acupuncture and other alternative therapies.The plans may also include such benefits as Harvard Pilgrim Advantage plans include the following benefits: Cost examplesĬosts vary depending on a person’s location and the plan, and the costs in Maine may be different from in Massachusetts, or in New Hampshire.įor example, for a person living in Cumberland County, the premiums in 2021 average: The Harvard Pilgrim website tool may help a person find the approximate costs of their healthcare plans. However, the coinsurance for durable medical equipment is a standard 20% across all plans.Ī person may also pay a plan premium, although the Harvard Pilgrim Stride Basic Rx HMO plan does not have a monthly premium. When an individual enrolls in a Harvard Pilgrim Advantage plan, they must pay various healthcare costs, including deductibles, copays, and coinsurance.įor example, if a person gets medically approved surgery as an outpatient, copays in 2021 may range from $225 to $300. This online tool may be useful in finding a new plan. If a person moves away from the three states in which Harvard Pilgrim offers Advantage plan coverage, they may be excluded from their Advantage plan and will need to find a new plan in the new location. If a person is eligible for original Medicare, they can enroll in a Harvard Pilgrim Advantage plan. There are several options to get detailed information about Harvard Pilgrim’s Advantage plans, including calling the Harvard Pilgrim client care number at 1-86 (TTY: 711), available from 8am to 8pm or using the online portal. Special enrollment periods (SEPs): A person may also qualify to enroll at other times, depending on special circumstances such as moving homes, qualifying for Extra Help or Medigap, or moving to an institution.Fall open enrollment period (OEP): From October 15 through December 7, an individual can change from original Medicare to a Medicare Advantage plan or switch between Medicare Advantage plans.The coverage starts the month after a person has enrolled. General enrollment period (GEP): If a person missed their IEP, they can also enroll from January 1 to the end of March.Initial enrollment period (IEP): When a person is first eligible for Medicare, they can enroll in the plan 3 months before their 65th birthday, during their birthday month, and for up to 3 months afterward.Harvard Pilgrim offers one HMO-POS plan, the Harvard Pilgrim Stride Choice Rx.Ī person can enroll in a Harvard Pilgrim Medicare Advantage plan during several Medicare enrollment periods, including: However, if a person chooses to do that, there may be higher copays or coinsurance. HMO Point-of-Service (HMO-POS) plans are similar to HMO plans, but a person can get some types of healthcare outside the plan’s network.
COMPARE MEDICARE ADVANTAGE PLANS AND MEDIGAP PLANS FULL
The various plans offer basic benefit level to full coverage.
Harvard Pilgrim offers four HMO plans, including: However, if a person uses a provider outside the plan network, such as in an emergency, they may have to pay extra costs. A person chooses an in-network primary care doctor, who then coordinates the person’s healthcare. With HMO plans, healthcare providers in the plan’s network provide healthcare services. Harvard Pilgrim offers two types of Medicare Advantage plans, called Medicare Advantage Stride HMO and HMO-POS. For Medicare, this usually applies to prescription drugs. Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments.Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund.Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan: This article looks at the Harvard Pilgrim Health Care Advantage plans, availability, coverage and benefits, and costs. The plans provide the same benefits as original Medicare and may also offer additional benefits. Medically approved companies, such as Harvard Pilgrim Health Care, administer the plans.Īccording to the Kaiser Family Foundation (KFF), more than 24 million United States citizens enrolled in Medicare Advantage in 2020. Medicare Part C, also called Medicare Advantage, offers plans that combine original Medicare (parts A and B) coverage. Original Medicare Part A covers hospital, skilled nursing facility care, and hospice, and Part B pays for medically necessary care to diagnose and treat conditions, and some preventive services. Medicare is a federal insurance plan for people aged 65 and older.
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