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Tufts Health Plan

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Author: Kaitlyn Short

LAST UPDATED: April 6th, 2024

Founded by a dean emeritus of Tufts Medical School, Tufts Health Plan is a nonprofit health insurer servicing Massachusetts, Connecticut, Rhode Island, and New Hampshire. 

Some of its plans are only available in Massachusetts and Rhode Island. However, employers based in these states with employees living in other states can offer plans through Tufts Health Plan because of the insurer's partnership with Cigna.

Depending on your area, you can find Medicaid, Medicare, individual or family plans, and employer-sponsored health insurance through Tufts Health Plan.

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The Good

  • Nonprofit Organization
  • Medicare and Medicaid
  • Employer-Sponsored Plan Options

Nonprofit Organization

Tufts Health Plan is a nonprofit organization. Since boosting profits is not a goal of the insurer, it's easier for Tufts Health Plan to focus on the quality and affordability of its services.

Medicare and Medicaid

Tufts Health Plan offers Medicaid plans in Massachusetts and Rhode Island.

If you are eligible for Medicare, you can get a Medicare Advantage or Medicare Supplement plan from Tufts Health Plan. Medicare Supplement (Medigap) plans are standardized by the federal government, and it's unclear which Medigap plan is available through Tufts Health Plan.

Those who qualify for both Medicare and Medicaid can benefit from Tufts Health Plan's dual-eligibility plans that offer combined Medicare and Medicaid coverage. These plans include access to a care manager, which is typical for these plans.

Employers can also offer employer-sponsored Medicare plans. Plan options include Medicare Advantage, prescription drug, and Medigap.

Employer-Sponsored Plan Options

Tufts Health Plan offers a good range of plans that employers can offer employees. Some of these plans are on the health insurance exchange. Others may not be.

Tufts Health Plan's specialty is coverage in Rhode Island and Massachusetts. However, employers with employees not in those states can benefit from the insurer's plans offered in partnership with Cigna. These plans allow employers to offer one of the most sought after benefits to employees wherever they live, which helps make Tufts Health Plan competitive.

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The Bad

  • Insufficient Customer Reviews
  • Primarily Available in 2 States
  • Limited Individual and Family Plans
  • Unclear Membership Perks and Support Programs

Insufficient Customer Reviews

Best Company has not received many Tufts Health Plan reviews, so conclusions about the customer experience and customer satisfaction are not available.

Primarily Available in 2 States

Tufts Health Plan's health insurance is primarily available to people and employers in Rhode Island and Massachusetts. Its service area also includes New Hampshire and Connecticut. 

Although the company has partnered with Cigna to offer health plans to employers with employees outside of Tuft Health Plan's service area, its reach for Medicare, Medicaid, and individual or family health plans is more limited than larger insurers in the industry.

Limited Individual and Family Plans

Tufts Health Plan offers two kinds of health plans on the Massachusetts Health Connector, which is the state's health insurance marketplace. (Massachusetts doesn't use HealthCare.gov.)

Larger insurance carriers sometimes offer more marketplace health plans and even offer additional health plan options off of the health insurance marketplaces. If you're interested in more options, finding another health insurance company may be beneficial.

However, if a health plan from Tufts Health Plan meets your needs, it's worth considering.

Unclear Membership Perks and Support Programs

Many health insurance companies offer support programs and incentives for developing healthy habits to their members. 

While Tufts Health Plan's website mentions support programs for its Medicare and Medicaid members, it does not offer any information on what's available to members with other health plans.

If you're interested in support programs and incentives, work with Tufts Health Plan directly to learn more about whether these are included in their offerings. If similar programs are not offered, you may want to consider another insurance provider.

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The Bottom Line

Although more customer insight would be beneficial, Tufts Health Plan's offerings are worth exploring further if they're available in your area.

If support programs and health incentives are important to you, you may need to work with another insurer that offers these with their individual and family plans.

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8 Reviews

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13%

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1 grade

75%

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Steve Stahl Eastham, MA

Overall Tufts has been ok. However, let me warn you about one area in which they are dismal. Tufts says that they cover Acupunture for chronic back pain under their Medicare coverage. They say they will cover all but $20 per visit with up to 10 visits initially and more if there is progress. However, I saw two different practitioners for a total of 5 visits. I submitted a total of three claims and all of them required appeals and when I finally got notified after submitting a total of 4 appeals that I would get paid, I received a phone call that one of my claims was paid at $10 less that what it should have been but they can't reissue the check, so if I wanted to get what they actually needed to pay me, I was welcome to appeal again. My first claim was made in March, and I just received the check for that now in December of the same year. If you do go this route, make sure you find out the NPI number for your acupuncturist and also what the codes they need to use in their receipt that Medicare requires. But even with that, don't expect to get an easy reimbursement. They were truely shameless in how they handled this. Another negative for this company is that they advertise dental care, but my dentist is not in their network. I guess they don't reimberse enough to providers and my provider dropped them.

11 months ago

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Lauren Hofer Medway, MA

Just called Tufts customer service and was greeted by, “Son of a b….”. From that point forward, despite repeating the basic information several times, the customer service representative was unable to understand my question. I was transferred, apparently, to another party who asserted that, “We’re going to take care of you from this point forward.” The new representative then announced her goodbyes! I said, “Wait. You haven’t answered my question!” And, I explained again. Here are the facts: Wellness Allowance Reimbursement Form submitted 3/21/23; Tufts asserts receipt of same 4/11/23 (three weeks to go from Medway to Canton - 20 miles?); Tufts asserts claim approved and check go out 6/1/23 (72 days from when I submitted claim); rep told me it could take 19 days to travel the 20 miles. Summary: unprofessional and incompetent. LH

1 year ago

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Paul Dutra Ludlow, MA

Here's a simple and total honest appraisal of Tufts Health Plan - STAY AWAY! In all of our years of different health care coverage plans and companies, Tufts is without question, the absolute worst! First of all, they fight you for every claim, and that's if you can actually speak to a real person. They will find every way possible to deny even the simplest claims. Their 'customer service' people are rude, arrogant and poorly trained. And they can't seem to get anything right, and certainly never the first time. Believe me, take from honest and experience people, stay away from Tufts and you'll never regret it!

1 year ago

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Jessica V

I called 66 listed providers on tufts own website page. It took 2 weeks. 85% no longer accept tufts together and 15 weren't accepting new patients. You shouldn't have a list!

8 months ago

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Beverley Barnes Waltham, MA

Absolutely horrible. They refuse to cover things that they are required to cover by law. They create new requirements so you can never get things covered, even if you ask them ahead of time and do everything they said. Useless and expensive.

1 year ago

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John Armstrong Cambridge, MA

Getting a colonoscopy in a couple of days. The doctor is in network and it is still costing me $964 out of pocket. Plus the 2 days I’ll miss work. How come it is costing so much for a diagnostic test that I didn’t even ask for? I pay $350 a month for this garbage insurance as a single man.

2 years ago

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Eileen South Dartmouth, MA

Had to go out of network. They gave me an organizational determination

4 years ago

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bob

not much, to expensive, poor coverage, high copays

6 years ago