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PFFS Terms and Conditions of Payment
 
 
Tufts Medicare Preferred PFFS: 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.

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 your yearly drug costs (paid by both 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.

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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