Harvard Pilgrim Health Care Medicare Review & Complaints: Health Insurance (2023)

Harvard University-connected healthcare company Harvard Pilgrim is a not-for-profit insurer offering individual and group health insurance plans as well as a Medicare program. They serve several states in the New England area with both Medicare Advantage and Medicare Supplement policy choices.

This Harvard Pilgrim Medicare review will cover which plans are available as well as how to get Harvard Pilgrim Medicare quotes.

Before you decide to buy Harvard Pilgrim Medicare insurance, take the time to shop and compare. Enter your ZIP code now for free quotes.

About Harvard Pilgrim Health Care

Harvard Pilgrim traces back to 1969 when they were created as the first not-for-profit health care system in the New England area and the first HMO as well. Created by the Dean of Harvard Medical School, Harvard Pilgrim today remains closely connected to the University, running a research institute in conjunction with the school created to learn more about how the health care system impacts individuals.

The Harvard Pilgrim Health Care Foundation has been in operation since 1980, providing assistance including food and healthcare assistance to local communities in need.

Currently, Harvard Pilgrim offers their Medicare plans in three states: Massachusetts, Maine, and New Hampshire. Although the company also serves Connecticut with other products, Medicare plans are not offered in that state. Medicare plan availability differs by county in the three states they serve, and it is not offered everywhere. Harvard Pilgrim Medicare replacement plans offer the same coverage as original Medicare

Harvard Pilgrim Medicare Plans

There are two main types of Medicare plans available through Harvard Pilgrim. Medicare Advantage plans called Stride offer HMO coverage, and Medicare Supplement plans follow the standard system. There is a third product known as Medicare Enhance that is only offered through employers to those transitioning to Medicare.

For the purpose of this review, we selected the zip code in which Harvard Pilgrim’s headquarters is located, in Massachusetts. Plans differ by zip code.

Harvard Pilgrim Medicare Advantage

For our sample area, there are three Harvard Pilgrim Medicare Advantage plans for 2021. They are the Harvard Pilgrim Medicare Stride plans and all are HMO plans.

The Basic plan has no deductible with a $5 copay for primary care. Specialist visits are $0 and hospital stays have a $360 copay for the first six days. There is a $445 prescription deductible for Tiers 3,4, and 5, with Tier one starting at a $0 copay.

The Value Rx plan has no deductible and a $5 copay for primary care visits. The specialist copay is $40, and hospital stays have a $275 copay per day for the first six days. This plan includes prescription drug coverage with a $320 deductible; Tiers one and two are exempt from the deductible and Tier 1 has no copay.

The Value Rx Plus plan has lower copays in return for a higher monthly premium. There is still no deductible, and copays are $0 for primary care and $25 for specialist visits. Inpatient hospital care has a copay of $200 for the first five days. There is no prescription deductible on this plan, and again Tier 1 drugs have a $0 copay.

Both of these plans include dental, vision, and hearing coverage. There is also a $150 allowance for over-the-counter drugs and supplies and the plans also include a fitness membership reimbursement.

Harvard Pilgrim Medicare Supplement

Unlike most states, Massachusetts does not use the letter-coded system to standardize Medicare Supplement. Instead, the state has its own version of the standard plans.

There are two plans. Core covers the same things as Plan A in other states, including the coinsurance amounts for both Parts A & B and the first three pints of blood each year. It also offers fitness reimbursement and foreign travel coverage.

Medicare Supplement 1 adds additional coverage to the basics, covering deductibles for Parts A & B and the skilled nursing coinsurance amount.

Harvard Pilgrim Medicare Enhance

Offered only as an employee benefit plan, Medicare Enhance comes in several different levels that the employer can select from. What is offered depends on what the employer has chosen.

These plans are designed to help employees that are in the process of transitioning from their individual health plan to Medicare as they reach the age of 65. They are not offered to individuals, so there is not much detail on the website.

Harvard Pilgrim Medicare Rates

The Stride Basic plan has no premium above and beyond your regular Medicare premium making it the most affordable Harvard Pilgrim Medicare Advantage plan. For our sample area, the Stride Value Rx plan has a monthly premium of $67.00. The Value Rx Plus has a monthly rate of $168.00.

The zero-premium Advantage plan is new to Harvard Pilgrim since we last reviewed it, which is good to see. Again, for an HMO, the rates are a little on the high side. Due to limited networks, HMOs are usually more affordable than PPO plans, but that does not seem to be the case here. Our rates are only really comparable in the same area, and not nationwide, but based on what we have seen from our other sample rates Harvard Pilgrim is more expensive than similar insurers.

Since Massachusetts uses a different standard system for Supplement plans, they are difficult to compare to other places in terms of rates.

The Core plan, which is similar to Plan A elsewhere, has a monthly rate of $136, while the upgraded plan is $242 a month. These rates are again quite high based on what we have seen elsewhere.

Harvard Pilgrim Health Care Medicare Claims Process

Ease of Filing a Claim (Online, Over the Phone, Mobile Apps)

Harvard Pilgrim Health Care offers a convenient and modern approach to filing claims. Policyholders have the option to file claims through multiple channels, including online, over the phone, and through mobile apps. This flexibility ensures that policyholders can choose the method that best suits their preferences and needs.

Average Claim Processing Time

The average claim processing time is a critical factor for policyholders. Harvard Pilgrim Health Care is committed to providing efficient claim processing services.

While specific processing times may vary depending on the complexity of the claim and other factors, the company strives to process claims in a timely manner to ensure that policyholders receive the coverage and benefits they are entitled to promptly.

Customer Feedback on Claim Resolutions and Payouts

Customer feedback is invaluable in assessing the quality of an insurance provider’s claims process. Harvard Pilgrim Health Care places a strong emphasis on customer satisfaction and aims to provide fair and prompt claim resolutions and payouts. Policyholders’ experiences and feedback play a significant role in shaping the company’s commitment to continuous improvement in this regard.

Digital and Technological Features of Harvard Pilgrim Health Care Medicare

Mobile App Features and Functionality

Harvard Pilgrim Health Care offers a user-friendly mobile app that empowers policyholders with convenient features and functionality. The app allows users to access their insurance information, view policy details, check claim status, and even file claims directly from their mobile devices. The intuitive design and features of the app enhance the overall customer experience.

Online Account Management Capabilities

Managing insurance policies and accounts online has become a necessity for today’s tech-savvy consumers. Harvard Pilgrim Health Care provides robust online account management capabilities, allowing policyholders to handle tasks such as paying premiums, updating personal information, and reviewing policy documents with ease.

This digital convenience simplifies the administrative aspects of insurance.

Digital Tools and Resources

In addition to the mobile app and online account management, Harvard Pilgrim Health Care offers a range of digital tools and resources to support policyholders in making informed decisions about their healthcare coverage.

These resources may include online calculators, educational materials, and access to a network of healthcare providers, all designed to enhance the overall value of the insurance coverage provided by Harvard Pilgrim Health Care.

Harvard Pilgrim Medicare Ratings and Consumer Reviews

Harvard Pilgrim Health Care has a B- rating with the Better Business Bureau (BBB), a lowered rating that is the result of the failure to respond to six complaints against the business. The complaint volume, however, is low, with only 13 complaints in the past three years and five of those filed in the past 12 months.

The various branches of Harvard Pilgrim Health Care scored well overall in the National Committee for Quality Assurance annual survey of health plans. The main companies, serving the three states where Medicare is available, have an overall 4-star rating. Only the Connecticut PPO branch of the company scored lower, with a 3.0 overall.

On Yelp there are 20 reviews of the company with an overall rating of 1.5-stars. There are two positive reviews and the rest are negative, citing expensive premiums and denial of coverage. None of the reviews appear to refer to Medicare plans specifically.

Overall, there are not a lot of complaints about Harvard Pilgrim, but failure to respond to complaints on the BBB is always a matter of some concern. There is some balance to that problem, however, in the good ratings from the NCQA.

Harvard Pilgrim Medicare: The Bottom Line

Harvard Pilgrim’s Medicare plans are pricey for the coverage they provide, particularly for an HMO plan. In spite of the connection with one of the most prestigious medical schools in the country, there are a few concerns with their reputation. That said, Medicare plans here may appeal to those who like the Harvard connection or to those who have already had individual insurance with Harvard Pilgrim prior to switching to Medicare, as it will allow continued use of the same providers.

Now that you know all about Harvard Pilgrim Medicare plans, it’s time to see what your other choices are. Enter your ZIP code now for fast, free quotes.