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Call: 1-866-457-6921 (TTY: 711)
Oct. 1 - Mar. 31: 8am - 8pm, 7 days a week
Apr. 1 - Sept. 30: 8am - 8pm, Mon - Fri

Frequently Asked Questions

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What is Medicare?

Medicare is a federal government health insurance program that was created in 1965 by the Social Security Administration. It is health insurance for people 65 or older, under 65 with certain disabilities, and any age with End-Stage Renal Disease (ESRD).

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What are the different parts of Medicare?

Medicare Part A (Hospital Insurance)

  • Helps cover inpatient care in hospitals

  • Helps cover skilled nursing facility, hospice and home health care

Medicare Part B (Medical Insurance)

  • Helps cover doctor's services and outpatient care

  • Helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse

Medicare Part C (Medicare Advantage Plans)

  • Plans that are offered by private companies approved by the Centers for Medicare & Medicaid Services (CMS)

Medicare Part D (Prescription Drug Insurance)

  • A prescription drug option run by private insurance companies approved by and under contract with Medicare

  • Helps cover the cost of prescription drugs

It is important to note that although Medicare does provide benefits and services, it does not cover everything:

  • You may have to pay deductibles, copays and/or coinsurance costs for services. When Medicare covers a service, you usually have to pay for a portion of the cost. That portion of the cost is called a deductible, copay or coinsurance. Deductibles are the amount you are responsible for before Medicare begins to pay. After your deductible is paid, you may also have to pay a copay or coinsurance. The coinsurance is usually 20% of the Part B service.

  • If you travel outside of the United States, generally Medicare will not cover you for any services, even in the event of an emergency.

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Why is Harvard Pilgrim’s Stride℠ (HMO) Medicare Advantage Plan a good choice for me?

Often people believe that Medicare pays for all hospitalization and doctor costs. When first enrolled in Medicare, people are surprised to learn that there are gaps in their coverage and that they are responsible for paying for services that Medicare doesn’t completely cover. That’s how Harvard Pilgrim can help you. Our Stride℠ (HMO) Plan option helps fill in the gaps that Medicare doesn’t cover.

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Am I eligible to join Stride℠ (HMO) Plan?

To be considered eligible for Harvard Pilgrim’s Stride℠ (HMO) Plan, you must meet the following requirements:

  • You are entitled to Medicare Part A (hospitalization) and are enrolled in Medicare Part B (medical) and continue to pay Part B premiums if not otherwise paid for under Medicaid or by another third party

  • Permanently live within the Stride℠ (HMO) service area which includes Barnstable, Bristol, Essex, Middlesex (excluding zip codes 01824, 01826, and 01863), Norfolk, Plymouth, Suffolk and Worcester counties in Massachusetts.

  • Most Medicare beneficiaries can join, including those eligible on the basis of disability

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When do I enroll?

There are limits on when and how often you can change the way you get your Medicare coverage. Switching from one plan like Stride℠ (HMO) to one of the other plans we offer, or to a plan offered by another organization, counts towards making a change. If you have both Medicare and Medicaid, you can change to another plan at any time or to Medicare.

Initial Enrollment Period

  • When you are first eligible for Medicare, you have a 7-month period to sign up. This 7-month period begins 3 months before your 65th birthday, including the month you turn 65, and ends 3 months after you turn 65.

From October 15, 2018 through December 7, 2018

  • Change from Medicare to a Medicare Advantage Plan

  • Change from a Medicare Advantage Plan back to Medicare

  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan

  • Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that does offer drug coverage

  • Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage

  • Join a Medicare Prescription Drug Plan

  • Switch from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan

  • Drop your Medicare Prescription Drug coverage completely

Medicare Advantage Open Enrollment Period (OEP) From January 1, 2019 through March 31, 2019

  • The new OEP allows individuals enrolled in a Medicare Advantage plan, including newly Medicare Advantage eligible individuals, to make a one-time election to go to another Medicare Advantage plan or Original Medicare. Individuals using the OEP to make a change may make a coordinating change to add or drop Part D coverage.

  • Make a one-time election to go from a Medicare Advantage Plan back to Original Medicare and add a Medicare Part D Plan.

  • Make a one-time election to switch from one Medicare Advantage Plan to another Medicare Advantage Plan.

  • Generally, you cannot make any other changes during the year unless you meet special exceptions such as if you move or lose other insurance coverage.

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Can I keep my doctor?

With Harvard Pilgrim’s Stride℠ (HMO) Plan you will need to choose a primary care provider (PCP) who will work with you to provide the care you need. You will need to receive all your medical services from Stride℠ (HMO) network providers who will work together to coordinate your care, except in emergency or urgent care situations or for out-of-area dialysis services. You can change your provider at any time by simply calling Member Services.

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What will I pay?

With Stride℠ (HMO) your financial obligations consist of a monthly plan premium. You may pay deductibles, copayments/coinsurance for medical services in addition to your Medicare Part B premium. Your copayment/coinsurance must be paid at the time of service. You will receive a bill for your monthly premium, which you may choose to pay by electronic fund transfer for convenience.

  • The 2019 monthly plan premium for StrideSM (HMO) Basic Rx Plan in Barnstable, Bristol, Plymouth, Suffolk and Worcester counties is $0 per month.

  • The 2019 monthly plan premium for StrideSM (HMO) Value Rx Plan in Barnstable, Bristol, Essex, Middlesex (excludes ZIP Codes 01824, 01826, 01863), Norfolk, Plymouth and Suffolk counties is $67 per month.

  • The 2019 monthly plan premium for StrideSM (HMO) Value Rx Plan in Worcester county is $79 per month.

  • The 2019 monthly plan premium for StrideSM (HMO) Value Rx Plus Plan in Barnstable, Bristol, Essex, Middlesex (excludes ZIP Codes 01824, 01826, 01863), Norfolk, Plymouth and Suffolk counties is $163 per month.

  • The 2019 monthly plan premium for StrideSM (HMO) Value Rx Plus Plan in Worcester county is $190 per month.

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Am I covered if I travel?

With Harvard Pilgrim’s Stride℠ (HMO) Plan, you will have coverage for unexpected emergencies that take place while traveling worldwide.

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How do I enroll?

It’s easy to enroll in Harvard Pilgrim’s Stride℠ (HMO) Plan.

  • Enroll over the telephone with a plan representative by calling:
    1-866-457-6921, TTY: 711

Oct. 1 – Mar. 31, 8am – 8pm, 7 days a week;
Apr. 1 – Sept. 30, 8am – 8pm Mon. – Fri.

  • Attend one of our local sales meetings where a sales person will be present with information and applications

  • Enroll online

  • Contact your local agent

  • Visit http://www.Medicare.gov to enroll through the CMS Medicare Enrollment Center

  • Fill out and sign a paper application and return it to:

Harvard Pilgrim Health Care Enrollment
PO Box 152108
Tampa, FL 33684-2108

Prior to submitting your enrollment form for processing, please take the time to complete the entire enrollment form. If the enrollment form received is incomplete, it may be returned to you for additional information.

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When will my coverage begin?

Your coverage is effective as of the first day of the calendar month following the month in which Harvard Pilgrim received your signed, completed application. For example:

  • If Harvard Pilgrim received your signed, completed application on July 15, your coverage under Stride℠ (HMO) will be effective August 1.

  • If you are enrolling during the annual open enrollment period, October 15 - December 7, your coverage will be effective on January 1 of the following year.

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Why is Harvard Pilgrim’s Medicare Supplement Plan a good choice for me?

Often people believe that Original Medicare pays for all hospitalization and doctor costs. When first enrolled in Medicare, people are surprised to learn that there are gaps in their coverage and that they are responsible for paying for services that Medicare doesn’t completely cover. That’s how Harvard Pilgrim can help you. Our Medicare Supplement Plan options help fill in the gaps that Medicare doesn’t cover.

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Am I eligible to join a Medicare Supplement Plan?

To be considered eligible for Harvard Pilgrim’s Medicare Supplement Plan, you must meet the following requirements:

  • Your legal residence is in the state of Massachusetts

  • You are eligible for Medicare Part A and Medicare Part B and enrolled in Medicare Part B

  • If you are under age 65 and qualify for Medicare coverage because of a disability, and the disability that qualifies you for Medicare is not solely End-Stage Renal Disease (ESRD)

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Can I keep my doctor?

With Harvard Pilgrim’s Medicare Supplement Plan you will be able to keep your current doctor if he/she is a Medicare participating doctor. Most doctors participate in Medicare, so it is very likely that you would be able to keep your current doctor. To find out if your doctor is a Medicare participating doctor, just call your doctor’s office and ask if they accept Medicare.

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Can I go to any hospital?

With Harvard Pilgrim’s Medicare Supplement Plan you will be able to go to any hospital that participates in the Medicare program. Most hospitals participate in Medicare so, with our Medicare Supplement Plan, you’ll most likely be able to go to any hospital.

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Do I need referrals for specialty care?

With Harvard Pilgrim’s Medicare Supplement Plan, you will be able to see any specialist or go to any specialist facility, without a referral, as long as that specialist or facility accepts Medicare. Most specialists and specialist facilities participate in Medicare, so it is very likely that you would be able to go to any specialist or facility.

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Will I be covered or will I have to pay more if I go out of network?

With Harvard Pilgrim’s Medicare Supplement Plan, there is no network, so you can go to any doctor or hospital that participates in Medicare.

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Are there copayments for doctor visits?

With Harvard Pilgrim’s Medicare Supplement 1 Plan, once you pay your monthly premium you will not have any copayments for physician services. With Harvard Pilgrim’s Core Plan, a Medicare Part B deductible (which covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment) will apply.

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Are there any premium savings?

Yes! In Massachusetts you may qualify for a discounted premium rate for the first three years when you enroll in Harvard Pilgrim’s Medicare Supplement Plan. To qualify for these discounts you must be at least age 65 and apply for coverage within six months of your Part B effective date.

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If I move out of the state can I still keep my plan?

With Harvard Pilgrim’s Medicare Supplement Plan, your plan travels with you. You will be able to move anywhere in the United States and still be covered by your Medicare Supplement Plan.

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Am I covered if I travel?

With Harvard Pilgrim's Medicare Supplement Plan, you will have coverage for all covered services, not just emergency and urgent care, in the United States. You will also have coverage for unexpected emergencies that take place while traveling worldwide.

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When do I enroll?

The best time to enroll in Harvard Pilgrim’s Medicare Supplement Plan is during your Medicare Supplement initial open enrollment period since you can save money on your premiums when you’re initially eligible for Medicare. This period lasts for six months and begins on the first day of the month in which you are 65 or older and enrolled in Medicare Part B.

You can send in your application for our plan before your Medicare Supplement open enrollment period starts. This may be important if you currently have coverage that will end when you turn 65. This will allow you to have continuous coverage.

If you have group health coverage through an employer because either you or your spouse is currently working, you may want to wait to enroll in Part B. When coverage through your employer ends, you will be able to enroll in Part B and take advantage of the discount if you enroll within six months.

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How do I enroll?

It’s easy to enroll in Harvard Pilgrim’s Medicare Supplement Plan.

  • Enroll online

  • Enroll over the telephone with a plan representative by calling:
    1-866-457-6921, TTY: 711 (Monday – Friday 8:30 a.m. – 5:00 p.m.), or

  • Contact your local agent

  • Complete a paper enrollment form. Prior to submitting your enrollment form for processing, please take the time to complete the entire enrollment form. If the enrollment form received is incomplete, it may be returned to you for additional information.

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When will my coverage begin?

Your coverage is effective the first day of the month following the month in which Harvard Pilgrim received your signed, completed enrollment form. For example, if we received your enrollment form on January 15th, your coverage under Harvard Pilgrim’s Medicare Supplement Plan will be effective February 1st.

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Oct. 1 - Mar. 31: 8am - 8pm, 7 days a week
Apr. 1 - Sept. 30: 8am - 8pm, Mon - Fri

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Thank you for your interest in our Medicare options for 2018

For complete details on options available from Harvard Pilgrim or to enroll call us at 1-866-457-6921, TTY/TDD users call: 711,
Oct. 1 - Mar. 31: 8am - 8pm, 7 days a week
Apr. 1 - Sept. 30: 8am - 8pm, Mon - Fri.

We look forward to speaking with you.

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If you would like further information before you enroll, please select the appropriate link below: