There are many different types of health insurance and each insurance company may offer multiple different plans to hundreds of employers and their employees. For this reason, it is very important that you understand the unique components of your plan and ask your health plan or employer what care and services they will cover and what they expect you to pay for directly. The best way to reach your insurer is typically the member services number on your insurance card.
Below, we’ve listed the health insurance plans and products that are accepted at Tufts Medical Center. If your health insurance company or plan is not listed, please contact your health insurance provider to better understand your benefit plan and provider network available to you.
Many insurance plans have different levels of costs for their members depending on where they receive care. The information below can be used as a reference but you should check with your plan to see what level of coverage you will receive for any care provided by Tufts Medical Center. It is also important to check with your insurance plan to see if you need additional referrals and/or authorizations before getting care at Tufts MC.
Emergency department physicians may not be in-network with all the payors or plans listed below. Please contact your insurance company regarding coverage for the physician component of emergency services at Tufts Medical Center.
Co-payments
Please Note: Starting November 1, 2018, we can no longer accept cash as a form of payment for deductibles, co-payments or co-insurance at Tufts Medical Center outpatient clinics. We accept all forms of credit cards, debit cards and personal checks. This change allows us to ensure proper documentation of your payment. We apologize for any inconvenience and thank you for your understanding.
This new policy applies to outpatient clinics only at Tufts MC. The pharmacy, Emergency Department and the dining options within Tufts MC will still accept cash. Learn more >
Insurance payers and plans
The level of coverage you receive is determined by your health insurance provider. Some health insurance companies may use other companies to cover certain services such as mental health or transplant-related services. Some services may not be covered by your insurance plan. Again, it is very important that you ask your health insurance provider or employer what care and services they will cover and what they expect you to pay for directly.
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Insurance Payer
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Plans Accepted
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Aetna
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- All Commercial Plans
- Medicare Advantage PPO
- Medicare Supplemental (i.e. Medex) -- (if patient has Medicare as primary)
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| Anthem Blue Cross Blue Shield |
- HMO- only with referral/prior auth.
- PPO
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Blue Cross Blue Shield of Massachusetts
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- Most Massachusetts Plans
- Medicare Advantage
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| Blue Cross Blue Shield of Rhode Island |
- PPO (large employer groups)
RI ConnectorCare:
- Blue Solutions HAS
- Basic Blue Direct
- Vantage Group Direct
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Blue Cross Blue Shield -- Out of State
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- BCBSMA has a reciprocal relationship with other states' BCBS PPO Plans. Verify details of benefit plan for patients with out-of-state BCBS HMO/POS to determine if Tufts MC and PO are in network.
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BMC HealthNet
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- Medicaid MCO (specialty care only)
- QHP Silver (Connect Care) (specialty care only) *will no longer be accepted effective 1/1/2021
- Senior Care Option (SCO)
ACO Plans:
- Community Alliance (Boston)
- Mercy Alliance (Springfield)
- Signature Alliance (Brockton)
- SouthCoast Alliance
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Cigna
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- All Commercial Plans
- Medicare Supplemental (i.e. Medex) -- (patient has Medicare as primary)
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Commonwealth Care Alliance
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- One Care Plan (specialty care only for ages 18-64)
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| Community Health Options- ME and NH |
- Commercial- subsidized plans for individuals and families
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| Coventry |
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Fallon Health
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- Direct
- Flex Care
- Preferred Care PPO
- Select
- Senior Plans (specialty care only)
ACO Plans:
- Berkshire Fallon Health- Collaborative
- Fallon 365 Care- Reliant Medical Group
- Fallon 365 Care- Southboro Medical Group
- Tufts Medicine Care Plan
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First Health
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Harvard Pilgrim Health Care
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- HMO
- POS
- PPO
- Medicare Supplemental
- National Plans
- Stride Medicare Advantage (specialty care only)
- Maine's Choice HMO
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Health New England |
- PPO (for out-of-network benefits for specialty care only)
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| Health Plans, Inc. |
- HMO
- PPO
- EPO (administered through HPHC)
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| Humana Military- Tricare East Region |
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MaineCare
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- Maine Medicaid (when referred directly from MaineCare)
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| MassHealth |
- CarePlus
- Standard
Primary Care ACO Plans:
- Community Care Collaborative (C3)- (includes 15 federally qualified health centers across Mass.)
- Partners Healthcare Choice
- Steward Healthcare Choice
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Medicare
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- For specific Medicare plans accepted, refer under each Insurance Payer’s Plans Accepted.
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MultiPlan, Inc./PHCS
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| NCE Health Plans (The National Congress of Employers) |
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Neighborhood Health Plan - MA
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- All Commercial Plans (Massachusetts Connector Products)
ACO Plans:
- My Care Family - (Lawrence Family Health Center, Lowell General Hospital, Neighborhood Health Plan)
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New Hampshire Healthy Families (NHHF)
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| Oxford Health Plans |
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Senior Whole Health
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Tricare
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- See Humana Military- Tricare Region East
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Tufts Health Plan
Note: While we work very closely with Tufts Health Plan and most other major insurers, we are not affiliated with Tufts Health Plan in any way. While we accept the majority of their plans, we do not accept Tufts Medicare Preferred for Primary Care services.
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- CareLink Plan Design
- Lifespan Premier Choice (HMO and PPO tiered products for RI employer groups)
- Most Commercial Plans
- Medicare Supplemental
- Tufts Medicare Preferred (specialty care only)
- Senior Care Option (SCO)
- Unify (dual eligibility 18-64)
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Tufts Health Public Plans
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- Tufts Direct
- Tufts Together (for specialty care only)
- Tufts Unify (dual eligibility 21-64 yrs old)
ACO Plans:
- Tufts Together with Atrius Health
- Tufts Together with Beth Israel- Deaconess Care Organization
- Tufts Together with Boston Children's Hospital ACO
- Tufts Together with Cambridge Health Alliance
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Unicare
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United Healthcare
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- Choice Plus
- Erickson Advantage POS
- Erickson Advantage Champion/Guardian HMO-POS-SNP
- Group Medicare Advantage PPO
- Medicare Supplemental (Plan Core & Plan Supplement 1)
- Passport Plan
- PPO
- UnitedHealthcare Senior Care Options (SCO)
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| U.S. Family Health Plan Brighton Marine |
- Specialty Care only with approved referral prior to scheduling.
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Veterans Health Administration (VHA) |
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- Choice Plus
- Evercare Senior Care Option
- Passport Plan
- PPO
- Medicare Supplemental
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- Choice Plus
- Evercare Senior Care Option
- Passport Plan
- PPO
- Medicare Supplemental
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