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Harvard Pilgrim Health Care Medicare Review

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Eric Stauffer is a former insurance agent and banker turned consumer advocate. His priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best...

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UPDATED: Nov 30, 2018

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Harvard University-connected healthcare company Harvard Pilgrim is a not-for-profit insurer offering individual and group health 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.

About Harvard Pilgrim

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.

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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.

Stride Medicare Advantage

For our sample area, there are two Stride plans, both HMO, available to choose from.

The Value Rx plan has no deductible and a $20 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 $10 for primary care and $25 for specialist visits. Inpatient hospital care has a copay of $150 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.

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 a 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.

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.

Rates

For our sample area, the Stride Value Rx plan has a monthly premium of $61.00, and the Value Rx Plus has a monthly rate of $157.00.

A zero-premium Advantage plan is not offered, which is unusual particularly for an HMO. Again, for an HMO, these 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 $115, while the upgraded plan is $217 a month. These rates are again quite high based on what we have seen elsewhere.

Claims

Like all health insurance companies, Harvard Pilgrim handles claims directly with providers. They are an HMO, which usually means claims are all internal and handled without much input or assistance from the insured.

It is not surprising that we were unable to find claims information for the Medicare plan, although there are two toll-free numbers that can be called with questions, one for Advantage and one for Supplement.

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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 for some concern. There is some balance to that problem, however, in the good ratings from the NCQA.

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.

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About Eric Stauffer

Author: Eric StaufferI am a former insurance agent and banker turned consumer advocate. My priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best place to get it.

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