As open enrollment for Medicare Advantage began on Oct. 15, we want to update you on our plans and benefits for 2022.
We will continue to offer StrideSM (HMO) Medicare Advantage plans in New Hampshire. However, as we’ve announced previously, as of Jan. 1, 2022, Harvard Pilgrim will no longer be offering StrideSM (HMO) Medicare Advantage plans in Massachusetts or Maine. Our commitment to these markets remains strong, and we will continue to offer Harvard Pilgrim commercial and Medicare Supplement plans in Maine and Massachusetts.
The combined Tufts Health Plan and Harvard Pilgrim Health Care organization, Point32Health, is continuously evaluating its products in each market. We determined that in Massachusetts for 2022, we will invite existing Stride℠ (HMO) Medicare Advantage members to join the Tufts Medicare Preferred HMO plans. We’re confident that the Tufts Medicare Preferred HMO plans will deliver greater value and service to our former StrideSM (HMO) Medicare Advantage members in Massachusetts.
Please refer to this article from last month’s issue of Network Matters for further information and information on how we’re assisting members in making this transition.
StrideSM (HMO) in New Hampshire
For 2022, StrideSM (HMO) Medicare Advantage plans will continue to be available throughout the state of New Hampshire. Members of StrideSM (HMO) plans in New Hampshire will still be able to receive care from providers in other states, such as Maine and Massachusetts, who are contracted with Harvard Pilgrim’s StrideSM (HMO) network.
Depending on the county they live in, Medicare beneficiaries can choose from the following Stride℠ (HMO) plan options in New Hampshire (Note that Value Rx Plus is our only plan in Strafford County):
- Basic Rx – Our fastest growing plan ($0 premium)
- Value Rx – Our most popular plan ($49 premium)
- Choice Rx – Our only plan with an out-of-network benefit ($55 premium)
- Value Rx Plus – Our longest-tenured plan with service area statewide
($138 premium in Strafford County; $128 premium in all other counties)
Depending on your patient’s plan, below are updates for 2022. As a reminder, coverage for Medicare Parts A and B benefits is dependent on medical necessity, which may be subject to confirmation via prior authorization by the plan.
- $0 copayment for PCP visits
- Prescription drugs covered:
- No deductible or coverage gap for preferred generics, most Part D vaccines, and select insulins
- $0 copayment for preferred generics and most Part D vaccines
- $35 copayment for 30-day supply of select insulins
- Annual OTC allowance for mail-order items (amount varies by plan)
- Annual reimbursement for non-medical dental services (amount varies by plan)
- Annual reimbursement for other health-related items and services (amount varies by plan)
- Annual hearing exam and hearing aids covered (exam copayment varies by plan)
- $0 copayment for labs and diagnostic tests/procedures billed with:
- Welcome to Medicare preventive visit
- Medicare-covered Annual Wellness Visit
- Annual Physical supplemental benefit
- Lower copayment for outpatient surgery at ambulatory surgical centers (compared to outpatient hospital surgical departments)
- $0 copayment for many professional services via e-visit or virtual check-in
- $0 copayment for non-emergency medical transportation to and from medical appointments (prior authorization required)
Please also keep in mind that for members who have full Medicaid benefits or who are enrolled in the state-sponsored Qualified Medicare Beneficiary program, cost sharing may be $0 for Medicare-covered items and services.
If you have questions about our 2022 Stride℠ (HMO) Medicare Advantage plans or would like information to display in your office, please contact the Medicare Advantage Provider Service Center at 888-609-0692.