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Home > Broker > Plan Information > Medicare Supplement Plan - Broker > Q&A

Selling Harvard Pilgrim’s Medicare Supplement Plan?  These commonly asked questions may help

What is Medicare Supplemental Insurance?
Medicare Supplement Insurance (also called a Medigap policy) is a health insurance policy sold by private insurance companies to fill in the “gaps” in Original Medicare coverage.  Insurance companies who sell these policies must follow Federal and State laws that protect people with Medicare.

What does Medicare Supplemental Insurance cover?
Original Medicare pays for many health care services and supplies, but it doesn’t cover all health care costs. There are additional costs such as deductibles, coinsurance and copayments. These costs are sometimes called “gaps” in Medicare coverage. Some or all of these gaps may be covered by a Supplement Plan.  For example, with Original Medicare only, a person would pay a Part A deductible of $1,156 for inpatient hospitalization and that amount may increase in 2013.  Harvard Pilgrim’s Medicare Supplement Plan fills in those gaps and provides more coverage and protection for our members.

Who can purchase Medicare Supplemental Insurance?
To buy a Medigap policy, a person must have Medicare Part A and Part B. If they are under age 65 and have a disability they may also be eligible depending upon the state in which they reside. A person is guaranteed the right to buy a Medigap policy if they are:

  • In the Medigap open enrollment period,
  • Covered under a Medigap protection

How does a Medicare Supplement plan work?
Medicare Supplement plan supplements Medicare coverage by paying certain Medicare deductibles and coinsurance amounts not covered by Medicare.  A member can go to any Medicare participating doctor, specialist or hospital anywhere in the country. 

A Medicare Supplement member must show their Medicare Card (the red, white and blue card) along with their Harvard Pilgrim Medicare Supplement Card, to allow the medical provider to bill Medicare.  Members will also receive an Explanation of Benefits (EOB) from Medicare.  Medicare will then submit the claim to Harvard Pilgrim, who will process the claim. Harvard Pilgrim will then send a Medicare Supplement EOB to the member.

How much does Harvard Pilgrim’s Medicare Supplement Plan cost and what plan options are available?
Massachusetts premiums are community rated and renew on the first of the year. 

MassachusettsMonthly Premium Rates
Effective January 1, 2012 - December 31, 2012

When you turn 65 and become initially eligible for Medicare you may qualify for a discounted premium rate for the first 3 years of enrollment in our plan.*

  • 15 % in the first 12 months of enrollment
  • 10% in the second 12 months of enrollment
  • 5% in the third 12 months of enrollment

There are no discounts after the third year.

 

Rate without
discount

15% discount
Year 1

10% discount
Year 2

5% discount
Year 3

Core Plan

$98.50

$83.73

Amount based on 2013 rates

Amount based on 2014 rates

Supplement 1 Plan

$185.50

$157.68

Amount based on 2013 rates

Amount based on
2014 rates

To qualify for these discounts you must be:
At least age 65 and apply for coverage within 6 months of your Part B effective date.

In Massachusetts there are 2 options - Core and Medicare Supplement 1

Harvard Pilgrim’s Medicare Supplement Plan
Partial listing - Please see the Outline of Coverage for a complete list of benefits.
*Each year with Original Medicare, you pay a total of $140 for your Part B deductible before other cost sharing applies.

Medical
Benefits

Original Medicare
You Pay

Medicare
Supplement Core
Plan You Pay

Medicare
Supplement 1
PlanYou Pay

Inpatient Hospital
Coverage

Days 1-60: $1,156
Part A Deductible

Days 61-90: $289
per day

Days 1-60: $1,156
Part A Deductible

Days 61-90: $0

$0

Skilled
Nursing
Facility

Days 1-20: $0

Days 21-100: $144.50
per day coinsurance

Days 1-20: $0

Days 21-100: $141.50
per day coinsurance

 

$0

Emergency Room
Care

20% coinsurance for
the doctor and facility*

 

$0*

 

$0

Emergency Care in a Foreign Country

Coverage in the United States and while traveling
through Canada and Mexico

Coverage Worldwide

Diagnostic Tests,
X-Rays, Lab
Services and
Radiology Services

20% coinsurance for
diagnostic tests and
x-  rays*

$0 copay for  Medicare
covered lab services

$0*

•$0

Fitness
Reimbursement

No Coverage

$150 reimbursement for
health club membership annually

Services of
Physicians
and other
covered Health
Professionals

20% coinsurance for
most physicians
services*

$0*

$0

Preventive Care
Services
- As covered by
Medicare

Covered in full

Part B deductible
does not apply

$0

Part B deductible
does not apply

$0

Part B deductible
does not apply

Annual
Wellness
Exam

Covered in full

Part B deductible
does not apply

$0

Part B deductible
does not apply

$0

Part B deductible
does not apply

Maine premiums are community rated and renew on the first of the year.  

MaineMonthly Premium Rates

Effective January 1, 2012 - December 31, 2012

 

All Ages

 

Plan A

 

Plan F

 

Plan M

 

Plan N

 

Billed Monthly

 

$112

 

$164

 

$119

 

$113

In Maine there are 4 options: A, F, M, N:

Harvard Pilgrim’s Medicare Supplement Plan
Partial listing - Please see the Outline of Coverage for a complete list of benefits.
*Except for Plan F, all HPHC plans and original Medicare require that you pay the $140 Part B deductible before other cost sharing applies.

Medical
Benefits

Original Medicare
You Pay

Plan A
You Pay

Plan F
Your Pay

Plan M
You Pay

Plan N
You Pay

Inpatient
Hospital
Coverage

Days 1-60: $1,156, Part A Deductible

Days 61-90: $289
per day

Days 1-60: $1,156, Part A Deductible

Days 61-90: $0

Days 1-60: $0

Days 61-90: $0

Days 1-60: 50%
of Medicare
Part A Deductible

Days 61-90: $0

Days 1-60: $0

Days 61-90: $0

Skilled
Nursing
Facility

Days 1-20: $0  
copay per day

Days 21-100:
$144.50 per day

Days 1-20: $0

Days 21-100:
$144.50 per day
coinsurance

Days 1-20: $0

Days 21-100: $0

Days 1-20: $0

Days 21-100: $0

Days 1-20: $0

Days 21-100: $0

Emergency
Room Care

20% coinsurance for the doctor and facility*

$0*

$0

$0*

$50 copay*

Emergency
Care in a Foreign
Country

Not covered outside of the U.S.

Not covered outside of the U.S.

First $250 each calendar year.
Then 20% of amounts over the $50,000 lifetime maximum.

Diagnostic
Tests, X-Rays,
Lab Services
and Radiology
Services

20% coinsurance for diagnostic tests and x-rays*

$0 copay for Medicare covered
lab services

$0*

$0

$0*

$20 copay per
office visit if
applicable*

Services of
Physicians
and other
covered Health
Professionals

20% coinsurance for most physician
services*

$0*

$0

$0*

$20 copay*

Preventive
Care Services
- As covered by Medicare

Covered in full
Part B deductible
does not apply

$0
Part B deductible
does not apply

$0
Part B deductible
does not apply

$0
Part B deductible
does not apply

$0
Part B deductible
does not apply

Annual Wellness Exam

Covered in full
Part B deductible
does not apply

$0
Part B deductible
does not apply

$0
Part B deductible
does not apply

$0
Part B deductible
does not apply

$0
Part B deductible
does not apply

Medicare Supplement Plans are available to all individuals, regardless of age, who are entitled to Medicare benefits due to disability. This policy may not cover all of your medical expenses. 

New Hampshire premiums are age rated and renew on the anniversary of when the policy was purchased. 

Monthly Premium Rates
Effective January 1, 2012 - December 31, 2012


Issue Age

Plan A

Plan F

Plan M

Plan N

<65

$150

$216

$157

$153

65

$111

$155

$116

$106

66

$112

$157

$117

$108

67

$115

$162

$119

$111

68

$118

$165

$123

$115

69

$120

$170

$126

$118

70

$124

$176

$130

$121

71

$127

$180

$133

$125

72

$131

$185

$136

$129

73

$133

$189

$139

$132

74

$135

$193

$142

$135

75

$138

$197

$145

$138

76

$141

$201

$148

$141

77

$144

$206

$150

$145

78

$146

$209

$152

$148

79

$149

$212

$154

$150

80+

$150

$216

$157

$153

Rates are in effect for 12 months from the member's initial enrollment date.

 

 

 

 

 

 

In New Hampshire there are 4 options: A, F, M, N. Please see the chart below:

Harvard Pilgrim’s Medicare Supplement Plan
Partial listing - Please see the Outline of Coverage for a complete list of benefits.
*Except for Plan F, all HPHC plans and original Medicare require that you pay the $140 Part B deductible before other cost sharing applies.

Medical
Benefits

Original Medicare
You Pay

Plan A
You Pay

Plan F
Your Pay

Plan M
You Pay

Plan N
You Pay

Inpatient
Hospital
Coverage

• Days 1-60: 1,156
Part A Deductible
• Days 61-90: $289
per day

• Days 1-60: $1,156
Part A Deductible
• Days 61-90: $0

• Days 1-60: $0

• Days 61-90: $0

• Days 1-60: 50%
of Medicare
Part A Deductible
• Days 61-90: $0

• Days 1-60: $0

• Days 61-90: $0

Skilled
Nursing
Facility

• Days 1-20: $0 
copay per day
• Days 21-100:
$144.50 per day

• Days 1-20: $0
• Days 21-100:
$144.50 per day
coinsurance

• Days 1-20: $0

• Days 21-100: $0

• Days 1-20: $0

• Days 21-100: $0

• Days 1-20: $0
• Days 21-100:
$0

Emergency
Royesyeom Care

• 20% coinsurance for the doctor and facility*

 

• $0*

 

• $0

 

• $0*

 

• $50 copay*

Emergency
Care in a Foreign
Country

 

Not covered outside of the U.S.

 

Not covered outside of the U.S.

 

First $250 each calendar year.
20% of amounts over the $50,000 lifetime maximum.

Diagnostic
Tests, X-Rays,
Lab Services
and Radiology
Services

• 20% coinsurance for diagnostic tests and x-rays*
• $0 copay for Medicare covered
lab services

 

• $0*

 

• $0

 

• $0*

 

• $20 copay per office visit if applicable*

Services of
Physicians
and other
covered Health
Professionals

• 20% coinsurance for most physician
services*

 

• $0*

 

• $0

 

• $0*

 

• $20 copay*

Preventive
Care Services
- As covered by Medicare

 

• Covered in full
Part B deductible
does not apply

 

• $0
Part B deductible
does not apply

 

• $0
Part B deductible
does not apply

 

• $0
Part B deductible
does not apply

 

• $0
Part B deductible
does not apply

Annual Wellness Exam

• Covered in full
Part B deductible
does not apply

• $0
Part B deductible
does not apply

• $0
Part B deductible
does not apply

• $0
Part B deductible
does not apply

• $0
Part B deductible
does not apply

Medicare Supplement Plans are available to all individuals, regardless of age, who are entitled to Medicare benefits due to disability. This policy may not cover all of your medical expenses. 

 

Can a person keep their current Physician if they join Harvard Pilgrim’s Medicare Supplement Plan?
With a Medicare Supplement plan there is no network requirement or restriction, as long as the physician is Medicare certified or accepts Medicare, he/she will accept Harvard Pilgrim’s Medicare Supplement Plan.

 Are referrals needed?
No, a person can go to any doctor, hospital, or provider that accepts Medicare.

Are eyeglasses covered?
Corrective eyeglasses are not covered under Harvard Pilgrim’s Medicare Supplement Plan; however members of Harvard Pilgrim will have access to special savings on many health related products and services.   As part of the Member Savings program, there is a Free Eyewear program where members can save 35% off eyeglasses and 40% off of frames at many selected vendors.

If eyeglasses are required due to cataract surgery, these benefits are covered by Medicare and therefore will be covered by Harvard Pilgrim’s Medicare Supplement Plan.  The cost sharing would vary based on which coverage option was chosen.

Are hearing aids covered?
Hearing aids are not covered under Harvard Pilgrim’s Medicare Supplement Plan; however members of Harvard Pilgrim will have access to special savings on many health related products and services.   As part of the Member Savings program, members can save up to $200 on each hearing aids purchased at our selected providers.

Is there foreign travel coverage?

  • In Massachusetts, the Core plan members will be covered for nationwide care and while traveling through Canada and Mexico.  On the Supplement 1 plan, members will be covered nationwide as well as worldwide for all Medicare covered services.
  • In Maine and NH, Plan A members will be covered for nationwide care and while traveling through Canada and Mexico.  Plan F, M, N members will have nationwide care, foreign coverage is provided as follows:  member pays a $250 deductible, then 20% coinsurance up to $50,000 lifetime limit.

Does Harvard Pilgrim’s Medicare Supplement plan provide any coverage for dental?
No, dental coverage is not Medicare covered benefit.

Are there any additional discounts on Medicare Supplement products?

  • In the state of Massachusetts our Medicare Supplement plans offer discounts to those 65 year of age or older who join the Medicare Supplement plan within  6 months of their Medicare Part B effective date.  They will receive 15% discount off their 1st year premium, then 10% discount off their 2nd year premium and 5% the 3rd year. 
  • In the state of Maine or New Hampshire we do not offer any additional discounts. 

Where do members send their payments? Can premiums be paid early?
Payments can be sent to:
HPHC Insurance Company
P.O. Box 970040
Boston, MA 02297-0040

Premiums can be paid early .  Note, there is no discount for doing so.

Can members join Harvard Pilgrim Medicare supplement plans at any time, regardless of their pre-existing conditions?

  • In Massachusetts we allow continuous open enrollment.  Medicare beneficiaries can join at any time without completing a medical questionnaire.
  • In Maine, under Continuous Enrollment rules Harvard Pilgrim will allow Medicare beneficiaries to switch to a "like" or "lesser" plan as long as they have proof of coverage with another carrier.  If they can’t obtain the proof of coverage, then they must complete the medical questionnaire on the application (with all “No” answers) to be eligible.  If that’s not possible, then Plan A is available to enroll into in the month of December. Under Guarantee Issue rules members can join our plans without completing the medical questionnaire as long as they apply within 90 days of the event that would qualify them for Guarantee Issue. 
  • In New Hampshire, under Continuous Enrollment rules, Harvard Pilgrim will allow Medicare beneficiaries to switch to our Medicare Supplement plan as long as they complete the medical questionnaire on the enrollment form (with all “No” answers), regardless of whether they have similar policy in force with another carrier or not.  They can enroll in Plan A at any time without completing the Medical Questionnaire. Under Guarantee Issue rules members can join our plans without completing the medical questionnaire as long as they apply within 63 days of the event that would qualify them for Guarantee Issue.