Individual and family plans offered directly through Harvard Pilgrim or on CoverME.gov. Get details on benefits, cost sharing and more in our 2024 Maine product guide.
HMO and HMO HSA – 2024
Choose a primary care provider (PCP) from Harvard Pilgrim’s HMO network. They’ll coordinate your care with participating specialists and hospitals.
Plan details:
- PCP required
- Referrals to most kinds of specialists required
- Must receive care for covered services from providers in the HMO directory (exceptions include medical emergencies)
- Includes Value 5-Tier prescription drug coverage
Maine’s Choice Plus HMO and Maine’s Choice Plus HMO HSA – 2024
Flexible plans that can help you save money with two networks of providers and hospitals.
Plan details:
- Two networks: Preferred Network (lower cost sharing) and Standard Network (higher cost sharing)
- PCP required
- Referrals to most kinds of specialists required
- Must receive care for covered services from providers in the Maine’s Choice Plus HMO directory (exceptions include medical emergencies)
- Includes Value 5-Tier prescription drug coverage
POS – 2024
Choose to get care with or without referrals and outside of Harvard Pilgrim’s network.
Plan details:
- PCP required
- In-network coverage and lower cost sharing when you receive care for covered services from participating providers with your PCP’s referral*
- Out-of-network coverage and higher cost sharing when you receive care for covered services from:
- Participating providers without your PCP’s referral
- Non-participating providers
- Find participating doctors and hospitals in the POS provider directory
- Includes Value 5-Tier prescription drug coverage
PPO – 2024
Choose to get care from providers inside or outside of our extensive network.
Plan details:
- PCP encouraged but not required
- Referrals not required
- In-network coverage and lower cost sharing when you receive care for covered services from participating providers
- Out-of-network coverage and higher cost sharing when you receive care for covered services from non-participating providers
- Find participating doctors and hospitals in the PPO provider directory
- Includes Value 5-Tier prescription drug coverage
Disclosures
*Certain in-network services do not require referrals.