|Part D Benefit:||Yes|
|Rx Gap Coverage:||Yes|
|Plan Phone #:||888-609-0692|
|Summary of Benefits:|
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.
The monthly premium for this plan in Rockingham County, NH is $83.00. This amount is paid directly to Harvard Pilgrim Health Care.
This plan has a monthly premium, but it isn't the full cost. The plan's premium is in addition to your Medicare Part B premium. If your income is over $85,000 ($170,000 for married couples), or you have a penalty due to late enrollment, you'll pay the standard Part B premium.
What you pay in premiums is independent of the health care services you use. You also have copayments and/or coinsurances (cost sharing) that you pay out of pocket when you use health care services or fill prescriptions.
Maximum Out-of-Pocket Limit
All 2017 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.
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.
Most plans have copayments when you see your primary care doctor or a specialist. Here's how this plan works:
|Primary Care Doctor:||0 to 20% co-insurance|
|Physician Specialist:||$40 co-payment|
|Occupational Therapist:||$25 co-payment|
|Physical Therapist:||$25 co-payment|
|Speech Terapist:||$25 co-payment|
Medicare covers a wide range of preventive care services, including cardiovascular screenings, alcohol misuse screening and counseling, depression screen, and diabetes screening, to name just a few. Here's how this plan covers the following at no cost:
- 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
- Colorectal cancer screenings
- Depression screening
- Diabetes screenings
- HIV screening
- Medical nutrition therapy services
- Obesity screening and counseling
- Prostate cancer screenings (PSA)
- Sexually transmitted infections screening and counseling
- Tobacco use cessation counseling
- Vaccines including Flu shots Hepatitis B shots Pneumococcal shots
- 'Welcome to Medicare' preventive visit
- Yearly 'Wellness' visit
Urgent Care and Emergency Room
Urgent care and emergency room services are covered under Medicare Part B and have copayment or coinsurance fees. Some Medicare Advantage plans waive these fees if you are admitted as an inpatient within a specified number of days.
|Urgent Care:||$40 co-payment |
Co-insurance waived if admitted within 3 Days
|Emergency Care:||$75 co-payment |
Co-insurance waived if admitted within 3 Days
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:
- Day 1 to 5 you pay $265 per day
- See the Summary of Benefits for additional copayment periods.
Prescription Drug Coverage
Harvard Pilgrim Stride Value Rx Plus includes Medicare Part D coverage for your prescription medications. The table below outlines what you will pay (the copayment) at your pharmacy at each tier level.
If you are entitled to Part D assistance, your premium will be adjusted based on your percentage.
The Part D deductible is $160.00. This is the amount you will pay until the plan begins to pay its portion.
Medicare Plan Rating
Medicare gave the Harvard Pilgrim Stride Value Rx Plus plan an average rating of 4.0 out of 5 stars. This rating is Above Average, by Medicare's definition.
Medicare evaluates the quality of all Medicare Advantage plans. Plans are rated using a one to five-star scale, with five stars being the highest quality. If a plan is rated less than 2.5 stars, Medicare will not allow new members to enroll.
Compare Harvard Pilgrim Stride Value Rx Plus with these top rated plans available in Rockingham County:
- Anthem MediBlue Access
- AARP MedicareComplete Plan 2
- AARP MedicareComplete Plan 3
- Humana Gold Plus H5619-040
- Harvard Pilgrim Stride Value Rx
Harvard Pilgrim Stride Value Rx Plus Availability
Harvard Pilgrim Stride Value Rx Plus is available in Newfields, Newmarket, Hampton, New Castle, Stratham, Nottingham, Hampton Falls, East Candia, Newton, South Hampton, Fremont, East Derry, East Kingston, Rye Beach, Chester, Atkinson, Exeter, Sandown, Epping, Derry, Greenland, North Salem, Windham, North Hampton, Salem, Londonderry, Auburn, Danville, Candia, West Nottingham, East Hampstead, Rye, Seabrook, Raymond, Plaistow, Portsmouth, Newton Junction, Hampstead, Deerfield, Kingston, Northwood, and all other areas of Rockingham County.
This page was last updated on 10/25/2016.