doctors and specialists
  • Hospital stays
  • X-rays and lab tests, and much more

Behavioral health (mental health and/or substance use)

  • You have access to different types and levels of mental health and substance use services based on your needs and recovery goals.

Pharmacy

  • You get your prescriptions through one plan as well as over-the-counter items, such as vitamins, allergy medications, nicotine patches, hydrocortisone cream, etc.

Vision

  • You can get a yearly routine eye exam as well as coverage for eyeglasses and contact lenses.

Dental

  • Your covered dental services include: two routine cleanings each year, an X-ray panel every two years, fillings, orthodontic services, crowns, root canals and dentures (denture services are covered once every seven calendar years).

Medical equipment

  • Your plan covers durable medical equipment (DME) including related supplies, replacement parts, training, modifications, and repairs. Examples of DME that are covered include:
    • Wheelchairs
    • Crutches
    • Powered mattress systems
    • Diabetic supplies
    • Hospital beds ordered by a provider for use in the home
    • Intravenous (IV) infusion pumps
    • Speech generating devices
    • Oxygen equipment and supplies
    • Nebulizers
    • Walkers
  • Other DME items may be covered, including environmental aids or assistive/adaptive technology. The plan may also cover you learning how to use, modify, or repair your DME item. Your Care Team will work with you to decide if these other DME items and services are right for you and will be in your Individualized Care Plan (ICP).
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You’ll also get added support to help you reach your health potential, such as:

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You will see your PCP first for most health problems. Your PCP is a doctor or other provider who makes sure you get the care you need to stay healthy.

You’ll have one care coordinator who will get to know you and help manage your care.

Your Cityblock Health care team will work together to meet your health needs.

A long-term services (LTS) coordinator is part of your care team if you need long-term services and supports (LTSS) services. LTSS are services offered to members who need assistance to do everyday tasks, such as taking a bath, getting dressed, making food and taking medicine. Most of these services are provided in your home or the community, but they may be provided in a nursing home or hospital.

Your LTS coordinator will help you find community resources and supports to help you with overall wellness, independence and recovery.

You may need help with everyday tasks like taking a bath, getting dressed, preparing meals and eating. Personal care attendant services assist you with activities of daily living, if you qualify. For help with these hands-on tasks, you can hire a worker yourself or use an agency to hire one for you.

You may need help with skills and activities that help you manage your health, live independently and take part in your community.

The Tufts Health One Care member services team has bilingual staff and offers FREE translation services in more than 200 languages. We offer alternate formats such as large print and formats that work with screen reader technology, as well as braille and audio.

Medication Therapy Management (MTM) is a clinical program that provides education and information about your medicines. A Pharmacist will look for ways to improve your drug therapy. Services offered through the MTM program include a Comprehensive Medication Review and Targeted Medication Reviews.

There are never any premiums* or copayments (2024) for the services listed in the medical, behavioral health, pharmacy, dental and LTSS sections** of the Tufts Health One Care Summary of Benefits when:

  • Your services (including medical care, services, supplies and equipment) are deemed necessary according to your care plan.
  • You get your care from a network provider.

For more information about your benefits and costs, see your Tufts Health One Care Member Handbook or call us toll-free at 1+855-393-3154 (TTY: 711), seven days a week, from 8 a.m. to 8 p.m.

Have MassHealth but not Medicare?

Call MassHealth at 1+800-841-2900 (TTY: 711), to find out if you qualify for Medicare based on your health needs.

* Note: If you pay a premium to MassHealth for CommonHealth, you must continue to pay the premium to MassHealth to keep your coverage.
** Exceptions may apply; see your Member Handbook for details. 

 

 

Disclaimers

Tufts Health One Care is a health plan that contracts with both Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees.

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook (2024).

Si habla español, tiene disponible los servicios de asistencia de idioma gratis. Llame al 1+855-393-3154 (TTY: 711), siete días de la semana, de 8 a.m. a 8 p.m. La llamada es gratuita.

You can get this document for free in other formats, such as large print, formats that work with screen reader technology, braille, or audio. Call 1+855-393-3154 (TTY: 711), seven days a week, from 8 a.m. to 8 p.m. The call is free.

The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

Benefits may change on January 1 of each year.

 

H7419_4520_CMS Approved
Page modified on: 3/16/2022 5:35 PM