What Harvard Pilgrim Medicare Advantage Plans Are Offered in 2020?

What states offer Harvard Pilgrim Medicare Advantage plans?

Harvard Pilgrim offers a variety of Medicare Advantage plans in the Northeastern United States. States where plans are offered include:

• Maine
• Massachusetts
• New Hampshire

The availability of specific plans may vary based on your location. Some types of Harvard Pilgrim Medicare Advantage plans may not be offered in your area.

What are the Harvard Pilgrim Medicare Advantage plans?

There are two main types of plans offered by Harvard Pilgrim: Health Maintenance Organizations (HMOs) and HMO Point-of-Service (HMO-POS) plans.

Harvard Pilgrim HMO plans

An HMO plan covers care from providers within the plan’s network. These providers are referred to as being “in network.”

If you receive care outside of your plan’s network, you may be responsible for paying some or all of the cost. Exceptions are made for emergencies or urgent care.

Harvard Pilgrim offers four different HMO plans. These are:

• Harvard Pilgrim Stride Basic Rx (HMO)
• Harvard Pilgrim Stride Value Rx (HMO)
• Harvard Pilgrim Stride Value Rx Plus (HMO)
• Harvard Pilgrim Stride Gain Rx (HMO)

The level of coverage offered by these plans varies. Some offer more basic benefits, while others are more inclusive.

Harvard Pilgrim HMO-POS plans

An HMO-POS plan is similar to an HMO plan.

In an HMO-POS plan, you may be able to receive some care out of network. But you’ll need to pay a higher copay or coinsurance to do so.

Harvard Pilgrim offers one HMO-POS plan, called Harvard Pilgrim Stride Choice Rx (HMO-POS).

What Medicare Part D plans does Harvard Pilgrim offer?

Medicare Part D plans are prescription drug plans sold by private insurance companies.

Harvard Pilgrim currently doesn’t sell separate Part D plans. Instead, all its Medicare Advantage plans are bundled with Part D coverage.

What services do Harvard Pilgrim Medicare Advantage plans cover?

Medicare Advantage plans are required to cover the same set of benefits as original Medicare, which is made up of Medicare Part A and Medicare Part B.

This means Harvard Pilgrim covers the following types of services:

• visits to primary care doctors or specialists
• diagnostic and laboratory tests
• preventive care
• short-term inpatient stays at hospitals and skilled nursing facilities
• emergency and urgent care
• emergency transportation by ambulance
• outpatient sessions with a psychiatrist or other mental health professional
• occupational and physical therapy
• medical equipment or supplies, such as wheelchairs, oxygen, or diabetes supplies
• telehealth services
• hearing exams
• treatment programs for substance use disorders

Some Medicare Advantage plans include additional benefits that aren’t covered by original Medicare. For example, all Harvard Pilgrim Medicare Advantage plans offer some coverage of:

• prescription drugs
• preventive dental care
• periodontics
• vision, including eye exams, contacts, and eyeglasses
• hearing aids, including evaluation and fitting
• annual physicals
• over-the-counter drug benefits
• transportation for nonemergency care

Some types of Harvard Pilgrim Medicare Advantage plans may even include extra benefits like:

• comprehensive dental care
• alternative therapies for pain management, such as massage and acupuncture
• fitness benefits
• installation of safety devices within your home, such as a safety bar in the shower
• emergency care while traveling outside of the country

How much do Medicare Advantage plans from Harvard Pilgrim cost?

The costs of any Medicare Advantage plan can depend on the specific plan you choose, as well as on your location. Some costs associated with these plans include:

• Monthly premiums. You’ll pay this amount every month for your plan. Some plans have no monthly premium, such as the Harvard Pilgrim Stride Basic Rx plan.
• Copays and coinsurance. You’ll pay these after receiving care from a provider. For HMO-POS plans, copays and coinsurance will be more expensive if you use an out-of-network provider.
• Deductibles. Some Medicare Advantage plans may have a health or drug deductible that you must pay before they begin covering costs.
• Out-of-pocket costs. If a service or provider isn’t included in your plan, you may be responsible for paying any costs yourself.

The table below compares the costs of the different Harvard Pilgrim Medicare Advantage plans across three states.

What is Medicare Advantage (Medicare Part C)?

Medicare Advantage (Part C) is a type of insurance plan sold by private companies. You can enroll in a Medicare Advantage plan as an alternative to original Medicare (parts A and B).

While Medicare Advantage plans must offer at least the same benefits as original Medicare, they may also include additional coverage. Some examples of these extra benefits include:

• dental
• hearing
• vision
• annual physicals
• transportation
• fitness benefits, such as the SilverSneakers program

The types of plans and their costs vary by location. That’s why it’s important to compare the different Medicare Advantage plans in your area before deciding on one.

What is Medicare Part D?

Medicare Part D is prescription drug coverage. Like Medicare Advantage plans, Part D plans are sold by private insurance companies. They’re often bundled together with Medicare Advantage plans.

The specific prescription drugs covered in a Part D plan can vary. Each plan has a list of the medications that it covers. This list is called a formulary. Formularies typically include at least two prescription drugs in each drug category.

An insurance company can sometimes make changes to the medications included in its formulary. If these changes affect a prescription drug that you take, you’ll be notified.

The takeaway  

Harvard Pilgrim offers several different Medicare Advantage plans in Massachusetts, New Hampshire, and Maine. Most of these plans are HMOs.

Medicare Advantage plans available from Harvard Pilgrim cover the same services as original Medicare, as well as additional benefits like preventive dental care, vision, and hearing aids. Some specific plans may provide even more benefits on top of this.

The cost of these plans can vary depending on the specific type of plan and on your location. This means some types of plans may not be available in your area. Always compare different plans before choosing one in order to get the right coverage for your needs and budget.

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