Harvard Pilgrim Stride Value Rx Plus Rockingham County, New Hampshire 2016 Medicare Advantage Plan H6750-001

HMO Plan
$73.00
5-Star Rating:{plan}, a Medicare Advantage plan available in Rockingham County, NH, an average Medicare rating of 0.0 out of 5 stars.
Plan ID:H6750-001
Plan Year:2016
Full Premium:$73.00/mo
Annual MOOP:$5,000
Part D Benefit:Yes
Rx Deductible:$0.00/year
Rx Gap Coverage:Yes
Online Pharmacy:No
Plan Phone #:888-609-0692
Summary of Benefits: Harvard Pilgrim Stride Value Rx Plus Medicare Advantage Plan H6750-001 Summary of Benefits for Rockingham County, New Hampshire

Harvard Pilgrim Stride Value Rx Plus Medicare Advantage Plan for Rockingham County, New Hampshire seniors on Medicare.Harvard Pilgrim Stride Value Rx Plus is a Health Maintenance Organization (HMO) Medicare Advantage plan, by Harvard Pilgrim Health Care, available in Rockingham County, New Hampshire. It offers all of the basic benefits of Original Medicare and may include additional coverage.

With an HMO plan, like this one from Harvard Pilgrim Health Care, your out-of-pocket costs are much lower than Original Medicare. That's the big advantage.

IMPORTANT: You must use providers in the Harvard Pilgrim Health Care network to avoid incurring additional costs. You are responsible for all costs incurred out of network. Referrals are generally required to see specialists.

Monthly Premium

The monthly premium for this plan in Rockingham County, NH is $73.00. This amount is paid directly to Harvard Pilgrim Health Care.

If you enroll in this plan you will pay your Medicare Part B premium plus this plan's monthly premium. Most people pay the standard Part B premium, but some beneficiaries pay higher Part B premiums due to their annual income (over $85k for singles or $170k for married couples). Late enrollment penalties can also increase your Part B premium.

IMPORTANT NOTICE: Double-digit price hikes for Medicare Part B premiums are coming in 2016. The base tier premium is expected to jump from $104.90 to $120.70.

In addition to the premiums you also pay your share when you use healthcare services. Each time you see your doctor, or if you are admitted as an inpatient (hospitalized), you'll pay copayments. Your prescription drugs also have a cost sharing component.

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Maximum Out-of-Pocket Limit

All 2016 Medicare Advantage plans have a $6,700 maximum out-of-pocket (MOOP) limit. That said, Medicare allows for a voluntary MOOP as low as $3,400.This plan's MOOP is $5,000. This figure is not inclusive of your monthly premium or the cost of your prescriptions (Medicare Part D Coverage).

This means that you will no longer pay copayment or coinsurance as soon as your copayments and coinsurance for doctor visits and hospital care reaches $5,000. This is your guarantee that an illness or accident will send you into bankruptcy. Consider the MOOP along with the premium and the copay.

If you're comparing this plan with Original Medicare, don't forget that you pay about 20% of all covered expenses, but there's no limit. You have a lot of risk with Original Medicare unless you buy a Medicare Supplement to cover your copayments and coinsurances.

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Coverage, Copayments & Coinsurance

The Harvard Pilgrim Stride Value Rx Plus plan offers the same basic benefits as Original Medicare. The big difference is copayments and coinsurances. Below you will find (where available) what you will pay for common health care services.

Doctor Visits

Most plans have copayments when you see your primary care doctor or a specialist. Here's how this plan works:

  • Acupuncture and Other Alternative Therapies
  • Not covered
  • Ambulance Services
  • $250 copay
  • Chiropractic Care
  • Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position): $20 copay
  • Dental Services
  • Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth): $40-65 co-pay depending on the service
  • Diabetes Supplies and Services
  • Diabetes monitoring supplies: No cost to you
  • Diabetes self-management training: No cost to you
  • Therapeutic shoes or inserts: No cost to you
  • Diagnostic Tests, Lab and Radiology Services, and X-Rays
  • Diagnostic radiology services (such as MRIs CT scans): 20% of the cost
  • Diagnostic tests and procedures: No cost to you
  • Lab services: No cost to you
  • Outpatient x-rays: $10 copay
  • Therapeutic radiology services (such as radiation treatment for cancer): 20% of the cost
  • Doctor's Office Visits
  • Primary care physician visit: No cost to you
  • Specialist visit: $40 copay
  • Durable Medical Equipment (wheelchairs, oxygen, etc.)
  • 20% of the cost
  • Emergency Care
  • $65 copay
  • If you are admitted to the hospital within 3 days you do not have to pay your share of the cost for emergency care. See the Inpatient Hospital Care section for other costs.
  • Foot Care (podiatry services)
  • Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions: $40 copay
  • Hearing Services
  • Exam to diagnose and treat hearing and balance issues: $40 copay
  • Routine hearing exam (for up to 1 every year): $15 copay
  • Home Health Care
  • No cost to you
  • Mental Health Care
  • Inpatient visit:
  • Harvard Pilgrim Stride Value Rx Plus covers an unlimited number of days for an inpatient hospital stay.
  • $265 co-pay per day for days 1 through 5.
  • No cost to you per day for days 6 through 90.
  • No cost to you per day for days 91 and beyond.
  • Outpatient group therapy visit: $35 copay
  • Outpatient individual therapy visit: $35 copay
  • Outpatient Rehabilitation Services
  • Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions per day for up to 36 sessions up to 36 weeks): $25 copay
  • Occupational therapy visit: $25 copay
  • Physical therapy and speech and language therapy visit: $25 copay
  • Outpatient Substance Abuse
  • Group therapy visit: $35 copay
  • Individual therapy visit: $35 copay
  • Outpatient Surgery
  • Ambulatory surgical center: $200 copay
  • Outpatient hospital: $200 copay
  • Over-the-Counter Items
  • Visit the plan's website to see their list of covered over-the-counter items.
  • Prosthetic Devices (braces, artificial limbs, etc.)
  • Prosthetic devices: 20% of the cost
  • Related medical supplies: 20% of the cost
  • Renal Dialysis
  • 20% of the cost
  • Transportation
  • Not covered
  • Urgently Needed Care
  • $65 copay
  • If you are admitted to the hospital within 3 days you do not have to pay your share of the cost for urgent care. See the Inpatient Hospital Care section for other costs.
  • Vision Services
  • Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening): $40 copay
  • Routine eye exam (for up to 1 every year): $15 copay
  • Contact lenses (for up to 1 every year): No cost to you
  • Eyeglasses (frames and lenses) (for up to 1 every year): No cost to you
  • Eyeglass frames (for up to 1 every year): No cost to you
  • Eyeglass lenses (for up to 1 every year): No cost to you
  • Eyeglasses or contact lenses after cataract surgery: No cost to you
  • Harvard Pilgrim Stride Value Rx Plus pays up to $150 every year for eyewear.

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Hospital Stays

If you are admitted to a hospital or clinic for treatment and stay overnight, you are an inpatient. Most plans have tiered costs for inpatient treatment. Here's how this plan covers you:

  • Harvard Pilgrim Stride Value Rx Plus covers an unlimited number of days for an inpatient hospital stay.
  • $265 co-payment per day for days 1 through 6.
  • You pay nothing per day for days 7 through 90.
  • You pay nothing per day for days 91 and beyond.
  • Harvard Pilgrim Stride Value Rx Plus covers up to 100 days in a Skilled Nursing Facility (SNF).
  • $0 co-payment per day for days 1 through 20.
  • $125 co-payment per day for days 21 through 100.

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Preventive Care

Medicare covers some preventive care services, including cardiovascular screenings, alcohol misuse screening and counseling, depression screen, and diabetes screening. This plan covers preventive services as follows:

  • Preventive Care
  • You pay nothing
  • Harvard Pilgrim Stride Value Rx Plus covers many preventive services including:
    • Abdominal aortic aneurysm screening.
    • Alcohol misuse counseling.
    • Bone mass measurement.
    • Breast cancer screening (mammogram).
    • Cardiovascular disease (behavioral therapy).
    • Cardiovascular screenings.
    • Cervical and vaginal cancer screening.
    • Colonoscopy.
    • Colorectal cancer screenings.
    • Depression screening.
    • Diabetes screenings.
    • Fecal occult blood test.
    • Flexible sigmoidoscopy.
    • HIV screening.
    • Medical nutrition therapy services.
    • Obesity screening and counseling.
    • Prostate cancer screenings (PSA).
    • Sexually transmitted infections screening and counseling.
    • Tobacco use cessation counseling (counseling for people with no sign of tobacco-related disease) .
    • Vaccines including Flu shots Hepatitis B shots Pneumococcal shots.
    • Welcome to Medicare preventive visit (one-time checkup).
    • Yearly Wellness visit.
  • All other preventive healthcare services approved by Medicare during the contract year will be covered.

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Prescription Drug Coverage

This plan includes Medicare Part D coverage for your prescription medications. The formulary (00015316) has a total of 4,007 prescription medications. The table below outlines what you will pay (the copayment) at your pharmacy for medications at each tier level.

Formulary Drug Details:Tier 1Tier 2Tier 3Tier 4Tier 5
  — Drugs per Tier:1682151476769443
  — Cost-Sharing in ICP:$4.00$10.00$45.00$95.0033%

If you are entitled to Part D assistance, your premium will be adjusted based on your percentage.

The Part D deductible on this plan is $0.00 (first dollar coverage).

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Medicare Plan Rating

The Harvard Pilgrim Stride Value Rx Plus plan is new for plan year 2016 and has not yet been rated by Medicare. This is why the rating is showing 0 out of 5 stars.

Each Medicare Advantage plan receives a 1.0 to 5.0 star rating by Medicare (annually). The quality assessment of plans helps people considering enrollment. A plan with 5 stars has the highest quality.

Compare Plans

Compare Harvard Pilgrim Stride Value Rx Plus with these top rated plans available in Rockingham County:

Harvard Pilgrim Stride Value Rx Plus Availability

Harvard Pilgrim Stride Value Rx Plus is available in Sandown, Hampton, Newton Junction, West Nottingham, Windham, East Candia, Seabrook, Newton, Candia, Derry, Rye, East Kingston, Kingston, Chester, East Hampstead, Stratham, Epping, Exeter, Greenland, Newfields, Newmarket, Danville, North Hampton, Deerfield, Salem, Northwood, Hampstead, Plaistow, New Castle, Rye Beach, North Salem, Hampton Falls, Portsmouth, Fremont, Nottingham, Auburn, Londonderry, Atkinson, Raymond, South Hampton, East Derry, and all other areas of Rockingham County.

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This page was last updated on 10/12/2015.