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.

Often people believe that Medicare pays for all hospitalization and doctor costs. When first enrolled in Medicare, people are surprised to learn that there are gaps in their coverage and that they are responsible for paying for services that Medicare doesn’t completely cover. That’s how Harvard Pilgrim can help you. Our Stride℠ (HMO) Plan option helps fill in the gaps that Medicare doesn’t cover.

To be considered eligible for Harvard Pilgrim’s Stride℠ (HMO) Plan, you must meet the following requirements:

• You are entitled to Medicare Part A (hospitalization) and are enrolled in Medicare Part B (medical) and continue to pay Part B premiums if not otherwise paid for under Medicaid or by another third party
• Permanently live within the Stride℠ (HMO) service area which includes all of New Hampshire
• Most Medicare beneficiaries can join, including those eligible on the basis of disability

NOTE: Medicare Supplement benefit Plan F, will not be offered to individuals newly eligible for Medicare on or after January 1, 2020.

There are limits on when and how often you can change the way you get your Medicare coverage. Switching from one plan like Stride℠ (HMO) to one of the other plans we offer, or to a plan offered by another organization, counts towards making a change. If you have both Medicare and Medicaid, you can change to another plan at any time or to Medicare.

Initial Enrollment Period

• When you are first eligible for Medicare, you have a 7-month period to sign up. This 7-month period begins 3 months before your 65th birthday, including the month you turn 65, and ends 3 months after you turn 65.

From October 15, 2022 through December 7, 2022

• Change from Medicare to a Medicare Advantage Plan
• Change from a Medicare Advantage Plan back to Medicare
• Switch from one Medicare Advantage Plan to another Medicare Advantage Plan
• Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that does offer drug coverage
• Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage
• Join a Medicare Prescription Drug Plan
• Switch from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan
• Drop your Medicare Prescription Drug coverage completely

Medicare Advantage Open Enrollment Period (OEP) From January 1, 2024 through March 31, 2024

• OEP allows individuals enrolled in a Medicare Advantage plan, including newly Medicare Advantage eligible individuals, to make a one-time election to go to another Medicare Advantage plan or Original Medicare. Individuals using the OEP to make a change may make a coordinating change to add or drop Part D coverage.
• Make a one-time election to go from a Medicare Advantage Plan back to Original Medicare and add a Medicare Part D Plan.
• Make a one-time election to switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
• Generally, you cannot make any other changes during the year unless you meet special exceptions such as if you move or lose other insurance coverage.

With Harvard Pilgrim’s Stride℠ (HMO) Plan you will need to choose a primary care provider (PCP) who will work with you to provide the care you need. You can count on your PCP to provide or authorize all of your routine health care and specialized services (including self-referrals). You'll receive all of your medical services from Stride℠ (HMO) network providers who will work together to coordinate your care, except in emergency or urgent care situations or for out-of-area dialysis services. You can change your primary care provider at any time by simply calling Member Services.

With Stride℠ (HMO) your financial obligations consist of a monthly plan premium. You may pay deductibles, copayments/coinsurance for medical services in addition to your Medicare Part B premium. Your copayment/coinsurance must be paid at the time of service. You will receive a bill for your monthly premium, which you may choose to pay by electronic fund transfer for convenience.

The 2024 monthly premium for Stride℠ (HMO) in New Hampshire is $0 per month for the Basic Rx (HMO) plan.

The 2024 monthly premium for Stride ℠ (HMO) Value Rx (HMO) Plan in Belknap, Cheshire, Grafton, Hillsborough, Merrimack, Rockingham & Sullivan counties is $49.

The 2024 monthly premium for Stride ℠ (HMO) Choice Rx (HMO-POS) Plan in Belknap, Cheshire, Grafton, Hillsborough, Merrimack, Rockingham & Sullivan counties is $60.

The 2024 monthly premium for Stride ℠ (HMO) Value Rx Plus (HMO) Plan in Belknap, Cheshire, Grafton, Hillsborough, Merrimack, Rockingham & Sullivan counties is $133 & $122 for Value Rx (HMO) in Strafford County.

With Harvard Pilgrim’s Stride℠ (HMO) Plan, you will have coverage for unexpected emergencies that take place while traveling worldwide.

Harvard Pilgrim’s Choice Rx (HMO-POS) plan provides you with the flexibility to go outside the Stride℠ (HMO) network for out-patient medical services. You can also go out-of-network within the plan service area.

• The only place you will not be covered is the U.S. territories, e.g. Puerto Rico and the U.S. Virgin Islands.
• Out-of-network providers must be state-licensed or state-certified and eligible to be paid by Original Medicare to furnish the services that are included in the POS benefit.
• Rx prescribers must also be eligible to be paid by Original Medicare and to treat the conditions for which they are prescribing the drug(s).

It’s easy to enroll in Harvard Pilgrim’s Stride℠ (HMO) Plan.

• Enroll over the telephone with a plan representative by calling:
  1-855-243-1145, TTY: 711

Oct. 1 – Mar. 31, 8am – 8pm, 7 days a week;
Apr. 1 – Sept. 30, 8am – 8pm Mon. – Fri.

• Attend one of our local sales meetings where a sales person will be present with information and applications
• Enroll online
• Contact your local agent
• Visit http://www.Medicare.gov to enroll through the CMS Medicare Enrollment Center
• Fill out and sign a paper application and return it to:

Harvard Pilgrim Health Care Enrollment
PO Box 152108
Tampa, FL 33684-2108

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 as of the first day of the calendar month following the month in which Harvard Pilgrim received your signed, completed application. For example:

• If Harvard Pilgrim received your signed, completed application on July 15, your coverage under Stride℠ (HMO) will be effective August 1.
• If you are enrolling during the annual open enrollment period, October 15 - December 7, your coverage will be effective on January 1 of the following year.

Often people believe that Original Medicare pays for all hospitalization and doctor costs. When first enrolled in Medicare, people are surprised to learn that there are gaps in their coverage and that they are responsible for paying for services that Medicare doesn’t completely cover. That’s how Harvard Pilgrim can help you. Our Medicare Supplement Plan options help fill in the gaps that Medicare doesn’t cover.

To be considered eligible for Harvard Pilgrim’s Medicare Supplement Plan, you must meet the following requirements:

• Your legal residence is in the state of New Hampshire
• You are eligible for Medicare Part A and Medicare Part B and enrolled in Medicare Part B
• Harvard Pilgrim’s Medicare Supplement Plan is available to all individuals, regardless of age, who are entitled to Medicare benefits due to disability.

Note: Medicare Supplement benefit Plan F, will not be offered to individuals newly eligible for Medicare on or after January 1, 2020.

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 go to any hospital that participates in the Medicare program. Most hospitals participate in Medicare so, with our Medicare Supplement Plan, you’ll most likely be able to go to any hospital.

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.

Depending upon the Harvard Pilgrim Medicare Supplement Plan that you choose, you may not have any out-of-pocket costs including copayments for physician services. Other Harvard Pilgrim Medicare Supplement Plans may require that you pay your Medicare Part A deductible or pay the Medicare Part B deductible and copayments.

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. Depending on the Medicare Supplement Plan you choose, you may also have coverage for unexpected emergencies that take place while traveling anywhere in the world.

The best time to enroll in Harvard Pilgrim’s Medicare Supplement Plan is during your Medicare Supplement initial open enrollment period. 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.

You are eligible for Guarantee Issue if:

• You have been involuntarily terminated or lost coverage from a Medicare Advantage Plan, employer retiree plan, COBRA coverage, Medicare Select, PACE, Demonstration or Medicare Supplement plan in the past 63 days.
• You voluntarily disenrolled from your Medicare Advantage, Medicare Select or PACE plan within the first 12 months of enrollment, and are applying for Medicare Supplement within 63 days of termination.
• The Harvard Pilgrim Medicare Supplement plan you are choosing is of equal or lesser coverage than your current Medicare Supplement policy and you have not had a gap in coverage of more than 63 days.

You are eligible for Continuous Open Enrollment if:

• You are applying for Plans F, M, G, and N at any time. Section 5 on the enrollment form must be completed with all "NO" responses.

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.