We’re pleased to provide you with an overview of our StrideSM (HMO/HMO-POS) Medicare Advantage plans to enable you to better serve our members.
2020 Service Area
For 2020, the service areas for our StrideSM (HMO/HMO-POS) Medicare Advantage plans include the following counties:
- Massachusetts: Barnstable, Bristol, Essex, Middlesex (excluding zip codes 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
In 2020, Medicare beneficiaries can choose from the following Harvard Pilgrim options:
StrideSM Basic Rx (HMO)
StrideSM Value Rx (HMO)
StrideSM Choice Rx (HMO-POS) NEW!
StrideSM Value Rx Plus (HMO)
StrideSM Gain RxSM (HMO)
All StrideSM Basic Rx (HMO) plans have a $0 monthly premium. All other StrideSM plans offer competitive member premiums, minimal to no PCP copays, and comprehensive benefits including Part D prescription drug coverage, inpatient hospital coverage, routine care and wellness visits, and annual vision and hearing exams.
For 2020, Harvard Pilgrim introduced two new plans that allow more choice for Medicare beneficiarie — the StrideSM Choice Rx (HMO-POS) plans are offered in Maine or New Hampshire. Harvard Pilgrim’s Point-of-Service (POS) benefit:
- Accommodates members who travel outside their plan’s service area for fewer than six months
- Covers outpatient (Part B) services from out-of-network providers
- Routine and preventive care are included
- Referrals for specialty care are still required from members’ in-network PCPs
- Cost sharing and prior authorization requirements are the same as for in-network
- Does not cover elective inpatient (Part A) care from out-of-network providers, including home health agencies and skilled nursing facilities
As a reminder, emergency and urgent care are always covered out-of-network regardless of the member’s Medicare Advantage plan.
Harvard Pilgrim’s StrideSM Medicare Advantage plans also offer the following at no additional premium cost:
- An annual Wallet Benefit to help cover qualified health and wellness expenses such as a fitness tracker, fitness membership and classes, prescription eyewear, bathroom safety devices (and installation), acupuncture visits, massage therapy, and more*
- A yearly allowance for eligible over-the-counter (OTC) products, including incontinence supplies, toothbrushes, water flossers, and a digital scale
- Routine dental coverage such as preventive services, periodontal maintenance, and fillings*
- Yearly exams to screen for vision and hearing changes
- Coverage for hearing aids and batteries
- Curb-to-curb transportation to and from non-emergency medical appointments*
*Benefits vary by plan
Member Incentive Program
Harvard Pilgrim offers a wellness program for our StrideSM Medicare Advantage members that rewards them for making healthy choices. Members can earn merchant gift cards for completing these activities:
- Annual wellness visit
- Diabetes eye exam
- Colorectal cancer screening
Members also have access to a host of health information and tools through CafeWell Rewards.