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PFFS Terms and Conditions of Payment
 
 
Tufts Medicare Preferred HMO: Prescription Benefit
Tufts Medicare Preferred offers two prescription drug options. By selecting either one of these options, you are automatically enrolled in a qualified Medicare Part D prescription drug plan. Please compare the two prescription drug options below. If you enroll in the Tufts Medicare Preferred HMO and you want the Medicare prescription benefit, you must purchase it through our plan.

Click on Step 3 to Select Your Premium.
 
 
Print Comparison Chart  Download Adobe Reader( Adobe® Reader® required )
  Rx Option Rx Plus Option
Description You pay NO upfront deductible You pay NO upfront deductible
Yearly drug costs paid by both you and Tufts Medicare Preferred Covered up to $2,700 Covered up to $2,700
Copays for up to a 30-day supply at a retail pharmacy Tier 1: $10
Tier 2: $35
Tier 3: $65
 Tier 1: $10
Tier 2: $30
Tier 3: $60
Copays for up to a 90-day supply through mail order Tier 1: $20
Tier 2: $70
Tier 3: $130 		Tier 1: $20
Tier 2: $60
Tier 3: $120
"Coverage Gap" After yearly drug costs paid by you and Tufts Medicare Preferred reach $2,700 but before your yearly out-of-pocket costs reach $4,350 You pay 100% of the Tufts Medicare Preferred negotiated price for your prescription drug costs. You are covered for Tier 1 (member pays 100% for Tier 2 and 3):
Copays for up to a 30-day supply at a retail pharmacy   Tier 1: $10
Copays for up to a 90-day supply through mail order   Tier 1: $20
After the "Coverage Gap"
Copays for retail and mail order		 Tier 1: $2
Tier 2: $8
Tier 3: $14 		Tier 1: $2
Tier 2: $8
Tier 3: $14
 
Note:
See the list of covered drugs (formulary) and directory of participating pharmacies for locations where you can get your prescriptions filled. Some medications require prior authorization or dispensing limits. For more information, see the Summary of Benefits booklet.

If you live in one of the following zip codes, you live outside the service area and are not eligible to enroll in our HMO plan: Bristol County - 02715, 02718, 02764, 02779, 02780, 02783. Plymouth County: 02344, 02346, 02347, 02348, 02349.


H2256-2009-19 9/30/08
This document was last modified: 9/30/08
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