Tufts Medicare Preferred

Plan Information

Medical Benefit

Plan Information

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PFFS Terms and Conditions of Payment

Tufts Medicare Preferred PFFS: Medical Benefit

Tufts Health Plan Medicare Preferred's new Private Fee-for-Service (PFFS) plan offers different levels of coverage to meet your medical and prescription coverage needs.

The chart below gives you a brief overview of our PFFS medical coverage options. For a more detailed description of plan benefits and costs, see the Tufts Medicare Preferred PFFS Summary of Benefits booklet.

Once you have compared the medical benefits below, compare your prescription drug options by clicking on 'Prescription Benefit' on the menu to the left.

Click on Step 2 to Select Your Prescription Drug Plan.

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	PFFS Basic	PFFS Prime
Doctor's Office Visits	$25	$15
Specialist's Office Visits	$25	$15
Inpatient General Hospital Coverage	$200/day for day(s) 1-5; After Day 5: $0 co-payment	$200/year
Worldwide Emergency Coverage	$50	$50
Maximum Out-Of-Pocket Costs (per calendar year)	$3,350	$0
Vision Services	$25 co-payment for one routine eye exam per year; $150 toward eyewear every year	$15 co-payment for one routine eye exam per year; $150 toward eyewear every year
Hearing Services	$25 co-payment for one routine hearing test per year	$15 co-payment for one routine hearing test per year
Annual Fitness Beneft	$150 toward fitness club membership per year

Note:
A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. Your doctor or hospital is not required to agree to accept the plan's terms and conditions, and thus may choose not to treat you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may choose not to provide health care services to you, except in emergencies. Providers can find the plan's terms and conditions on our website at: tuftshealthplan.com/medicare.

H3057-2009-17 9/30/08

This document was last modified: 9/30/08

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The Medicare Advantage contract between Tufts Health Plan and the Centers for Medicare & Medicaid Services (CMS) is valid for one calendar year. The benefits, premiums, copayments and service area offered by Tufts Health Plan are subject to change on an annual basis. Please contact Tufts Health Plan Medicare Preferred for details. Tufts Health Plan Medicare Preferred is a medicare advantage organization that contracts with the Federal Government.

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