Harvard Pilgrim Health Care Medicare Review

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New England-based Harvard Pilgrim Health Care, is a not-for-profit company connected with Harvard University. Serving three states on the East Coast, the company offers comprehensive health care services in addition to individual health care plans and Medicare coverage. Harvard Pilgrim also offers group coverage through local employers.

About Harvard Pilgrim

Founded in 1969, Harvard Pilgrim Health Care stands as the oldest not-for-profit health care system as well as the first HMO plan to be offered in New England. The plan was founded by the Dean of the Harvard Medical School, and continues to be closely connected to the University to this day. The Harvard Pilgrim Health Care Institute, a teaching and research institution, works together with the Medical School on research and education into how the health care system impacts individuals.

In 1980, the Harvard Pilgrim Health Care Foundation was created to help improve services from health to nutrition for the people in the local area, including providing food to people in need.

Currently, Harvard Pilgrim Health Care plans are available only to residents of Maine, Massachusetts, Connecticut, and New Hampshire. Medicare plans, however, are not available in Connecticut at the time of this review, and only offered in certain counties in the other three states. This creates a very limited coverage area for Medicare.

Harvard Pilgrim’s Medicare Plans

Harvard Pilgrim offers three different Medicare options. They have a Medicare Advantage plan, Medicare Supplement, and their Medicare Enhance, which is designed to help with the transfer over from employee benefits to Medicare. While the Medicare Advantage Plans come with included prescription drug coverage, there is no separate Part D coverage offered.

Stride Medicare Advantage

Harvard Pilgrim’s Medicare Advantage plan is known as Stride. Stride is an HMO plan that works within the Harvard Pilgrim network of providers. The available benefits and options depend on where you live; however, for the purpose of this review we will take a look at the plans in Massachusetts.

There are two plan options available, with choice of the type of included prescription drug coverage. These are the Value Rx and Stride Value Rx Plus. The latter is the more expensive plan and offers some additional benefits.

Value Rx has a $0 deductible for care, but has a $320 prescription deductible, with the exception of Tier 1 and Tier 2 drugs. The maximum out of pocket is $3,400. Inpatient hospital stays are charged at $275 a day for the first five days, with no charge thereafter. Co pays are $20 for regular office visits and $40 for specialists, with preventative care covered at no charge. Other co-pays vary based on the service.

Value Plus covers the same services but has some differences in terms of out of pocket expenses. The same yearly limit applies, but co pays are generally lower. There is no deductible either for medical services or drugs. Regular doctor visits are $10 and specialist visits charged at $30. The inpatient hospital daily charge is $150 for the first five days. After $750, there is no inpatient co pay for the rest of the year. Again, the other co pays vary depending on the type of service, but are generally lower than the Value plan.

For both plans, hearing screening and hearing aids are covered with a co pay, in addition to preventative dental care. Vision care is also included without co pays, which vary based on the service. The Value Plus plan includes slightly lower co pays for these services.

Overall, the plans are comprehensive with additional coverage that is not available from your average insurance company, including hearing and vision care.

Medicare Supplement Plans

The Medicare Supplement Plans that are available vary somewhat by state, but there are two basic plans.

Medicare Supplement Core is the more affordable plan, while Medicare Supplement 1 includes more coverage at a higher premium. While there are costs for all of the covered services under the Core plan, there is no cost for any of the covered services under the more expensive plan.

Both plans have an additional premium on top of the basic premiums you pay for Medicare Parts A & B, and are designed to cover what is not covered under those plans. There is no explanation as to how these plans match up to the usual letter plan designations.

Medicare Enhance

This option is designed for employers to offer enhanced coverage above and beyond Medicare Parts A & B as they transition to a retiree plan. There are three options for this type of plan, each offering different coverage. They are Medicare Enhance, Medicare Enhance Preventative Plus, and Medicare Enhance Preventative Plus with Deductible

Medicare Enhance plans are only available through an employer, so there is not an option for individuals seeking their own Medicare or Medicare Supplement coverage.

Harvard Pilgrim Medicare Pricing

Since Harvard Pilgrim only offers coverage in a very limited area, we are not able offer a price comparison to other national insurance companies.

They do, however, make very clear what their premiums are for their Stride and Supplement programs. The pricing is readily available on the website, and can be found on the Summary of Benefits page.

The Stride pricing in Massachusetts is $57 per month for the basic plan and $148 per month for the more advanced plan; both of these premiums are on top of the regular Medicare Part B premium. Considering the comprehensive coverage that is offered under the plans, these premiums don’t appear to be out of line, but local residents will need to compare them to the other companies in Harvard Pilgrim’s coverage area.

The Medicare Supplement Core and 1 plans are $112 and $212 per month respectively. Again, we can’t offer a price comparison based on the limited coverage area and the difference in designation from the usual lettered plans.

Ratings and Reviews

At a quick glance, Harvard Pilgrim appears to enjoy an excellent reputation.

The National Committee for Quality Assurance gives them an overall rating of 5.0, the highest possible rating. They ranked at a 4.0 in Consumer Satisfaction, 4.5 in Preventative Care, and 4.5 for Treatment in the breakdown. They have consistently rated at the top under the NCQA’s ranking system.

The Better Business Bureau (BBB) gives Harvard Pilgrim Health Care an A- rating. There are 14 complaints in the past three years with four of those closed in the past 12 months. Even for a small regional company, that’s a very low number of complaints.

We were unable to locate any reviews pertaining directly to the Medicare plans offered by Harvard Pilgrim. The few complaints that are out there seem to be regarding plan cost or denied claims for the company’s regular health insurance plans. Smaller companies such as this one often don’t appear on the major review sites for health insurance companies, but even so the overall ratings and lack of major complaints is encouraging.

Bottom Line

Harvard Pilgrim’s Medicare plans are available in a very limited area. As a result, this company won’t be an option for many people. For those in the coverage area, however, the company certainly has a good reputation as well as being connected to one of the most prestigious medical schools in the world. It’s difficult to judge whether or not the rates are in line with other companies in the region, but considering how strong Harvard Pilgrim’s reputation is, they are well worth adding the a price comparison list – and perhaps worth considering even if they are not the least expensive option. As always, the balance between good coverage and the right price should be the goal, and in this case the company’s ratings and comprehensive plans do carry some weight.

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