Harvard Pilgrim is a regional health insurance company serving the New England states of Massachusetts, Maine, and New Hampshire. If you live in these states, Harvard Pilgrim is an option you should consider for your Medicare Supplement or Medigap insurance.
Here is a brief history and background of Harvard Pilgrim, along with their product features, pricing, reviews, and our recommendation.
The company began in 1969 as the first not-for-profit healthcare system and HMO in the New England region. A dean of the Harvard Medical School established Harvard Pilgrim, and he still remains connected to the University and Medical School. This University backing allows the company to participate in ongoing innovative research around improving healthcare systems.
The company also established a Health Care Foundation in 1980. The foundation provides food and healthcare assistance to local New England communities. Since the beginning, they have given more than $140 Million in grant money to regional non-profits.
In 1994, Harvard Community Health Plan and the Pilgrim Health Plan merged. After the merger, the combined name became Harvard Pilgrim Health Care.
Even though they are a regional company, they rank high among national companies. Harvard Pilgrim is one of the country’s top-rated health companies according to the National Committee for Quality Assurance (NCQA). They named the company: America’s number one private health plan. They also ranked the company first in member satisfaction and care quality 8 times in a row.
Harvard Pilgrim Medicare Supplement Plans
Harvard Pilgrim offers two basic Medicare products for seniors. First, they offer the traditional Medicare Supplement Product, often called Medigap. Second, they offer a Medicare Advantage Plan. Let’s review both products and their coverage.
Medicare Supplement Plans
With original Medicare, Medigap lowers out-of-pocket expenses (parts A and B).
Your expenditures under Medicare are meant to be decreased significantly by these uniform policies, which broadly include:
Unlike many Medicare coverage options, you can enroll in Medigap at any time. Your initial enrollment period is the three months leading up to your 65th birthday, the running birthday month, and the three months following your 65th.
Medigap policies vary by region. Not every state offers every plan, and Medicare doesn’t mandate that insurance providers provide each Medigap plan.
Harvard Pilgrim offers Medicare Supplement Plans A, F, M, & N.
Medigap Plan A
Plan A is the basic benefit package for Supplement Plans. All other plans will include Plan A benefits
Plan A offers 100% coverage on:
- Medicare Part A coinsurance
- First 3 Pints of Blood
- Medicare Part A hospice coverage
- Medicare Part B copayments or coinsurance
Medigap Plan F
Medicare Supplement Plan F is the most purchased supplement product offered by Harvard Pilgrim because of its comprehensive benefits package. It covers 100% of the approved expenses that Original Medicare does not pay.
Medigap Plan M
Medicare Supplement Plan M is a good plan designed for Seniors on a budget. Plan M pays 50% of your Medicare Part A deductible. You will pay the Part B deductible and Part B excess charges. If you are a healthy individual with few health expenses, Plan M could be a good choice. If you rarely visit the doctors, the savings on your premium may outweigh your out-of-pocket costs. Plan M is not offered by many carriers, so comparison pricing will be limited.
Medigap Plan N
Medicare Supplement Plan N provides the basic coverage benefits of Plan A.
Plan M only pays 50% of your Medicare Part A deductible, but Plan N will cover 100% of the Part A deductible. You will be responsible for both the Medicare Part B deductible and Part B excess charges. There is a $20 co-pay for each visit to the doctor and up to $50 for each emergency room visit
Other Features and Benefits of Pilgrim Medicare Supplement
Beyond Medicare products, Harvard Pilgrim also has other benefits. They created a program called Celebrating 65® that helps individuals as they get ready to retire.
Because researchers have found that mindfulness helps with stress and chronic, the company created a program called “Mind the Moment”. They have created several classes and workshops that members can attend to lessen stress in their life.
Harvard Pilgrim offers personal health coaches. Members can call coaches for private consultations for:
- Stress Management
- Smoking Cessation
- Lowering Cholesterol
- Dealing with Back Pain
- Blood Pressure Control
- Weight Management
Medicare Advantage Plans by Havard Pilgrim Medicare
Inherently, Medicare Advantage plans must cover Original Medicare Part A and Part B. For extra convenience, Medicare Advantage plans offer extra benefits that regular Medicare doesn’t cover. All Harvard Pilgrim Medicare Advantage plans, for instance, provide some coverage of the following:
- Prescription Drugs
- Dental Care (Preventive)
- Vision Care, including eye examinations, contacts, and eyewear
- Annual physicals
- Over-the-counter medicine benefits
- Hearing aid with examination and fittings
- Transportation for non-emergency treatment
Some Harvard Pilgrim Medicare Advantage plan varieties may also offer supplemental benefits, such as:
- Comprehensive dental care
- Pain-relieving Therapies like massage and acupuncture
- Supplementary Fitness advantages
- Installation of safety features in your home, including a safety bar in the bathtub
- International emergency care while traveling
HMOs and HMO Point-of-Service (HMO-POS) plans are the two primary insurance categories offered by Harvard Pilgrim.
Harvard Pilgrim and Tufts Medicare Preferred HMO plans
An HMO plan pays for care from specialists who are part of the plan’s network. “In network” refers to these service providers.
You can be liable for some or all of the cost if you receive care outside the network of your insurance plan. However, for urgent care or emergencies, there is a provision for exceptions. These plans offer various levels of coverage. Some are more inclusive, while others provide more fundamental benefits.
Harvard Pilgrim and Tufts Medicare Preferred HMO-POS plans
There isn’t much difference between HMO-POS and HMO plan. You might be able to receive some care outside of the network under an HMO-POS plan. However, doing so will cost you more in terms of copay or coinsurance.
Prescription drug plans sold by commercial insurance firms are known as Medicare Part D plans. Harvard Pilgrim does not currently offer part D stand-alone plans. Instead, Part D insurance is included with all of its Medicare Advantage plans.
What Makes Harvard Pilgrim Different
After years of placing customers with Harvard Pilgrim, we’ve developed a list of Pros and Cons you should consider.
- Competitive Plan F premium, which is important because of the comprehensive nature of the plan.
- Over 25 years in the Medicare Supplements business.
- A full slate of Benefits that come along with being a customer
- Personal health coaching
- Regional company with local flavors. If you live in New England, you probably already know the doctors and hospitals in the program. 80,000 doctors and 183 hospitals participate.
- Known for Clinical programs, customer service, and health strategies.
- Covers many alternative therapies such as acupuncture, yoga, and Tai Chi
- Does not offer Medicare SELECT plans.
- Does not offer the most popular Medicare Supplement Plan G.
- Regional company and only available in four states, Maine, Massachusetts, and New Hampshire. They do have limited offerings in Connecticut.
Summary – Harvard Pilgrim Medicare
If you are in New England, Harvard Pilgrim is an excellent choice for Medicare products. Their pricing on Plan F is excellent considering the broad coverage being offered. Because of their not-for-profit status and size, they do not have an A.M. Best rating. However, this should not be a concern. They have been in business for long enough and are affiliated with Harvard University.
Like all competitors, you should get multiple comparisons before making a decision on your Medicare Supplement Insurance or Medicare Advantage plans. Pricing is a big consideration, but shouldn’t be the only one. Claims responsiveness and customer service need to be examined as well.
Let Us Help You
Most of us don’t have time to do comparison shopping for most products, especially complicated health insurance products. Use our expertise and a wide range of companies to help decide on the right product for you. Remember, Medicare supplements do not cover prescription drug plans. Otherwise known as Medicare Part D. But, don’t worry, we’ve got you covered on that, too.
We can do an analysis of your needs and then tailor the perfect product for your budget and health needs.
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