Plan vs plan · Worcester County, MA · 2027 plan year
Tufts Medicare Preferred HMO Smart Saver Rx (HMO) vs HumanaChoice Giveback H5216-138 (PPO)
Medicare.gov compares Medicare Advantage plans with each other. This page also shows Original Medicare, so you can see the full trade-off: premiums, copays, the yearly limit, extra benefits, and the rules about doctors and approvals.
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Tufts Medicare Preferred HMO Smart Saver Rx (HMO)
- Plan premium
- $0 a month
- Yearly limit, in network
- $7,150
- 2027 star rating
- 4 of 5
- Prior authorization needed for
- 18 services
HumanaChoice Giveback H5216-138 (PPO)
- Plan premium
- $0 a month
- Yearly limit, in network
- $7,150
- 2027 star rating
- 4 of 5
- Prior authorization needed for
- 24 services
In Massachusetts, you can go back to Medigap later
Massachusetts law makes Medigap companies accept you from February 1 to March 31 each year. Your age and health do not change the price. Coverage from that window starts on June 1. The companies also sell Medigap during the rest of the year. So you can try Medicare Advantage and go back to Original Medicare with Medigap later.
Read about Medigap rights on Medicare.govYour yearly cost, side by side
Move the controls to match your year. Totals include premiums, the Part B premium, copays, and drug costs.
Medigap plan with Original Medicare
Massachusetts sets its own Medigap plans: Core and Supplement 1A. Supplement 1 is open only to people who were eligible for Medicare before 2020. These plans are not the plans with letters, such as Plan G and Plan N. We have no prices for these plans, so the totals show Original Medicare without Medigap. Without Medigap you pay 20% of most costs, with no yearly limit. Check Medigap plans and prices for ZIP 01331 on Medicare.gov
Want to check your exact drugs? Medicare.gov lets you enter each drug and shows what each plan charges for it. Enter your drugs on Medicare.gov
Original Medicare
With no Medigap and Blue MedicareRx Value Plus (PDP)
$6,139 a year
- Premiums
- $2,820
- Medical costs
- $1,616
- Drugs
- $1,703
No yearly limit on what you pay for medical care.
Tufts Medicare Preferred HMO Smart Saver Rx (HMO)
HMO from Tufts Health Plan
$6,004 a year
- Premiums
- $2,514
- Medical costs
- $1,610
- Drugs
- $1,880
Most you can pay in a bad year, before drugs: $9,664.
HumanaChoice Giveback H5216-138 (PPO)
PPO from Humana
$6,790 a year
- Premiums
- $2,034
- Medical costs
- $2,935
- Drugs
- $1,821
Most you can pay in a bad year, before drugs: $9,184.
With these settings, Tufts Medicare Preferred HMO Smart Saver Rx (HMO) costs about $135 less a year than Original Medicare.
These are estimates, not quotes. Check every number with Medicare (Medicare.gov or 1-800-MEDICARE) and with the plan before you choose. What you pay depends on your doctors and hospitals, your drugs and pharmacy, and the care you use. Drug costs use typical prices for generic and brand-name drugs. Original Medicare amounts are 2027 projections from the 2026 Medicare Trustees Report. CMS sets the final amounts in November.
Text us about this comparisonWhat you pay each time you get care
In-network costs for one visit or one stay. The Original Medicare amounts follow your Medigap choice above: no Medigap.
Primary doctor visit
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Tufts Medicare Preferred HMO Smart Saver Rx (HMO)
$0
HumanaChoice Giveback H5216-138 (PPO)
$0
Specialist visit
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Tufts Medicare Preferred HMO Smart Saver Rx (HMO)
$60
HumanaChoice Giveback H5216-138 (PPO)
$45
Prior authorization
Lab tests
Original Medicare, no Medigap
$0
most Medicare-covered tests
Tufts Medicare Preferred HMO Smart Saver Rx (HMO)
$0-$60
Prior authorizationHumanaChoice Giveback H5216-138 (PPO)
$0
Prior authorization
MRI or CT scan
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Tufts Medicare Preferred HMO Smart Saver Rx (HMO)
$295-$350
Prior authorizationHumanaChoice Giveback H5216-138 (PPO)
$0-$780
Prior authorization
Emergency room
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Tufts Medicare Preferred HMO Smart Saver Rx (HMO)
$130
HumanaChoice Giveback H5216-138 (PPO)
$130
Urgent care
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Tufts Medicare Preferred HMO Smart Saver Rx (HMO)
$50
HumanaChoice Giveback H5216-138 (PPO)
$50
Outpatient surgery
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Tufts Medicare Preferred HMO Smart Saver Rx (HMO)
$0-$270
Prior authorizationHumanaChoice Giveback H5216-138 (PPO)
$0-$725
Prior authorization
Ground ambulance
Original Medicare, no Medigap
20%
after the $292 yearly Part B deductible
Tufts Medicare Preferred HMO Smart Saver Rx (HMO)
$375
Prior authorizationHumanaChoice Giveback H5216-138 (PPO)
$325
Prior authorization
Hospital stay, 5 days
Original Medicare, no Medigap
$1,788
Part A deductible each benefit period; $447 a day for days 61-90
Tufts Medicare Preferred HMO Smart Saver Rx (HMO)
$2,295
for a 5-day stay
Prior authorizationHumanaChoice Giveback H5216-138 (PPO)
$2,150
for a 5-day stay
Prior authorization
See every cost in one table
| What you pay in network | Original Medicare, no Medigap | Tufts Medicare Preferred HMO Smart Saver Rx (HMO) | HumanaChoice Giveback H5216-138 (PPO) |
|---|---|---|---|
| Monthly premium | Part B $209.50 + drug plan $25.50 | $0 + Part B $209.50 | $0 (pays back $40 a month of your Part B premium) + Part B $209.50 |
| Yearly limit on what you pay | No yearly limit | $7,150 in network | $7,150 in network; $10,750 in and out of network |
| Medical deductible | $292 Part B; $1,788 Part A each benefit period | $0 | $700 |
| Primary doctor visit | 20%, after the $292 yearly Part B deductible | $0 copay | $0 copay |
| Specialist visit | 20%, after the $292 yearly Part B deductible | $60 copay | $45 copayPrior authorization |
| Lab tests | $0, most Medicare-covered tests | $0-$60 copayPrior authorization | $0 copayPrior authorization |
| MRI or CT scan | 20%, after the $292 yearly Part B deductible | $295-$350 copayPrior authorization | $0-$780 copayPrior authorization |
| X-rays | 20%, after the $292 yearly Part B deductible | $0-$60 copayPrior authorization | $0-$145 copayPrior authorization |
| Emergency room | 20%, after the $292 yearly Part B deductible | $130 copay | $130 copay |
| Urgent care | 20%, after the $292 yearly Part B deductible | $50 copay | $50 copay |
| Outpatient hospital | 20%, after the $292 yearly Part B deductible | $0-$370 copayPrior authorization | $0-$800 copayPrior authorization |
| Surgery center | 20%, after the $292 yearly Part B deductible | $0-$270 copayPrior authorization | $0-$725 copayPrior authorization |
| Ground ambulance | 20%, after the $292 yearly Part B deductible | $375 copayPrior authorization | $325 copayPrior authorization |
| Hospital stay | $1,788, Part A deductible each benefit period; $447 a day for days 61-90 | $459 per day for days 1-6; $0 per day for days 7-90Prior authorization | $430 per day for days 1-6; $0 per day for days 7-90Prior authorization |
| Skilled nursing facility | $0, days 1-20, then $223.50 a day for days 21-100 | $0 per day for days 1-20; $221 per day for days 21-100Prior authorization | $10 per day for days 1-20; $221 per day for days 21-100Prior authorization |
| Mental health visit | 20%, after the $292 yearly Part B deductible | $0-$30 copay | $35 copayPrior authorization |
| Physical therapy | 20%, after the $292 yearly Part B deductible | $30 copayPrior authorization | $40 copayPrior authorization |
| Home health care | $0, Medicare-covered home health | $0 copayPrior authorization | $0 copayPrior authorization |
| Medical equipment | 20%, after the $292 yearly Part B deductible | 0%-50% coinsurancePrior authorization | 10% coinsurancePrior authorization |
| Part B drugs | 20% after the $292 Part B deductible | 0%-20% coinsurancePrior authorization | 0%-20% coinsurancePrior authorization |
| Drug deductible (Part D) | $700 with Blue MedicareRx Value Plus (PDP) | $700 | $700 |
| Drug tiers (one month, retail) | Preferred Generic: $0 copayGeneric: $3 copayPreferred Brand: 17% coinsuranceNon-Preferred Drug: 35% coinsuranceSpecialty Tier: 25% coinsurance | Preferred Generic: $0 copayGeneric: $2 copayPreferred Brand: 20% coinsuranceNon-Preferred Drug: 25% coinsuranceSpecialty Tier: 25% coinsuranceVaccines: $0 copay | Preferred Generic: $0 copayGeneric: $4 copayPreferred Brand: 19% coinsuranceNon-Preferred Drug: 30% coinsuranceSpecialty Tier: 25% coinsurance |
Not sure which of these costs apply to you?
Text us what you have now. We will help you read this comparison and check it with Medicare.gov.
A higher drug plan premium is not, by itself, a reason to switch
With Original Medicare, you buy a separate drug plan. In Massachusetts, 10 drug plans are for sale for 2027, from $13.30 to $284.70 a month. Half of them cost $114.75 a month or less.
- Every 2027 drug plan limits what you pay for covered drugs to $2,400 a year. The drug coverage in Medicare Advantage plans has the same limit.
- The premium is one part of your yearly cost. The calculator above adds premiums, medical costs, and drug costs, so you can see the whole year.
- A Medicare Advantage plan can cost less in a light year. But you also take on its network and prior authorization rules.
- If your income is limited, Extra Help can pay most of your drug plan premium and drug costs. Check Extra Help at SSA.gov
Doctors, referrals, and prior authorization
Cost is one side. The other side is how you get care. These rules come from the CMS plan files. Prior authorization means the plan must approve a service before you get it.
Original Medicare
- Any doctor or hospital in the U.S. that takes Medicare
- No referrals
- Prior authorization only for a short list of services
Tufts Medicare Preferred HMO Smart Saver Rx (HMO)
HMO
- You use doctors and hospitals in the plan network. Outside the network, the plan pays for emergencies and urgent care.
- You need a referral to see a specialist.
Prior authorization for 18 services
Diagnostic tests, MRI or CT, Radiation therapy, Outpatient hospital, Observation stay, Surgery center, Ambulance, Physical therapy, Occupational therapy, Home health, Cardiac rehab, Pulmonary rehab, Medical equipment, Prosthetics, Diabetic supplies, Hospital stay, Skilled nursing, Part B drugs
HumanaChoice Giveback H5216-138 (PPO)
PPO
- The plan has a network. You can go outside it, but you pay more.
- No referral needed to see a specialist.
Prior authorization for 24 services
Specialist visits, Diagnostic tests, MRI or CT, Radiation therapy, Outpatient hospital, Observation stay, Surgery center, Ambulance, Mental health visits, Psychiatrist visits, Physical therapy, Occupational therapy, Home health, Partial hospitalization, Cardiac rehab, Pulmonary rehab, Medical equipment, Prosthetics, Diabetic supplies, Dialysis, Substance use care, Hospital stay, Skilled nursing, Part B drugs
Extra benefits
| Extra benefit | Original Medicare | Tufts Medicare Preferred HMO Smart Saver Rx (HMO) | HumanaChoice Giveback H5216-138 (PPO) |
|---|---|---|---|
| Dental | No | Comprehensive, up to $1,000 a year | Preventive only |
| Eye exam | No | Yes | Yes |
| Glasses or contacts | No | Yes, $150 allowance | Yes, $100 allowance |
| Hearing aids | No | Yes, copays from $250 | Yes, copays from $575 |
| Over-the-counter allowance | No | No | No |
| Fitness benefit | No | Yes | Yes |
| Rides to care | No | No | No |
| Meals after a hospital stay | No | No | Yes |
| Emergency care abroad | No, unless your Medigap plan pays for it | Yes | Yes |
| Part B premium giveback | No | No | $40 a month |
What changed for 2027
Tufts Medicare Preferred HMO Smart Saver Rx (HMO)
Consolidated Renewal Plan; New Plan · 2026 plan H2256-046-0
- In-network out-of-pocket maximum up from $6,400 to $7,150
- Drug deductible up from $615 to $700
- Specialist visit: $50 copay to $60 copay
- Diagnostic radiology (MRI, CT): $100-$200 copay to $295-$350 copay
- Ground ambulance: $350 copay to $375 copay
- Inpatient hospital: $425 per day for days 1-6; $0 per day for days 7-90 to $459 per day for days 1-6; $0 per day for days 7-90
- Skilled nursing facility: $0 per day for days 1-20; $218 per day for days 21-100 to $0 per day for days 1-20; $221 per day for days 21-100
- Dental maximum down from $1,500 to $1,000
- Eyewear allowance down from $250 to $150
- OTC allowance removed
HumanaChoice Giveback H5216-138 (PPO)
Renewal Plan · 2026 plan H5216-138-0
- In-network out-of-pocket maximum up from $6,500 to $7,150
- Medical deductible up from $675 to $700
- Drug deductible up from $395 to $700
- Part B giveback down from $61 to $40
- Outpatient hospital: $0-$575 copay to $0-$800 copay
- Ground ambulance: $335 copay to $325 copay
- Inpatient hospital: $445 per day for days 1-6; $0 per day for days 7-90 to $430 per day for days 1-6; $0 per day for days 7-90
- Skilled nursing facility: $10 per day for days 1-20; $218 per day for days 21-100 to $10 per day for days 1-20; $221 per day for days 21-100
- Eyewear allowance down from $200 to $100
- Rides to care removed
- Overall star rating up from 3.5 to 4
More 2027 plans in Worcester County
- AARP Medicare Advantage from UHC MA-0003 (HMO-POS), H5253-157
- AARP Medicare Advantage from UHC MA-0006 (PPO), H8768-055
- HumanaChoice Giveback H7617-046 (PPO) (page for Hillsborough County, NH)
- Aetna Medicare Signature Extra (PPO), H5521-450
- Fallon Medicare Plus Orange (HMO), H9001-041
- HumanaChoice H5216-249 (PPO)
- Aetna Medicare Elite (PPO), H5521-160
- Humana USAA Honor Giveback (PPO), H5216-059 (page for Hartford County, CT)
County guide: 2027 plans in Worcester CountyState guide: Massachusetts
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Sources and method
Plan data comes from the CMS 2027 Plan Benefit Package and landscape files. The data is from 2026-10-10. We checked a sample of plans field by field against Medicare.gov. Original Medicare amounts are the 2027 projections in the 2026 Medicare Trustees Report (Tables V.E1 and V.E2). CMS sets the final amounts in November. Massachusetts sets its own Medigap plans: Core and Supplement 1A. Supplement 1 is open only to people who were eligible for Medicare before 2020. These plans are not the plans with letters, such as Plan G and Plan N. We have no prices or cost model for these plans, so the totals show Original Medicare without Medigap. You can look up Medigap plans and prices for ZIP 01331 on Medicare.gov. Totals use typical Medicare-allowed amounts for each service and typical drug prices.
- Tufts Medicare Preferred HMO Smart Saver Rx (HMO) on Medicare.gov · plan website · drug list · doctor directory
- HumanaChoice Giveback H5216-138 (PPO) on Medicare.gov · plan website · drug list · doctor directory
- Medigap prices for ZIP 01331 on Medicare.gov
- Medigap plans in Massachusetts: Medicare.gov, Choosing a Medigap Policy (2026), Section 7
- CMS Plan Benefit Package files, 2027
- CMS 2027 landscape files (premiums and limits)
- CMS 2027 plan crosswalk
- CMS 2027 Star Ratings
- 2026 Medicare Trustees Report: projected 2027 Part A and Part B amounts (Tables V.E1 and V.E2)
- CMS 2026 Part A and Part B amounts
- Medicare.gov: Medigap guaranteed issue rights
These are estimates, not quotes, and they are for education only. Check every number with Medicare and with the plan before you choose. What you pay depends on your doctors and hospitals, your drugs and pharmacy, and the care you use. Plans can change their benefits, premiums, drug lists, and networks each year.
Pinnie is not an insurance agent or broker and does not sell Medicare plans. Pinnie is not connected with or endorsed by the U.S. government or the federal Medicare program. For all your options, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.