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Tufts Health Direct ConnectorCare Plan Type III

Tufts Health Direct ConnectorCare Plan Type III is for people who earn between $23,545 and $35,316 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 III:

  • You pay a premium (monthly bill) between $78 and $142, depending on your income, family size, and where you live in Massachusetts
  • You pay co-paymentsClick for Definition when you get some covered services

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:

  • Primary care provider (PCP)
  • Specialist



$15 co-payment

$22 co-payment

Office visits:

  • PCP
  • Specialist



$15 co-payment

$22 co-payment

Outpatient surgery (hospital/ambulatory surgery centers)

$125 co-payment

X-rays and diagnostic imaging

No co-payment

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

$60 co-payment

Abortion services

$125 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)

$250 co-payment

Prescription Drugs

Medication via pharmacy (1-month supply):

  • Generic
  • Preferred
  • Nonpreferred



$12.50 co-payment

$25 co-payment

$50 co-payment

Medication via mail order (90-day supply):

  • Generic
  • Preferred
  • Nonpreferred



$25 co-payment

$50 co-payment

$150 co-payment

Emergency Care

Emergency care

$100 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

$250 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

$15 co-payment

Rehabilitation Services

Cardiac rehabilitation

$22 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

$250 co-payment

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

$22 co-payment

Other Benefits

Ambulance

No co-payment

Breastfeeding services

No co-payment

Chiropractic care

$22 co-payment

Cleft palate/cleft lip care

Depends on place of service

Dental emergency care/oral surgery

$100 co-payment

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

20% co-insurance

Hospice

No co-payment

Infertility services

Depends on place of service

Podiatry

$22 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

$750/$1,500
(individual/family)

All other servicesClick for Definition

$1,500/$3,000
(individual/family)

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

For more information, check our Tufts Health Direct ConnectorCare Plan Type III 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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