Tufts Health products

Tufts Health Plan offers a wide range of plans to meet the needs of members and employers throughout our service area. Our family of plans includes standard, tiered, and limited network products, senior plans, Medicaid plans, and more. Below, we offer an overview of our products.

Please utilize our other resources — including our member ID cards and the Tufts Health Plan portal — for assistance in understanding the member’s plan. For more information about our plans and to view sample member ID cards, see our Product Overview and Member ID Card Guide. Prior to rendering services at an appointment, please check the member’s eligibility and benefits via the Tufts Health Plan secure portal, NEHEN, NEHEN Net, or your preferred connection for eligibility services.

Learn about our Products

Commercial

Tufts Health Plan offers a range of products and plan designs including HMO, PPO, POS, EPO, Tiered, and Limited Network plans.

As part of Point32Health’s integration, the Commercial Markets business is moving toward a more unified product portfolio. We are migrating Tufts Health Plan’s commercial members to Harvard Pilgrim Health Care commercial plans. For the latest information about our Commercial migration, read our Integration FAQ.

Uniformed Services Family Health Plan (USFHP) is a Department of Defense-sponsored health plan through TRICARE. Tufts Health Plan is contracted with USFHP as a third-party administrator to process claims, referrals and authorizations, as well as offer care management and member service support. For more information and resources on USFHP including the Provider Manual, visit the USFHP provider website.

Senior Products

Tufts Health Plan offers Medicare plans that are available to Medicare-eligible individuals.

Tufts Medicare Preferred HMO is a Medicare Advantage plan that requires members to select a network PCP who helps to coordinate their care. HMO members must generally receive services in-network to be covered, except for urgent/emergent care or plan approved out-of-network services
Tufts Medicare Preferred PPO is a Medicare Advantage plan that does not require members to select a PCP. PPO members can receive covered services in- and out-of-network without referral, and cost share is generally higher for out-of-network services. For more information, please refer to the Tufts Medicare Preferred PPO Quick Reference Guide.
Tufts Health Plan Senior Care Options is a specialized Medicare Advantage plan (a Medicare “Special Needs Plan”) for individuals aged 65 and older who qualify for Medicare and qualify for MassHealth Standard (Medicaid). Participating providers are required to complete the Tufts Health Plan SCO training on an annual basis. For details, refer to the Required Trainings section of our training page. For information on continuing education resources, please refer to this flyer.

Tufts Health Public Plans

Tufts Health Public Plans include qualified health plans and products available to members who are enrolled in MassHealth or Rhode Island Medicaid.

Tufts Health Direct is a Massachusetts qualified health plan (a Commercial product) for individuals and small groups sold on the Massachusetts Health Connector and through HSA Insurance.
Tufts Health RITogether provides high-quality health care coverage to individuals enrolled in Rhode Island Medicaid.
Tufts Health Together provides high-quality, low-cost coverage to individuals enrolled in MassHealth. This includes a Managed Care Organization plan and two Accountable Care Partnership Plans: Tufts Health Together with Cambridge Health Alliance and Tufts Health Together with UMass Memorial Health.
Tufts Health One Care is a dual-eligible Medicare-Medicaid One Care plan. The One Care program is a MassHealth and CMS initiative to integrate the delivery and financing of Medicare and Medicaid services for those who are eligible for both Medicare and Medicaid. Visit our Provider Training webpage to access cultural competency resources, as well as a required One Care program training.