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County

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Zip Code	04401
Applicant	7/22/1984 Male
Coverage Start	7/23/2019

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Insurance Type	Medicare Advantage Plan (Part C w/ RX)
Insurance Provider	Harvard Pilgrim
Plan ID	H1660-5-0
Plan Year	2018
CMS Rating
Plan Type	HMO
Annual Deductible	$0.00

What To Know About This Plan	This plan has health and drug coverage

Why We Like This Plan	has both Health and Drug Coverage

Costs and Other Important Information

Plan Year	2018
Optional Supplemental Benefits	No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$4,900 In-network
Other health plan deductibles?	Yes
Health Plan Deductible	$0
Monthly Drug Plan Premium	$55.00
Monthly Health Plan Premium	$19.00

Benefits

SERVICE	COST
Inpatient hospital coverage	$250 for days 1 through 7 $0 for days 8 through 90
Outpatient hospital coverage	$175 per visit
Doctor visits	Primary: $0 copay Specialist: $25 per visit
Preventive care	$0 copay
Emergency care/Urgent care	Emergency: $80 per visit (always covered) Urgent care: $25 per visit (always covered)
Diagnostic procedures/lab services/imaging	Diagnostic tests and procedures: $10 Lab services: $10 Diagnostic radiology services (e.g., MRI): $100 Outpatient x-rays: $10
Mental health services	$250 for days 1 through 6 $0 for days 7 through 90 Outpatient group therapy visit with a psychiatrist: $25 Outpatient individual therapy visit with a psychiatrist: $25 Outpatient group therapy visit: $25 Outpatient individual therapy visit: $25
Skilled Nursing Facility	$0 for days 1 through 20 $160 for days 21 through 100
Rehabilitation services	Occupational therapy visit: $25 Physical therapy and speech and language therapy visit: $25
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 Plus (HMO)

State	Maine
County	Penobscot

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day Supply	Preferred Retail Pharmacies	Non-Preferred Retail Pharmacies	Mail-Order Pharmacies
Tier 1: Preferred Generic	Not offereds	$0 copay	Not offered
Tier 2: Non-Preferred Generic	Not offered	$10 copay	Not offered
Tier 3: Preferred Brand Name	Not offered	$47 copay	Not offered
Tier 4: Non-Preferred Brand Name	Not offered	$100 copay	Not offered
Tier 5: Specialty Tier	Not offered	33% coinsurance	Not offered

60 Day Supply	Preferred Retail Pharmacies	Non-Preferred Retail Pharmacies	Mail-Order Pharmacies
Tier 1: Preferred Generic	Not offered	$0 copay	Not offered
Tier 2: Non-Preferred Generic	Not offered	$20 copay	Not offered
Tier 3: Preferred Brand Name	Not offered	$94 copay	Not offered
Tier 4: Non-Preferred Brand Name	Not offered	$200 copay	Not offered
Tier 5: Specialty Tier	Not offered	33% coinsurance	Not offered

90 Day Supply	Preferred Retail Pharmacies	Non-Preferred Retail Pharmacies	Mail-Order Pharmacies
Tier 1: Preferred Generic	Not offered	$0 copay	Not offered
Tier 2: Non-Preferred Generic	Not offered	$30 copay	Not offered
Tier 3: Preferred Brand Name	Not offered	$141 copay	Not offered
Tier 4: Non-Preferred Brand Name	Not offered	$300 copay	Not offered
Tier 5: Specialty Tier	Not offered	33% coinsurance	Not offered

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
Statin Use in Persons with Diabetes	Not Rated

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

Last Name

Location/Distance

Please select the correct zip

Edwin, Bruno

D, Mcguire

Guillermo, Olivos

James, Riley

Thomas, Beebe

David, Newman

Sapna, Malik

Anne, Johnson

Kara, Smythe

Aimee, Beaton

Sveva, Brown

Raymond, Baxter

Eric, Wise

David, Martin

Bradley, Graustein

Brooke, Surran

Fahad, Alsindi

Justin, Levine

Doug, King

Jill, Overlock

Dragonfly Therapy

Elmer, Lommler

Poonam, Khadka

Suzanne, Bourque

Nicole, Duncan

Edwin Bruno, D.P.M.

Phone Number
(207) 942-3988
Office Locations
277 State St
Bangor, ME 04401

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Harvard Pilgrim Stride Value Rx Plus (HMO)

Apply For This Plan

Benefits & Coverage

Plan Details

Costs and Other Important Information

Benefits

Coverage Area for Harvard Pilgrim Stride Value Rx Plus (HMO)

Cost Sharing Information

CMS Ratings

Staying healthy - screenings, tests and vaccines

Managing Chronic Conditions

Member Experience with Health Plan

Member Complaints, and Changes in Health Plan's Performance

Health Plan Customer Service

Drug Plan Customer Service

Member Complaints, and Changes in Drug Plan's Performance

Member Experience with Drug Plan

Drug Pricing and Patient Safety

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Medicare Plans Found

Harvard Pilgrim Stride Value Rx Plus (HMO)

Apply For This Plan

Benefits & Coverage

Plan Details

Costs and Other Important Information

Benefits

Coverage Area for Harvard Pilgrim Stride Value Rx Plus (HMO)

Cost Sharing Information

CMS Ratings

Staying healthy - screenings, tests and vaccines

Managing Chronic Conditions

Member Experience with Health Plan

Member Complaints, and Changes in Health Plan's Performance

Health Plan Customer Service

Drug Plan Customer Service

Member Complaints, and Changes in Drug Plan's Performance

Member Experience with Drug Plan

Drug Pricing and Patient Safety

Physician Finder

Similar Plans

Related Articles

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get free advice

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