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Tufts Health Direct ConnectorCare Plan Type I


Tufts Health Direct ConnectorCare Plan Type I is for people who earn up to $11,772 yearly (for an individual) and meet other eligibility requirements.

View the income guidelines to see more family sizes and determine which Tufts Health Direct plan you may be eligible for.

As a Tufts Health Direct ConnectorCare member with Plan Type I:

  • You do not pay co-paymentsClick for Definition for services
  • You may pay co-payments for medications

Learn more about Tufts Health Direct cost-sharing terms.


Service

Cost

Outpatient Medical Care
(Hospital or clinic treatment that does not require an overnight stay)

Community health center visits

No co-payment
(primary care provider
[PCP]/specialist)

Office visits

No co-payment
(PCP/specialist)

Outpatient surgery (hospital/ambulatory surgery centers)

No co-payment

X-rays and diagnostic imaging

No co-payment

High-cost imaging (MRI, CAT, and PET)

No co-payment

Abortion services

No co-payment

Inpatient Medical Care
(Hospital or clinic treatment that requires at least one overnight stay)

Room and board (includes deliveries/surgery/X-rays/labs)

No co-payment

Prescription Drugs

Medication via pharmacy (1-month supply):

  • Generic
  • Preferred
  • Nonpreferred



$1 co-payment

$3.65 co-payment

$3.65 co-payment

Medication via mail order (90-day supply):

  • Generic
  • Preferred
  • Nonpreferred



$2 co-payment

$7.30 co-payment

$10.95 co-payment

Emergency Care

Emergency care

No co-payment

Inpatient Mental Health and/or Substance Abuse
(Hospital or clinic treatment that requires at least one overnight stay)

Mental health and/or substance abuse services

No co-payment

Outpatient Mental Health and/or Substance Abuse
(Hospital or clinic treatment that does not require an overnight stay)

Mental health and/or substance abuse services:

  • Methadone-related services (dosing, counseling, labs)
  • Applied behavioral analysis
  • Autism treatment

No co-payment

Rehabilitation Services

Cardiac rehabilitation

No co-payment

Home health care

No co-payment

Extended inpatient care (100 total days per benefit year):

  • Inpatient care in a skilled nursing facility
  • Inpatient care in a rehabilitation or chronic-disease hospital

No co-payment

Short-term outpatient rehabilitation (physical, occupational, and speech therapies)

No co-payment

Other Benefits

Ambulance

No co-payment

Breastfeeding services

No co-payment

Chiropractic care

No co-payment

Cleft palate/cleft lip care

No co-payment

Dental emergency care/oral surgery

No co-payment

Durable medical equipment/supplies/hearing aids/orthotics/prosthetics/oxygen and respiratory therapy equipment

No co-payment

Hospice

No co-payment

Infertility services

No co-payment

Podiatry

No co-payment

Qualified clinical trials

Depends on place of service

Routine vision (exam every 12 months for diabetics, 24 months for nondiabetics; up to $80 for basic frames/lenses every 24 months)

No co-payment

Wellness (preventive visits/contraceptives/family planning/nutrition)

No co-payment

Maximum Yearly Out-of-Pocket Expenses

PharmacyClick for Definition

$250/$500
(individual/family)

Limits and exclusions may apply.
American Indians and Alaskan Natives do not need to pay co-payments for covered services.

For more information, check our Tufts Health Direct ConnectorCare Plan Type I Summary of Benefits and Coverage (PDF).

For a complete list of services, check our Tufts Health Direct Member Handbook (PDF).

Learn more about Tufts Health Direct benefits.

Learn how to apply.

Questions?
Call us at 888-257-1985 (TTY: 888-391-5535), Monday through Friday, from 8 a.m. to 5 p.m. We're happy to help.

888-257-1985
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