q1medicare.com
Powered by Q1Group LLC
A non-government resource for the Medicare community
Powered by Q1Group LLC
A non-government Medicare community resource
  • Menu ☰
  • Home
  • Contact
  • MAPD
  • PDP
  • 2024
  • 2025
  • FAQs
  • Articles
  • Search ⌕
  • Contact
  • 2024
  • 2025
  • FAQs
  • Articles
  • Latest Medicare News
  • Search ⌕

2016 Medicare Advantage Plan Benefit Details for the Tufts Health Unify (Medicare-Medicaid Plan) - H7419-001-0
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2016 Medicare Advantage Plan Details
Medicare Plan Name:Tufts Health Unify (Medicare-Medicaid Plan)
Location:Suffolk, Massachusetts     Click to see other locations
Plan ID:H7419 - 001 - 0     Click to see other plans
Member Services:1-855-393-3154 TTY users 1-888-391-5535
— This plan information is for research purposes only. —
Click here to see plans for the current plan year
Medicare Contact Information:Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options.
TTY users 1-877-486-2048
or contact your local SHIP for assistance
Email a copy of the Tufts Health Unify (Medicare-Medicaid Plan) benefit details
— Medicare Plan Features —
Monthly Premium:$0.00 (see Plan Premium Details below)
Annual Deductible:$0
Health Plan Type:MMP
Maximum Out-of-Pocket Limit for Parts A & B (MOOP):$0
Additional Gap Coverage?Yes, some additional gap coverage.
Total Number of Formulary Drugs:4,206 drugsBrowse the Tufts Health Unify (Medicare-Medicaid Plan) Formulary
This plan has 3 drug tiers. See cost-sharing for all pharmacies and tiers. 
Formulary Drug Details:Tier 1Tier 2Tier 3Tier 4Tier 5
• Preferred Pharmacy
  Cost-Sharing during
  initial coverage phase:		$0.00$0.00$0.00  
• Number of Drugs per
  Tier:		25001706
Plan's Pharmacy Search:http://www.TuftsHealthUnify.org
Plan Offers Mail Order?Yes
Number of Members enrolled in this plan in Suffolk, Massachusetts:1,357 members
Number of Members enrolled in this plan in Massachusetts:2,639 members
Number of Members enrolled in this plan in (H7419 - 001):2,687 members
Plan’s Summary Star Rating: Insufficient data to rate this plan.
• Customer Service Rating: Insufficient data to rate this plan.
• Member Experience Rating: Insufficient data to rate this plan.
• Drug Cost Accuracy Rating: Insufficient data to rate this plan.
— Plan Premium Details —
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔100%
Subsidy		75%
Subsidy		50%
Subsidy		25%
Subsidy
Monthly Part D Premium with LIS:$0.00$0.00$0.00$0.00
— Plan Health Benefits —
** Cost **
Monthly premium, deductible, and limits on how much you pay for covered services
Some services may require a monthly payment amount.
You pay nothing
In this plan you will pay nothing for services from any provider.
Please note that you will still need to pay your cost-sharing for your Part D prescription drugs.
No. There are no limits on how much our plan will pay.
** Doctor and Hospital Choice **
Acupuncture
For up to 20 visit(s) every year:  You pay nothing
** Extra Benefits **
Inpatient mental health care
For inpatient mental health care see the "Mental Health Care" section.
Outpatient prescription drugs
For Part B drugs such as chemotherapy drugs1:  You pay nothing
Other Part B drugs1:  You pay nothing
You may get your drugs at network retail pharmacies and mail order pharmacies.
You pay nothing
If you reside in a long-term care facility you pay the same as at a retail pharmacy.
You may get drugs from an out-of-network pharmacy at the same cost as an in-network pharmacy.
You pay the following:
TierYour cost
Tier 1 (Generic Drugs)$0
Tier 2 (Brand Drugs)$0
Tier 3 (Non-Medicare OTC Drugs)$0
Institutional care
Nursing home services:   You pay nothing
** Important Information **
Monthly premium, deductible, and limits on how much you pay for covered services
Some services may require a monthly payment amount.
You pay nothing
In this plan you will pay nothing for services from any provider.
Please note that you will still need to pay your cost-sharing for your Part D prescription drugs.
No. There are no limits on how much our plan will pay.
** Outpatient Care and Services **
Acupuncture
For up to 20 visit(s) every year:  You pay nothing
Additional home care services
Personal care services:   You pay nothing
Private duty nursing services:   You pay nothing
Self-directed personal assistance services:   You pay nothing
Additional services
Behavioral Health Care Services:   You pay nothing
Chronic Disease and Rehabilitation Hospital Inpatient:   You pay nothing
Adult Day Health:   You pay nothing
Adult Foster Care:   You pay nothing
Day Habilitation:   You pay nothing
Group Adult Foster Care:   You pay nothing
Hospice:   You pay nothing
Orthotic Services:   You pay nothing
Speech and Hearing Services:   You pay nothing
Diversionary Behavioral Health Services:   You pay nothing
Community Based Services:   You pay nothing
Abortion:   You pay nothing
Gender Reassignment:   You pay nothing
Ambulance
You pay nothing
Chiropractic care
Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position):  You pay nothing
Routine chiropractic visit (for up to 20 every year):  You pay nothing
Dental services
Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth):  You pay nothing
Preventive dental services:
  • Cleaning (for up to 2 every year):  You pay nothing
  • Dental x-ray(s) (for up to 1 every two years):  You pay nothing
  • Fluoride treatment (for up to 2 every year):  You pay nothing
  • Oral exam (for up to 2 every year):  You pay nothing
    • Diabetes supplies and services
    Diabetes monitoring supplies:  You pay nothing
    Diabetes self-management training:  You pay nothing
    Therapeutic shoes or inserts:  You pay nothing
    Diagnostic tests, lab and radiology services, and x-rays (Costs for these services may be different if received in an outpatient surgery setting)
    Diagnostic radiology services (such as MRIs CT scans):  You pay nothing
    Diagnostic tests and procedures:  You pay nothing
    Lab services:  You pay nothing
    Outpatient x-rays:  You pay nothing
    Therapeutic radiology services (such as radiation treatment for cancer):  You pay nothing
    Doctor's office visits
    Primary care physician visit:  You pay nothing
    Specialist visit:  You pay nothing
    Durable medical equipment (wheelchairs, oxygen, etc.)
    You pay nothing
    Durable medical equipment for use outside the home:  You pay nothing
    MassHealth State DME Benefit Training in Usage Repairs Modifications:  You pay nothing
    Environmental Aids and Assistive/Adaptive Technologies:  You pay nothing
    Emergency care
    You pay nothing
    Foot care (podiatry services)
    Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions:  You pay nothing
    Routine foot care:  You pay nothing
    Hearing services
    Exam to diagnose and treat hearing and balance issues:  You pay nothing
    Routine hearing exam (for up to 1 every year):  You pay nothing
    Hearing aid fitting/evaluation (for up to 1 every year):  You pay nothing
    Hearing aid:  You pay nothing
    Home health care
    You pay nothing
    Additional hours of care:  You pay nothing
    Personal Care Services:  You pay nothing
    Mental health care
    Inpatient visit:
    Our plan covers an unlimited number of days for an inpatient hospital stay.
    You pay nothing
    Outpatient group therapy visit:  You pay nothing
    Outpatient individual therapy visit:  You pay nothing
    Outpatient rehabilitation
    Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions per day for up to 36 sessions up to 36 weeks):  You pay nothing.  Additional visits are covered but your cost may be more.
    Respiratory care services:  You pay nothing
    Occupational therapy visit:  You pay nothing
    MassHealth State Benefit Plan - Occupational Therapy Services:  You pay nothing
    Physical therapy and speech and language therapy visit:  You pay nothing
    MassHealth State Plan Benefit-Physical and Speech Svcs:  You pay nothing
    Outpatient substance abuse
    Group therapy visit:  You pay nothing
    Individual therapy visit:  You pay nothing
    Outpatient surgery
    Ambulatory surgical center:  You pay nothing
    Outpatient hospital:  You pay nothing
    Freestanding birth center services:  You pay nothing
    Over-the-counter items
    Not Covered
    Prosthetic devices (braces, artificial limbs, etc.)
    Prosthetic devices:  You pay nothing
    Related medical supplies:  You pay nothing
    MassHealth State Plan Benefit - Prosthetics:  You pay nothing
    Renal dialysis
    You pay nothing
    Transportation
      You pay nothing
    Urgently needed services
    You pay nothing
    Vision services
    Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening):  You pay nothing
    Routine eye exam (for up to 1 every year):  You pay nothing
    Contact lenses (for up to 1 every two years):  You pay nothing
    Eyeglasses (frames and lenses) (for up to 1 every two years):  You pay nothing
    Eyeglass frames (for up to 1 every two years):  You pay nothing
    Eyeglass lenses (for up to 1 every two years):  You pay nothing
    Eyeglasses or contact lenses after cataract surgery:  You pay nothing
    ** Hospice **
    Hospice
    You pay nothing for hospice care from a Medicare-certified hospice. You may have to pay part of the cost for drugs and respite care.
    ** Preventive Care **
    Preventive care
    You pay nothing
    Our plan covers many preventive services including:
    • Abdominal aortic aneurysm screening
    • Alcohol misuse counseling
    • Bone mass measurement
    • Breast cancer screening (mammogram)
    • Cardiovascular disease (behavioral therapy)
    • Cardiovascular screenings
    • Cervical and vaginal cancer screening
    • Colorectal cancer screenings (Colonoscopy Fecal occult blood test Flexible sigmoidoscopy)
    • Depression screening
    • Diabetes screenings
    • HIV screening
    • Medical nutrition therapy services
    • Obesity screening and counseling
    • Prostate cancer screenings (PSA)
    • Sexually transmitted infections screening and counseling
    • Tobacco use cessation counseling (counseling for people with no sign of tobacco-related disease)
    • Vaccines including Flu shots Hepatitis B shots Pneumococcal shots
    • "Welcome to Medicare" preventive visit (one-time)
    • Yearly "Wellness" visit
    Any additional preventive services approved by Medicare during the contract year will be covered.
    Family planning services:  You pay nothing
    Tobacco cessation counseling for pregnant women:  You pay nothing
    ** Inpatient Care **
    Inpatient hospital care
    Our plan covers an unlimited number of days for an inpatient hospital stay.
    You pay nothing
    Inpatient mental health care
    For inpatient mental health care see the "Mental Health Care" section.
    Institutional care
    Nursing home services:   You pay nothing
    Skilled Nursing Facility (SNF)
    Our plan covers an unlimited number of days in a SNF.
    You pay nothing
    Outpatient prescription drugs
    For Part B drugs such as chemotherapy drugs1:  You pay nothing
    Other Part B drugs1:  You pay nothing
    You may get your drugs at network retail pharmacies and mail order pharmacies.
    You pay nothing
    If you reside in a long-term care facility you pay the same as at a retail pharmacy.
    You may get drugs from an out-of-network pharmacy at the same cost as an in-network pharmacy.
    You pay the following:
    TierYour cost
    Tier 1 (Generic Drugs)$0
    Tier 2 (Brand Drugs)$0
    Tier 3 (Non-Medicare OTC Drugs)$0
    Additional home care services
    Personal care services:   You pay nothing
    Private duty nursing services:   You pay nothing
    Self-directed personal assistance services:   You pay nothing
    ** Outpatient Care **
    Diabetes supplies and services
    Diabetes monitoring supplies:  You pay nothing
    Diabetes self-management training:  You pay nothing
    Therapeutic shoes or inserts:  You pay nothing
    Foot care (podiatry services)
    Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions:  You pay nothing
    Routine foot care:  You pay nothing
    Hearing services
    Exam to diagnose and treat hearing and balance issues:  You pay nothing
    Routine hearing exam (for up to 1 every year):  You pay nothing
    Hearing aid fitting/evaluation (for up to 1 every year):  You pay nothing
    Hearing aid:  You pay nothing
    ** Outpatient Medical Services and Supplies **
    Outpatient substance abuse
    Group therapy visit:  You pay nothing
    Individual therapy visit:  You pay nothing
    Prosthetic devices (braces, artificial limbs, etc.)
    Prosthetic devices:  You pay nothing
    Related medical supplies:  You pay nothing
    MassHealth State Plan Benefit - Prosthetics:  You pay nothing
    ** Additional Benefits **
    Inpatient mental health care
    For inpatient mental health care see the "Mental Health Care" section.
    Institutional care
    Nursing home services:   You pay nothing




    Medicare Supplements
    fill the gaps in your
    Original Medicare
    1. Enter Your ZIP Code:
    » Medicare Supplement FAQs




    © Q1Group LLC 2005 - 2024  



    Tips & Disclaimers
    • Q1Medicare®, Q1Rx®, and Q1Group® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group.
    • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
    • Medicare has neither reviewed nor endorsed the information on our site.
    • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
    • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
    • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.com provide highlights of annual plan benefit changes.
    • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
    • Limitations, copayments, and restrictions may apply.
    • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
      Statement required by Medicare:
      "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
    • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
    • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
    • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
    • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
    • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
    • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
    • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
    • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
    • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
    • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
    • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
    • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
    • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
    • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
    • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
    .