at a glance
- Harvard Pilgrim offers Medicare Advantage plans in Massachusetts, New Hampshire, and Maine.
- The plans sold by Harvard Pilgrim include four HMO options and one HMO-POS plan.
- Many of these plans offer additional benefits not covered by original Medicare, such as dental care, vision services, and hearing aids.
- Harvard Pilgrim was founded by doctors nearly 50 years ago and now serves more than 3 million customers.
Medicare is a federal health insurance program that’s made up of several different parts. One of these parts is Medicare Part C (also called Medicare Advantage).
Medicare Advantage plans are offered by private insurance companies as an alternative to original Medicare. Harvard Pilgrim is an insurance company that offers several types of Medicare Advantage plans in 2021.
We’ll explore these Harvard Pilgrim plans in detail, including what they cover and how much they cost.
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.
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. However, you’ll pay a higher copay or coinsurance cost to do so.
Medicare Part D plans are prescription drug plans sold by private insurance companies.
Harvard Pilgrim currently doesn’t sell stand-alone Part D plans. Instead, all of its Medicare Advantage plans come bundled with Part D coverage.
Harvard Pilgrim offers a variety of Medicare Advantage plans in the Northeastern United States. States where plans are offered include:
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.
This means Harvard Pilgrim covers the following types of services:
- visits to primary care doctors or specialists
- diagnostic 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
- 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:
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.
- 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 different Harvard Pilgrim Medicare Advantage plans in three coverage locations.
|Boston, MA||Concord, NH||Portland, ME|
|Harvard Pilgrim Stride Basic Rx (HMO)||$0 monthly premium, $3,535 estimated annual cost||$0 monthly premium, $4,351 estimated annual cost||$0 monthly premium, $3,547 estimated annual cost|
|Harvard Pilgrim Stride Value Rx (HMO)||$67 monthly premium. $4,195 estimated annual cost||$44 monthly premium, $3,895 estimated annual cost||$30 monthly premium, $3,871 estimated annual cost|
|Harvard Pilgrim Stride Value Rx Plus (HMO)||$168 monthly premium, $4,939 estimated annual cost||$123 monthly premium, $4,807 estimated annual cost||—|
|Harvard Pilgrim Stride Gain Rx (HMO)||—||$28.50 monthly premium, $3,697 estimated annual cost||—|
|Harvard Pilgrim Stride Choice Rx (HMO-POS)||—||$54 monthly premium, $3,979 estimated annual cost||$34 monthly premium, $3,775 estimated annual cost|
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:
- annual physicals
- 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.
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. You can compare different plans here before choosing one to get the right coverage for your needs and budget.