Harvard Pilgrim Stride Basic Rx (HMO)

Medicare Advantage Plan for New Hampshire

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHarvard Pilgrim
Plan IDH6750-5-0
CMS Rating1
Plan TypeHMO
Annual Deductible$405.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage
  • has no additional premium costs outside of your Medicare Part B premium

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)
$6,700 In-network
Other health plan deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
Cost
Inpatient hospital coverage
$360 for days 1 through 5
$0 for days 6 through 90
Outpatient hospital coverage
20% per visit
Doctor visits
Primary:$20 per visit
Specialist:$40 per visit
Preventive care
$0 copay
Emergency care/Urgent care
Emergency:$80 per visit (always covered)
Urgent care:$45 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:$20
Lab services:$20
Diagnostic radiology services (e.g., MRI):20%
Outpatient x-rays:20%
Mental health services
$320 for days 1 through 5
$0 for days 6 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
$0 for days 1 through 20
$160 for days 21 through 100
Rehabilitation services
Occupational therapy visit:$30
Physical therapy and speech and language therapy visit:$30
Ambulance
$250
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:$40
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 Basic Rx (HMO)

StateNew Hampshire
CountyBelknap

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$15 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 offered25% 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$45 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 offered25% 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
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

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 Basic Rx (HMO) for New Hampshire

/
BEALE, ERNEST
NEONATOLOGY SERVICES - ELLIOT HOSPITAL
MANCHESTER, NH 03103
ROTHSTEIN, STEVEN
384 WILSON ST
MANCHESTER, NH 03103
SELLECK, WILLIAM
4 ELLIOT WAY
MANCHESTER, NH 03103
GIAKOVIS-STERLING, ESTHIA
184 TARRYTOWN RD
MANCHESTER, NH 03103
KLOC, CURTIS
184 TARRYTOWN RD
MANCHESTER, NH 03103
BRAUER, CHRISTOPHER
1 ELLIOT WAY
MANCHESTER, NH 03103
ORR, ROBERT
225 E 2ND AVE
ESCONDIDO, CA 92025
BOBOCEA, MANUELA
1 ELLIOT WAY
MANCHESTER, NH 03103
DONOFRIO, JENNIFER
150 TARRYTOWN RD
MANCHESTER, NH 03103
FEINS, ROBERT
144 TARRYTOWN RD
MANCHESTER, NH 03103
FIER, CARL
1 ELLIOT WAY
MANCHESTER, NH 03103
CHASE, ELIZABETH
445 CYPRESS ST
MANCHESTER, NH 03103
MCALEER, SARAH
4 ELLIOT WAY
MANCHESTER, NH 03103
GIRASOLE, CHRISTOPHER
4 ELLIOT WAY
MANCHESTER, NH 03103
SOGHIKIAN, GREGORY
700 LAKE AVE
MANCHESTER, NH 03103
LAVERY, ROBERT
1 ELLIOT WAY
MANCHESTER, NH 03103
HICKLE, PATRICK
1 ELLIOT WAY
MANCHESTER, NH 03103
GARSTKA, ALAN
1 ELLIOT WAY
MANCHESTER, NH 03103
WILKENS, SUSANNA
1 ELLIOT WAY
MANCHESTER, NH 03103
BARRETT, THOMAS
15 NELSON ST
MANCHESTER, NH 03103
ELDER, NATHAN
1 ELLIOT WAY
MANCHESTER, NH 03103
HOEPP, LAWRENCE
184 TARRYTOWN RD
MANCHESTER, NH 03103
WASSERMAN, GARY
150 TARRYTOWN RD
MANCHESTER, NH 03103
THOMAS, KENNETH
182 TARRYTOWN RD
MANCHESTER, NH 03103
MEINZ, HEIDI
150 TARRYTOWN RD
MANCHESTER, NH 03103
Details
ERNEST BEALE, MD
Phone Number
(603) 663-2692
Office Locations
NEONATOLOGY SERVICES - ELLIOT HOSPITAL
MANCHESTER, NH 03103
NEONATOLOGY SERVICES - ELLIOT HOSPITAL MANCHESTER NH, 03103

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