What is Harvard Pilgrim Medicare?

What is the Harvard Pilgrim Medicare Enhance Product?

Enhance is a version of Harvard Pilgrim’s supplement product. This product is specifically available to primary residents of ME, MA, NH, and CT. You must be enrolled in Medicare Part A & B.

Here are the key benefits of Enhance:

• The plan complements Medicare by paying Medicare parts A & B deductibles and coinsurance
• No Requirement to choose a primary care provider (PCP) or to obtain referrals to specialists
• Any doctor who currently accepts Medicare is eligible, regardless of where they are located in the United States.
• No prior authorization from Harvard Pilgrim is needed to receive care
• Coverage for preventative services such as physicals and routine eye exams, as well as necessary services and emergency care
• Built-In discount and saving programs for products & services such as nutrition/weight management, eyewear, and medicine services

How does Medicare Enhance work?

Harvard Pilgrim’s Medicare Enhance plan works like other supplement policies.

To use the benefits, you simply see your medical provider who is eligible for payment by Medicare. Whenever their services are covered by Medicare, the provider will first bill Medicare for the services you receive. Then you or the provider will submit the summary notice (MSN) to Harvard Pilgrim for payment of the deductible and/or coinsurance amount. In cases where services are not covered by Medicare, the plan may be billed directly to the medical provider or you.

Emergency Situations

You are always covered for the care you need in a Medical Emergency, regardless if this is from a physician, hospital, or emergency room. Ambulance transportation is covered as well.

Sometimes there is confusion about what counts as a medical emergency. Here are some of the more common examples: heart attack or suspected heart attack, stroke, shock, major blood loss, choking, severe head trauma, loss of consciousness, seizures, and convulsions.

Is Harvard Pilgrim Health Care covered by Medicaid?

No, it is not. It is easy to confuse Medicaid and Medicare. Medicare is specifically for seniors over 65 years old. Medicaid is specifically designed for any individual that meets certain requirements including minimum income requirements or disability

Is Harvard Pilgrim good?

If you live in the states where Harvard Pilgrim is available, they are an excellent choice for coverage.

As a company, they began in 1969 as the first not-for-profit healthcare system

and HMO in New England. As the name may suggest, they are connected to Harvard University and collaborate in ongoing research and innovation to improve healthcare systems. They also established a non-profit in 1980 to provide food and assistance to local New England communities. Since the beginning of this charitable endeavor, they have given more than $140 million in grant money to regional charities.

The company is excellent, but a related question is why is Harvard Pilgrim so good at what they do.

First, they rank high in all the agencies that examine healthcare companies. This is due primarily due to customer satisfaction ratings. The National Committee for Quality Assurance has ranked them as one of the top health companies. They named Harvard Pilgrim “America’s number one private health plan” as well as first in member satisfaction and care quality 8 times in a row.

Managed Care magazine featured them in a story about their high quality of care.

In the article, they interviewed David Stefan from J.D. Power. One key to their ability to provide superior customer care was communication.

Stefan said:
“We ask people if they believe they understand howto use their health plan to best get their health needs met,” says Stefan. “On that question, Harvard is above just about everybody else we look at. Among those members who don’t quite understand how to use the health plan, we ask, ‘What is it that you’re looking for?’ The big thing that comes out is wanting to know how to access preventive services. Harvard does extremely well.”

This speaks volumes about how they care for their customers.

What is a Medicare Enhanced Plan?

The term Enhanced can be confusing. Harvard Pilgrim is using it as branding to distinguish a particular plan from other products they sell.

Enhanced can mean many different things in the Medicare world. It may refer to Enhanced benefits inside a Medicare Advantage plan. It also can refer to the prescription drug portion of Medicare commonly known as Medicare Part D. The enhanced prescription drug plans will often extend partial coverage of pharmaceuticals when normal coverage runs out.

What is Harvard Pilgrim Stride?

Pilgrim Stride is Harvard Pilgrim’s Medicare Advantage plan. The plan is limited to specific HMOs and follows the guidelines of other Advantage plans. Advantage plans replace Original Medicare rather than supplement Medicare coverage as does their Enhance product or other Medicare supplement products.

Is Harvard Pilgrim part of United Healthcare?

This is a common question we get from many of the companies we represent. Because of the advertising and branding, United Health does. Many customers are confused about their products and reach.

Harvard Pilgrim is not part of United Healthcare, but a separate company offering its own products and servicing its own customers.

If you are interested in learning more about United Healthcare. Here’s our review of United Healthcare and its products.

Summary

To summarize, Harvard Pilgrim is an excellent company. Their Medicare Enhance coverage is a good product for those eligible. If you live in ME, MA, or NH, this is one product to consider.

Speak to one of our agents to determine your eligibility and whether this is a good fit for you.