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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

October 2018

Medicare Advantage: Expansion and New Benefits for 2019

As open enrollment for Medicare Advantage begins this month, we want to update you on our expanded service area and new benefits for 2019.

Expanded service area

We’re pleased to announce that we’ve expanded our service area for StrideSM (HMO) Medicare Advantage plans from 20 to 26 counties for 2019:

  • Massachusetts: Barnstable, Bristol, Essex, Middlesex (excluding 01824, 01826, and 01863), Norfolk, Plymouth, Suffolk, and Worcester
  • Maine: Androscoggin, Cumberland, Franklin, Kennebec, Knox, Sagadahoc, Waldo, and York
  • New Hampshire: Belknap, Carroll, Cheshire, Coos, Grafton, Hillsborough, Merrimack, Rockingham, Strafford, and Sullivan

New benefits & plan changes for 2019

As in 2018, members can choose from the following Stride plan options: Basic Rx (HMO), Value Rx (HMO), or Value Rx Plus (HMO). Plans continue to offer competitive member premiums, minimum PCP copays, and comprehensive benefits including: Part D prescription drug coverage; inpatient hospital coverage; routine care and wellness visits; preventive dental coverage; low-cost hearing exams and robust hearing aid coverage with copayments; and annual eye exams.

Among the updates for 2019 are:

  • $0 premium Basic Rx plan available in all ME and NH counties and most MA counties
  • $0 copayment for diabetic retinopathy screening
  • OTC benefit changes for Value Rx and Value Rx Plus plans ($200 and $250 per year, respectively, increasing from $150 per year)
  • A new Wallet Benefit, a spending allowance to help cover qualified healthcare expenses such as fitness, eye wear, acupuncture, massage therapy, and more. The Wallet Benefit amount varies by plan:
    • Basic Rx (HMO): $250 per year
    • Value Rx (HMO): $325 per year
    • Value Rx Plus (HMO): $400 per year
  • New Gain Rx plan for Hillsborough, Merrimack, and Rockingham counties in New Hampshire. This plan is designed for beneficiaries who are eligible for Medicare and Medicaid. Gain Rx members who are eligible for both Medicare and full Medicaid coverage will have $0 premiums and no copayment or coinsurance for PCP office visits, specialist office visits, outpatient surgery, or inpatient hospital stays
  • Opioid edits at pharmacy point of service when two or more prescribers have written orders, or when Morphine Milligram Equivalent (MME) is 90mg or greater

If you have questions about our 2019 StrideSM(HMO) Medicare Advantage plans or would like information to display in your office, please contact your Provider Relations representative.

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