To get the best Web site experience, please enable JavaScript in your browser’s preferences.

 



Tufts Health Direct Platinum


Tufts Health Direct offers two platinum plan levels, Platinum Zero and Platinum 500, each with their own annual deductibles and out-of-pocket maximums, and their own cost sharing for covered services.

Learn more about Tufts Health Direct cost-sharing terms.

Key differences:

Tufts Health Direct Platinum Zero

Tufts Health Direct Platinum 500

No annual deductibles

Has an annual medical deductible, and no annual pharmacy deductible

Higher out-of-pocket expenses than Platinum 500

Lower out-of-pocket expenses than Platinum Zero

Note: Some medical services require that you meet your deductible before co-payments apply.

See coverage costs below:


Tufts Health Direct Platinum Zero

Tufts Health Direct Platinum 500

Annual deductible (individual/family)

MedicalClick for Definition

$0/$0

$500/$1,000

PharmacyClick for Definition

$0/$0

$0/$0

Annual out-of-pocket maximum (individual/family)

MedicalClick for Definition

$1,500/$3,000

$1,250/$2,500

PharmacyClick for Definition

$500/$1,000

$250/$500


Costs for covered services

Covered service

Co-paymentsClick for Definition and co-insuranceClick for Definition

Platinum Zero

Platinum 500

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

Community health center visits:

  • Primary care provider (PCP)
  • Specialist



$25 co-payment

$40 co-payment



$20 co-payment

$35 co-payment

Office visits:

  • PCP
  • Specialist



$25 co-payment

$40 co-payment



$20 co-payment

$35 co-payment

Outpatient surgery (hospital/ambulatory surgery centers)

$500 co-payment

No co-payment*

X-rays and diagnostic imaging

$20 co-payment

$20 co-payment

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

$150 co-payment

$100 co-payment*

Abortion services

$500 co-payment

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)

$500 co-payment

No co-payment*

Prescription Drugs

Medication via pharmacy (1-month supply):

  • Generic
  • Preferred
  • Nonpreferred



$15 co-payment

$30 co-payment

$50 co-payment



$15 co-payment

$25 co-payment

$45 co-payment

Medication via mail order (90-day supply):

  • Generic
  • Preferred
  • Nonpreferred



$30 co-payment

$60 co-payment

$150 co-payment



$30 co-payment

$50 co-payment

$135 co-payment

Emergency Care

Emergency care

$150 co-payment

$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

$500 co-payment

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

$25 co-payment

$20 co-payment

Rehabilitation Services

Cardiac rehabilitation

$40 co-payment

$35 co-payment

Home health care

No co-payment

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



$500 co-payment

$500 co-payment




No co-payment*

No co-payment*

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

$40 co-payment

$35 co-payment

Other Benefits

Ambulance

No co-payment

No co-payment

Breastfeeding services

No co-payment

No co-payment

Chiropractic care

$40 co-payment

$35 co-payment

Cleft palate/cleft lip care

Depends on place of service

Dental emergency care/oral surgery

$150 co-payment

$100 co-payment*

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

20% co-insurance

20% co-insurance

Hospice

No co-payment

No co-payment

Infertility services

Depends on place of service

Podiatry

$40 co-payment

$35 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

No co-payment

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

No co-payment

No co-payment

* After deductible

Limits and exclusions may apply.
American Indians and Alaskan Natives do not need to pay co-payments or co-insurance for services received through the Indian Health Service.

For more information, check our Tufts Health Direct Platinum Zero Summary of Benefits and Coverage (PDF), and Tufts Health Direct Platinum 500 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
  Call us  
->
  Contact us  
->
  About us  
->