About Our Stride (HMO/HMO-POS) Medicare Advantage Plans

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.

2021 Service Area

The service areas for our StrideSM (HMO) Medicare Advantage plans were updated for 2021 and will include the following counties:

  • Massachusetts: Barnstable, Bristol, Essex, Middlesex (excluding zip codes 01824, 01826, and 01863), Norfolk, Plymouth, Suffolk, and Worcester
  • Maine: Cumberland, Franklin, Kennebec, and York
  • New Hampshire: Belknap, Carroll, Cheshire, Coos, Grafton, Hillsborough, Merrimack, Rockingham, Strafford (Value Rx Plus HMO plan only), and Sullivan

Plan Options

In 2021, Medicare beneficiaries can choose from the following Harvard Pilgrim options (depending on the county in which they reside):

All StrideSM Basic Rx (HMO) plans have a $0 monthly premium. All other StrideSM (HMO) 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.

2021 Benefits

For 2021, benefits include (among others):

  • Aligned copayments for services provided in outpatient hospital facilities, including outpatient surgery, outpatient observation, and advanced diagnostic radiology
  • No member cost share for telemedicine virtual check-ins and e-visits
  • $25 copayment per one-way trip for Non-Emergency Medical Transportation other than ambulance (prior authorization is required)*
  • Full coverage for vaccines covered by Medicare under Part D; no cost to members for most vaccines, including shingles, unless they are in the Catastrophic Coverage stage of their Part D benefit
  • No member cost sharing for Therapeutic Continuous Glucose Monitoring Systems (prior authorization is required)
  • $35 copayment for a 30-day supply of Formulary insulins, including insulin pens, from participating retail pharmacies or $70 for a 90-day supply from participating mail order pharmacies

*Benefits vary by plan

Self-Referral Option

Stride℠ (HMO) members residing in Maine and New Hampshire may self-refer for specialized care and do not need approval from their PCP to see a network specialist or other provider. Although members have direct access to specialized care, we encourage them to consult with their PCPs first. This self-referral option includes the Choice Rx (HMO-POS) plans, which offer the option for members to seek care outside the Stride℠ (HMO) provider network for Medicare-covered outpatient items and services.

Supplemental Benefits

Harvard Pilgrim’s StrideSM (HMO) 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, routine chiropractic visits, 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

Gain Rx℠ (HMO)-Specific Benefits

The Gain Rx℠ (HMO) plan is designed to complement the New Hampshire Medicaid Program, even though it is not a specialized Medicare Advantage Plan (also known as a Medicare “Special Needs Plan”). The service area for this plan includes Cheshire, Coos, Hillsborough, Merrimack, and Rockingham counties in 2021, and benefits specific to Gain Rx℠ include:

  • A $15 copayment for PCP visits (instead of 20% coinsurance)
  • Reimbursement of up to $325 for items and services covered by the Stride℠ (HMO) Wallet Benefit (instead of a $150 allowance for prescription eye wear)
  • Worldwide coverage for urgent and emergency care, including emergency ambulance
  • Part D cost sharing for Tier 2-4 drugs changed to copayments (instead of 25% coinsurance)

Member Incentive Program

Harvard Pilgrim offers a wellness program for our StrideSM (HMO) 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.