Harvard Pilgrim is a Medicare Advantage and Medicare Supplement (Medigap) insurance provider. These plans are sold to residents of Massachusetts, Maine, and New Hampshire. Harvard Pilgrim offers five distinct Medigap plan options in Maine and New Hampshire. It offers three different types of plans in Massachusetts. If you live in one of these states and are looking for Medigap coverage, here’s what you should know about Harvard Pilgrim’s options.
What services are covered by Harvard Pilgrim supplement plans?
Medigap insurance is sold by private insurance firms such as Harvard Pilgrim to lower your out-of-pocket expenses. The plans are standardised and titled after the letters A through N, albeit some are no longer accessible (for example, Plan H and Plan J). These are distinct from the letter-name components of Medicare, such as Medicare Parts A and B. Medicare Parts refer to your healthcare coverage, such as hospital insurance (Part A) or medical insurance (Part B) for things like doctor’s visits. Medigap policies help to offset the costs of this coverage. Among the expenses that Medigap policies can cover are:
- Part A costs. Part A charges, such as the Part A deductible, Part A coinsurance, and Part A hospice and skilled nursing facility care deductibles or copayments, may be covered by Medigap policies.
- Part B costs, such as coinsurance or copayments, and Part B excess charges, may be covered by Medigap plans.
- Treatment for foreign travel emergencies. This coverage option assists with the payment of certain healthcare costs (typically up to roughly 80%) while travelling internationally.
- Up to the first three quarts of blood If you need a blood transfusion while in the hospital, these plans will cover the first three pints of blood, which can be expensive to pay for out of pocket.
- Out-of-pocket expenses Plans K and L restrict out-of-pocket spending to a certain amount. If you spend the predetermined amount on healthcare in a particular year, your Medigap coverage will cover the remainder of your out-of-pocket spending for the rest of the year.
In terms of coverage, each policy is unique. When deciding on the ideal one for you, keep your needs and budget in mind.
Harvard Pilgrim Medigap plan extra benefits
Plan users can also take advantage of additional benefits provided by Harvard Pilgrim. Discounts and savings programmes, for example, are examples of these perks.
- Membership in the Universal Dental Plan, which provides a 20 to 50% discount on any dental services performed by its network of affiliated practitioners.
- Discounts on hearing aids and eyewear
- Savings on alternative therapies including massage therapy, acupuncture, and chiropractic care
- Reimbursement for fitness facility or class subscription fees
New Hampshire and Maine
Customers in New Hampshire and Maine can purchase Medicare supplement insurance A, F, G, M, and N through Harvard Pilgrim. These Medigap policies are standardised and have the following features:
- Medigap Plan A covers Part A and Part B coinsurance but not skilled nursing facility coinsurance, foreign travel exchange, or the Medicare Part A and Part B deductibles.
- Plan F was the most comprehensive Medigap plan until Medicare discontinued its distribution to new Medicare beneficiaries on January 1, 2020. The plan covers coinsurance, copayments, and deductibles for Parts A and B, as well as blood up to the first three pints and 80 percent of overseas travel health costs.
- Plan G is the most comprehensive Medigap plan available, covering Medicare Part A and Part B coinsurance and copayments, the Part A deductible, blood up to three pints, and 80 percent of overseas travel healthcare costs.
- Medigap Plan M. Medigap Plan M covers, among other things, Part A coinsurance and hospice care coinsurance, blood up to the first three pints, and half of the Medicare Part A deductible.
- Medigap Plan N is similar to Plan M in that some office and emergency department visits demand a copayment.
Below is a chart that allows you to compare the Medigap plans that Harvard Pilgrim offers:
| Plan A | Plan F | Plan G | Plan M | Plan N | |
|---|---|---|---|---|---|
| Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up | yes | yes | yes | yes | yes |
| Part B coinsurance or copayments | yes | yes | yes | yes | yes, with some set copayments |
| Blood (first 3 pints) | yes | yes | yes | yes | yes |
| Part A hospice care coinsurance or copayments | yes | yes | yes | yes | yes |
| Skilled nursing facility care coinsurance | no | yes | yes | yes | yes |
| Part A deductible | no | yes | yes | 50% | yes |
| Part B deductible | no | yes | no | no | no |
| Part B excess charges | no | yes | yes | no | no |
| Foreign travel exchange (up to plan limits) | no | 80% | 80% | 80% | 80% |
Available plans in Massachusetts
Massachusetts structures Medigap plans differently than most states. Instead of having plan options A through N, Massachusetts has three plans:
- Core Plan
- Supplement 1 Plan
- Supplement 1A Plan
The following chart compares the coverage offered by each of these plan types:
| Core Plan | Supplement 1 Plan | Supplement 1A Plan | |
|---|---|---|---|
| Basic benefits | yes | yes | yes |
| Part A inpatient hospital deductible | no | yes | yes |
| Skilled nursing facility coinsurance | no | yes | yes |
| Part B deductible | no | yes* | no |
| Foreign travel emergency | no | yes | yes |
| Inpatient days in mental health hospitals | 60 days | 120 days | 120 days |
| State-mandated benefits | yes | yes | yes |
*Note that if you’re new to Medicare after January 1, 2020, you can no longer purchase a Supplement 1 Plan due to changes that prohibit new policies from covering the Part B deductible.
The “basic benefits” referenced in the chart above cover the following costs:
- Part A coinsurance plus coverage for 365 additional days after Medicare coverage ends
- Part B coinsurance
- first three pints of blood
- hospice coinsurance or copayments
The state-mandated benefits cover costs such as Pap tests and mammograms. You can check your plan details for additional coverage required in your state.
How much do Harvard Pilgrim Medicare supplement plans cost?
Medicare supplement plans can vary based on:
- the plan selected
- the area you live in
- other factors, such as your age and if you smoke
You can search for cost estimates for Medigap plans using Medicare’s plan finder tool.
The following are some examples of monthly Medigap premium ranges in Harvard Pilgrim’s service areas. For these examples, we used data for a 65-year-old woman who doesn’t smoke.
| Plan A | Plan F | Plan G | Plan M | Plan N | |
|---|---|---|---|---|---|
| Bangor, ME | $134–$293 | $220–$378 | $199–$353 | $172–$312 | $155–$225 |
| Portland, ME | $134–$293 | $220–$378 | $199–$353 | $172–$313 | $155–$225 |
| Concord, NH | $98–$198 | $174–$354 | $139–$330 | $156–$211 | $102–$252 |
| Core Plan | Supplement 1 Plan | Supplement 1A Plan | |
|---|---|---|---|
| Boston, MA | $108–$163 | $201–$259 | $156–$251 |
| Cambridge, MA | $108–$163 | $201–$259 | $156–$251 |
These are just cost estimates. Monthly premiums may vary based on your ZIP code, age, and overall health status.
You can contact the company directly for a price quote for your specific situation.
What is Medigap?
Medigap aims to reduce out-of-pocket spending when you have original Medicare (parts A and B).
These standardized policies are intended to reduce your costs under Medicare, which include:
- copayments
- coinsurance costs
- deductibles
Unlike with many Medicare policies, you can sign up for Medigap at any time. You are first eligible during your initial enrollment period: the 3 months before, the month of, and the 3 months after your 65th birthday.
Medigap plans are location-specific. Not all plans are offered in every state, and Medicare doesn’t require insurance companies to sell every Medigap plan.
If you have Medicare Advantage (Part C), you can’t purchase a Medigap policy.
However, you can have original Medicare with a Part D (prescription drug) policy and a Medigap policy. Medicare requires you to have a Part D policy, but you don’t have to purchase a Medigap plan.
Source: Healthline Media
Note: The material on this website may help you make personal insurance decisions, but it is not meant to provide advice on the purchase or use of any insurance or insurance products. Society World Media does not conduct insurance business in any way and is not licenced as an insurance firm or producer in any US jurisdiction. Society World Media does not encourage or endorse any third parties who may conduct insurance transactions.
