Tufts High-Deductible PPO Plan

The new high-deductible PPO plan contains some similarities to and some differences with the current PPO plan. The main similarity is the freedom to choose your own doctors both inside and outside of the Tufts network.

The differences include the fact that the high-deductible PPO has a larger up-front deductible, but almost no copayments once the annual deductible for medical services has been satisfied; however, prescriptions continue to have copayments. 

The high-deductible plan is accompanied by a health savings account (HSA) that allows you to put money aside, before income taxes, to pay for all of your medical expenses using pre-tax dollars. 

An HSA allows dollars to "roll over" from one year to the next and provides tax advantages: contributions are made before income taxes, balances grow tax-free, and all withdrawals for qualified medical expenses are tax-free. The tables below offer a quick comparison of the PPO plan and the high-deductible PPO plan, as well as a look at some of the kinds of expenses that you may have to cover out-of-pocket prior to meeting the higher deductible of the new high-deductible PPO plan. 

For more information about the HSA, visit WageWorks

 In-Network (Tufts Providers)Out-of-Network (Non- Tufts Providers
DeductibleIndividual $1,500, Family $3,000 
Preventive CareCovered in Full20% Coinsurance
Annual PhysicalCovered in Full20% Coinsurance
Office VisitDeductible20% Coinsurance 
Routine Vision Exam$25 per visit, 1 exam every 12 Months 20% Coinsurance 
Emergency RoomDeductibleDeductible
Inpatient HospitalDeductible20% Coinsurance 
Copayment MaximumIndividual $5,000, Family $10,000Individual $5,000, Family $10,000
Prescription Drugs (in/out of Network)No Tiers
Deductible applies, then copays of $15-$50
Speciality Drugs (in-Network only) - Special pricing may apply 

Full High-Deductible PPO Cost Summary 2023

Tip: Consider enrolling in a health savings account (HSA) or health care FSA to pay for copays and other services not covered by the plan.