Tufts Health Plan Insurance Review & Complaints (2024)

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Tufts Health Plan is a nonprofit operating mainly in Massachusetts and Rhode Island, with coverage extended to nearly one million members. They offer a range of health insurance plans for individuals and families as well as group plans for employers.

About Tufts health plan

Tufts Health Plan came out of Tufts University Medical School in 1979 when Dr. Morton Madoff founded an HMO health plan connected to the school. Shortly thereafter, the plan added the option of a POS format, leading the way for other similar companies to do the same, although today most plans offered are HMO plans. Health coverage was extended to New Hampshire in 1995, and later to Rhode Island and a few counties in Connecticut as well.

Tufts offers individual health plans on two different networks as well as Medicare and Medicaid options. You can read our full review of Tufts Medicare plans here. The majority of Tufts’ 1 million plus members receive their insurance through group plans provided by employers. Currently, individual and family plans are only offered in Massachusetts, with other states offering group health plans.

Read more: Tufts Health Plan Medicare Review & Complaints: Health Insurance

Tufts Health headquarters is located in Watertown, MA, with branches throughout the service area.

What Tufts health plans are offered?

Tufts offers two families of plans, Direct and Premier. Direct is a more low-cost option while Premier offers a larger range of in-network providers. The two networks include different providers, but both are HMO’s, which means the networks are limited.

Tufts Health Direct

There are several levels of Tufts Health Direct plans, ranging from catastrophic to platinum levels, along with the ConnectorCare plans. Some plans are specifically for low-income families and have income qualifications. Out-of-network care coverage is not offered for any plans offered by Tufts.

The Catastrophic Plan has a $7,150 individual deductible and $14,300 for a family. Primary care visits have a 50% coinsurance, and other visits are not covered until the deductible is met. The deductible with this plan is also the out-of-pocket limit. Prescription drugs are not covered until after the deductible.

The Direct Bronze Plan has a $2,500 individual and $5,000 family deductible. There is a separate pharmacy deductible of $250 for an individual and $500 for a family. Primary care visits have a $25 copay while specialist visits have a $50 copay. After the deductible, prescriptions start at a $25 copay.

Direct Silver 2200 has a $2,200 individual deductible and a $4,400 family deductible. Primary care visits have a $50 copay while specialist visits have a $75 co-pay. Prescription drugs start at a $35 copay.

Direct Silver 2000 has a $2,000 individual and $4,000 family deductible. There is a $30 copay for primary care visits and a $50 copay for specialists. Prescription drugs start at $20.

Direct Gold 1000 has a $1,000 individual deductible and a $2,000 family deductible. Primary care visits are a $20 copay while specialist visits have a $45 copay. Generic drugs start at a $20 copay.

Direct Gold 500 is a low deductible plan with a $500 individual and $1,000 family deductible. Primary care visits have a $20 copay and specialist visits have a $35 copay. Prescription drug coverage starts at $15 for generic Tier 1 drugs.

Direct Platinum is a $0-deductible plan with a $25 copay for primary care visits and a $40 copay for specialist visits. Generic drugs start at $15.

There are three Direct ConnectorCare plans, all of which have income requirements to qualify. Type I is a $0 deductible plan with no co-pays whatsoever for any office visits. Generic drugs start at $1 and there is a low out-of-pocket limit of $250 for an individual and family on prescriptions.

Type II is a similar $0-deductible plan with slightly higher out-of-pocket limits. Co-pays are $10 for primary care and $18 for specialist visits. Prescription drug coverage starts at $10.

Like the others, Type III has no deductible, but again the out-of-pocket limits are higher. Co-pays are $15 for primary care and $22 for specialists. Prescription drugs start at $12.50 for Tier 1 drugs.

Tufts Health Premier

There is one Premier plan at each metallic level. These plans offer a wider network than the Direct plans, but there is still no out-of-network coverage.

The Bronze Saver 3300 has an individual deductible of $3,300 and a family deductible of $6,600. Co-pays are $40 for primary care visits and $65 for specialist visits. Tier 1 drugs start at a $35 copay.

Premier Silver 2000 has an individual deductible of $2,000 and a family deductible of $4,000. Co-pays are $30 for a primary care visit and $50 for a specialist visit. Generic drug coverage starts at $20.

The Premier Gold 1000 plan has a $1,000 individual deductible and a $2,000 family deductible, with co-pays of $30 for primary care and $45 for specialist visits. Prescription drugs start at a $20 copay.

Finally, the Premier Platinum plan is a $0-deductible plan that has a $25 copay for primary care visits and a $45 copay for specialists. Tier 1 drugs start at a $15 copay.

Tufts  is committed to providing high-quality and affordable health care, improving the health and wellness of their members, and creating healthier communities throughout New England. You can read our rundown of Massachuesetts Medicare Advantage companies to learn about how folks are staying healthy with Medicare insurance in the New England area.

What prescription drugs are covered?

Tufts Health Together uses a Preferred Drug List (PDL) as our list of covered drugs. To quickly find out if we cover a specific drug, look it up in our PDL. They update the PDL every three months. The PDL applies only to drugs you get at retail and specialty pharmacies. The PDL does not apply to drugs you get if you are in the hospital

How to get Tufts rates?

Tufts Health offers a quick rate chart on its website that outlines plan costs based on income level for the Direct plans. ConnectorCare Level 1 is offered with no monthly premium at the lowest income level, and rates rise from there. Prices are not given for catastrophic or metallic-level plans, which vary based on plan level and income.

Since Tufts is a regional HMO, it is difficult to compare their rates to other companies. They do appear to have plans available at all income levels, right down to a $0-premium option for low-income individuals and families.

Claims Process at Tufts Health Plan

Ease of Filing a Claim (Online, Over the Phone, Mobile Apps)

Tufts Health Plan makes it convenient for policyholders to file claims. They offer multiple channels for claim submission, including online, over the phone, and through mobile apps. This flexibility allows policyholders to choose the method that best suits their preferences and needs.

Average Claim Processing Time

The average claim processing time at Tufts Health Plan is not explicitly mentioned in the provided content. Policyholders may want to inquire directly with the insurance provider or refer to their official website for more information on claim processing times.

Customer Feedback on Claim Resolutions and Payouts

Customer feedback on claim resolutions and payouts is essential for assessing an insurance company’s performance. While the content does not provide specific customer feedback, policyholders can explore online reviews and customer testimonials to gain insights into Tufts Health Plan’s claim resolution and payout experiences.

Discover the Digital and Technological Features Offered by Tufts Health Plan

Mobile App Features and Functionality

Tufts Health Plan offers a mobile app that provides policyholders with convenient access to their insurance information. The content does not detail the specific features and functionality of the app, so interested individuals should visit the official Tufts Health Plan website or app store for a comprehensive overview of what the mobile app offers.

Online Account Management Capabilities

The content mentions online account management capabilities without specifying their extent. Policyholders can typically expect online account management to include tasks such as reviewing policy details, making premium payments, tracking claims, and accessing important documents.

For a detailed list of online account management features, it’s advisable to visit Tufts Health Plan’s official website.

Digital Tools and Resources

The content briefly touches on Tufts Health Plan’s commitment to providing high-quality and affordable healthcare. While specific digital tools and resources are not mentioned, policyholders can explore the insurer’s website and mobile app for resources such as health and wellness guides, cost estimation tools, and educational materials related to healthcare coverage.

What are the ratings and consumer reviews?

Tufts Health Plans has an A rating with the Better Business Bureau (BBB), and there have been 11 complaints against them in the past three years. This is a change from our attempt to retrieve a BBB rating on Tufts when we reviewed their Medicare plans – at the time the company returned a “Not Rated” on the file. That has been updated, and now the file lists three complaints that have not been resolved among the 11 as the reason for the slightly lowered rating.

Tufts has an overall rating of 5.0 from the National Committee for Quality Assurance. Their rating in the area of consumer satisfaction, however, is a 3.5 with lower rankings in the areas of getting care quickly and easily. Tufts does rank quite high overall in most of the other rankings.

There are currently seven reviews on Pissed Consumer, with two company responses to the issues. Complaints typically surround customer service issues and billing errors.

Tufts overall has a low complaint volume that does not seem to raise any major red flags, although they could be more responsive to complaints online. Overall, they have a good reputation.

What’s the bottom line?

Tufts is a good choice for anyone in their service area looking for an HMO plan at a relatively low cost. Provider networks are limited, particularly in the Direct plans, but this may not be a problem for those who rarely travel and do not have complex health needs. The company has a solid reputation with generally high ratings and a low complaints volume.

On January 4th, 2021, Tufts Health Plan and Harvard Pilgrim Health Care joined together to improve health care for everyone.

Read more:

• Harvard Pilgrim Health Care Insurance Review & Complaints
• Harvard Pilgrim Health Care Medicare Review & Complaints: Health Insurance