Harvard Pilgrim Health Care

Medicare is a federal government health insurance program that was created in 1965 by the Social Security Administration. It is health insurance for people 65 or older, under 65 with certain disabilities, and any age with End-Stage Renal Disease (ESRD).

Medicare Part A (Hospital Insurance)

• Helps cover inpatient care in hospitals
• Helps cover skilled nursing facility, hospice and home health care

Medicare Part B (Medical Insurance)

• Helps cover doctor's services and outpatient care
• Helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse

Medicare Part C (Medicare Advantage Plans)

• Plans that are offered by private companies approved by the Centers for Medicare & Medicaid Services (CMS)

Medicare Part D (Prescription Drug Insurance)

• A prescription drug option run by private insurance companies approved by and under contract with Medicare
• Helps cover the cost of prescription drugs

It is important to note that although Medicare does provide benefits and services, it does not cover everything:

• You may have to pay deductibles, copays and/or coinsurance costs for services. When Medicare covers a service, you usually have to pay for a portion of the cost. That portion of the cost is called a deductible, copay or coinsurance. Deductibles are the amount you are responsible for before Medicare begins to pay. After your deductible is paid, you may also have to pay a copay or coinsurance. The coinsurance is usually 20% of the Part B service.
• If you travel outside of the United States, generally Medicare will not cover you for any services, even in the event of an emergency.

With Harvard Pilgrim’s Medicare Supplement Plan you will be able to keep your current doctor if he/she is a Medicare participating doctor. Most doctors participate in Medicare, so it is very likely that you would be able to keep your current doctor. To find out if your doctor is a Medicare participating doctor, just call your doctor’s office and ask if they accept Medicare.

With Harvard Pilgrim’s Medicare Supplement Plan, you will be able to see any specialist or go to any specialist facility, without a referral, as long as that specialist or facility accepts Medicare. Most specialists and specialist facilities participate in Medicare, so it is very likely that you would be able to go to any specialist or facility.

With Harvard Pilgrim’s Medicare Supplement Plan, there is no network, so you can go to any doctor or hospital that participates in Medicare.

With Harvard Pilgrim’s Medicare Supplement 1 Plan, once you pay your monthly premium you will not have any copayments for physician services. With Harvard Pilgrim’s Medicare Supplement Core Plan, and Medicare Supplement 1A Plan, a Medicare Part B deductible (which covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment) will apply.

Yes! In Massachusetts you may qualify for a discounted premium rate for the first three years when you enroll in Harvard Pilgrim’s Medicare Supplement Plan. To qualify for these discounts you must be at least age 65 and apply for coverage within six months of your Part B effective date.

With Harvard Pilgrim’s Medicare Supplement Plan, your plan travels with you. You will be able to move anywhere in the United States and still be covered by your Medicare Supplement Plan.

With Harvard Pilgrim's Medicare Supplement Plan, you will have coverage for all covered services, not just emergency and urgent care, in the United States. You will also have coverage for unexpected emergencies that take place while traveling worldwide.

The best time to enroll in Harvard Pilgrim’s Medicare Supplement Plan is during your Medicare Supplement initial open enrollment period since you can save money on your premiums when you’re initially eligible for Medicare. This period lasts for six months and begins on the first day of the month in which you are 65 or older and enrolled in Medicare Part B.

You can send in your application for our plan before your Medicare Supplement open enrollment period starts. This may be important if you currently have coverage that will end when you turn 65. This will allow you to have continuous coverage.

If you have group health coverage through an employer because either you or your spouse is currently working, you may want to wait to enroll in Part B. When coverage through your employer ends, you will be able to enroll in Part B and take advantage of the discount if you enroll within six months.

It’s easy to enroll in Harvard Pilgrim’s Medicare Supplement Plan.

• Enroll online
• Enroll over the telephone with a plan representative by calling:
  1-877-906-4742, TTY: 711 (Monday – Friday 8:30 a.m. – 5:00 p.m.), or
• Contact your local agent
• Complete a paper enrollment form. Prior to submitting your enrollment form for processing, please take the time to complete the entire enrollment form. If the enrollment form received is incomplete, it may be returned to you for additional information.

Your coverage is effective the first day of the month following the month in which Harvard Pilgrim received your signed, completed enrollment form. For example, if we received your enrollment form on January 15th, your coverage under Harvard Pilgrim’s Medicare Supplement Plan will be effective February 1st.