Harvard Pilgrim Stride Value Rx (HMO)

Medicare Advantage Plan for Massachusetts

select spinner
PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHarvard Pilgrim
Plan IDH1660-9-0
CMS Rating1
Plan TypeHMO
Annual Deductible$320.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage

Plan Details

Costs and Other Important Information

Plan Year:
2018
Optional Supplemental Benefits
No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$3,400 In-network
Other health plan deductibles?
Yes
Health Plan Deductible
$0
Monthly Drug Plan Premium
$40.00
Monthly Health Plan Premium
$21.00

Benefits

Service
Cost
Inpatient hospital coverage
$275 for days 1 through 6
$0 for days 7 through 90
Outpatient hospital coverage
$250 per visit
Doctor visits
Primary:
$20 per visit
Specialist:
$40 per visit
Preventive care
$0 copay
Emergency care/Urgent care
Emergency:
$100 per visit (always covered)
Urgent care:
$40 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
$20
Lab services:
$20
Diagnostic radiology services (e.g., MRI):
$150
Outpatient x-rays:
$20
Mental health services
$275 for days 1 through 6
$0 for days 7 through 90
Outpatient group therapy visit with a psychiatrist:
$40
Outpatient individual therapy visit with a psychiatrist:
$40
Outpatient group therapy visit:
$40
Outpatient individual therapy visit:
$40
Skilled Nursing Facility
$20 for days 1 through 20
$160 for days 21 through 100
Rehabilitation services
Occupational therapy visit:
$20
Physical therapy and speech and language therapy visit:
$20
Ambulance
$150
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
$25
Routine foot care:
Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
20% per item
Prosthetics (e.g., braces, artificial limbs):
20% per item
Diabetes supplies:
$0 copay
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
20%
Other Part B drugs:
20%

Coverage Area for Harvard Pilgrim Stride Value Rx (HMO)

StateMassachusetts
CountySuffolk

Cost Sharing Information

All cost-sharing assumes in-network healthcare providers.

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offereds$0 copayNot offered
Tier 2: Non-Preferred GenericNot offered$10 copayNot offered
Tier 3: Preferred Brand NameNot offered$47 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$100 copayNot offered
Tier 5: Specialty TierNot offered26% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered$0 copayNot offered
Tier 2: Non-Preferred GenericNot offered$30 copayNot offered
Tier 3: Preferred Brand NameNot offered$141 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$300 copayNot offered
Tier 5: Specialty TierNot offered26% coinsuranceNot offered

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical health
Not Rated
Improving or maintaining mental health
Not Rated
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care management
Not Rated
Care for older adults – medication review
Not Rated
Care for older adults – functional status assessment
Not Rated
Care for older adults – Pain screening
Not Rated
Osteoporosis management in women who had a fracture
Not Rated
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
Not Rated
Reducing the risk of falling
Plan all-cause readmissions

Member Experience with Health Plan

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan
Care Coordination

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Beneficiary access and performance problems
Health plan quality improvement

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Not Rated
Call center – foreign language interpreter and TTY/TDD availability - Medical

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Beneficiary access and performance problems
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs
Not Rated

Drug Pricing and Patient Safety

MPF Price Accuracy
High risk medication
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate

Physician Finder

Physicians that accept Harvard Pilgrim Stride Value Rx (HMO) for Massachusetts

/
SILVA, CATHERINE
10 GOVE ST
EAST BOSTON, MA 02128
MOTT KEIS, RACHEL
10 GOVE ST
EAST BOSTON, MA 02128
BENTLEY, MARI
10 GOVE ST
EAST BOSTON, MA 02128
SOYANO, ALBERTO
10 GOVE ST
EAST BOSTON, MA 02128
BLEVINS, PENGWYNNE
10 GOVE ST
EAST BOSTON, MA 02128
DOHLMAN, JAN
10 GOVE ST
EAST BOSTON, MA 02128
CARDENAS, LILIA
10 GOVE ST
EAST BOSTON, MA 02128
CHAMBERLAIN, LAURA
10 GOVE ST
EAST BOSTON, MA 02128
KOSTICH, MIRJANA
10 GOVE ST
EAST BOSTON, MA 02128
HUTNER, ALINE
10 GOVE ST
EAST BOSTON, MA 02128
HELLER, CHARMALIE
10 GOVE ST
EAST BOSTON, MA 02128
MANANDHAR, MONICA
10 GOVE ST
EAST BOSTON, MA 02128
KUEBLER, FRANCES
10 GOVE ST
EAST BOSTON, MA 02128
HAZARIKA, RAJNEESH
10 GOVE ST
EAST BOSTON, MA 02128
LAMBL, BARBARA
10 GOVE ST
EAST BOSTON, MA 02128
CHOU, LORETTA
10 GOVE ST
EAST BOSTON, MA 02128
RANEY, JENNIFER
10 GOVE ST
EAST BOSTON, MA 02128
ZARRAGA-FORSYTH, IDA
10 GOVE ST
EAST BOSTON, MA 02128
SIMON, STEVAN
50 MERIDIAN ST
EAST BOSTON, MA 02128
BERMAN, STEVEN
983 BENNINGTON ST
EAST BOSTON, MA 02128
PETRIELLO, ALFRED
12 BENNINGTON ST
EAST BOSTON, MA 02128
PATIL, SONAL
10 GOVE ST
EAST BOSTON, MA 02128
PEDULLA, JAMES
10 GOVE ST
EAST BOSTON, MA 02128
BEAUPARLANT, HENRY
10 GOVE ST
EAST BOSTON, MA 02128
Details
CATHERINE SILVA, M.D.
Phone Number
(617) 569-5800
Office Locations
10 GOVE ST
EAST BOSTON, MA 02128
10 GOVE ST EAST BOSTON MA, 02128

Similar Plans

PremiumPlan NameCMS Rating
from $0
Fallon Senior Plan Plus Enhanced Rx (HMO-POS)
Details
from $0
Tufts Medicare Preferred HMO Saver Rx (HMO)
Details
from $0
AARP MedicareComplete Plan 1 (HMO)
Details
from $0
Medicare PPO Blue SaverRx (PPO)
Details
from $12
EnvisionRxPlus (PDP)
Details

Related Articles

Related Searches

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.

{}