Harvard Pilgrim Health Care Review
Editor's Rating
Harvard Pilgrim Health Care provides excellent customer service along with quality coverage. Its affordable prices make it a good option for shoppers on a budget.
Harvard Pilgrim is a regional company that sells policies in New Hampshire, Maine, Massachusetts and Connecticut. Although it recently merged with Tufts Health Plan, it still operates under the Harvard Pilgrim name.
Harvard Pilgrim Health Care: Our thoughts
Harvard Pilgrim Health Care is a good choice for New Englanders who want strong coverage, high-quality customer support and affordable pricing. Harvard Pilgrim stands out for its wide array of plan options and comprehensive coverage areas, such as dental, vision and mental health.
While most of Harvard Pilgrim's offerings are HMOs, PPOs are available in certain regions.
- HMOs (health maintenance organizations) typically have cheaper costs but require you to get care from within a network of health care providers.
- PPOs (preferred provider organizations) tend to charge higher prices but give you greater flexibility in terms of seeing the doctors you want.
Plan costs and options
Harvard Pilgrim has cheaper-than-average prices, especially for Bronze, Silver and Gold plans.
Plan types vary by area. Even within a single state, your coverage choices will depend on your location. Generally speaking, HMOs make up most Harvard Pilgrim plan options. PPOs are available in some locations. You can purchase individual and group health insurance through Harvard Pilgrim. It also offers several Medicare Advantage and Medicare Supplement (Medigap) plans.
Harvard Pilgrim Health Care rates
Harvard Pilgrim has competitively priced plans that will appeal to cost-conscious consumers. Compared to the regional average, you would save an average of $95 a month on a Bronze plan, $65 a month on a Silver plan and $105 a month on a Gold plan. Harvard Pilgrim's deductibles and out-of-pocket maximums are about average for the region.
Find Cheap Health Insurance in Your Area
Harvard Pilgrim does not offer Catastrophic or Platinum health insurance.
Monthly rates
Harvard Pilgrim | Regional average | |
|---|---|---|
| Bronze | $338 | $433 |
| Silver | $446 | $511 |
| Gold | $497 | $602 |
All rates are for a 40-year-old nonsmoker.
When shopping for plans, you should also take into account the deductible and out-of-pocket max. Your deductible is the amount of money you need to pay before your health insurance kicks in, while your out-of-pocket max is the total amount that you will pay for care and services in a single year. Certain services such as preventive care, emergency room visits and emergency transportation are typically covered even if you haven't met your deductible.
Medicare Advantage plans
Harvard Pilgrim only offers Medicare Advantage plans in New Hampshire. You can choose from four plans, which range from $0 to $142 a month in premiums. All plans come with enhanced drug coverage.
Medicare Supplement (Medigap) plans
You can buy Harvard Pilgrim Medicare Supplement (Medigap) Plans A, F, G, M and N in Maine and New Hampshire. Massachusetts organizes Medicare Supplement plans differently than other states. In Massachusetts, you can buy a Core Plan, a Supplement 1 Plan or a Supplement 1A Plan through Harvard Pilgrim.
Supplement 1 Plans are virtually identical to the popular Medigap Plan F, while Supplement 1A Plans cover the same areas as Plan G. You should consider Plan F or a Supplement 1 Plan if you became eligible for Medicare prior to 2020. If you qualified for Medicare after that date, you should choose Plan G or a Supplement 1A Plan.
The only difference between the two plans is that Supplement 1 Plans cover your Medicare Part B deductible, while Supplement 1A Plans don't. Otherwise, both plans offer the following benefits.
- Inpatient hospital costs
- Medical costs
- 3 pints of blood
- Hospice coinsurance or copayment
- Inpatient hospital deductible
- Skilled nursing facility coinsurance
- Foreign travel emergency care
- 120 inpatient days at a mental health hospital
- Annual pap smears and mammograms
Because all Medicare Supplement plans are required by law to include the same key services, cost is the main factor to consider when shopping around. You should avoid purchasing a Medigap policy through Harvard Pilgrim since its prices are above average for all plan types except for the relatively unpopular Plan M.
Extra benefits and coverage for members
Harvard Pilgrim stands out for its array of member benefits. These range from telehealth to in vitro fertilization (IVF) therapy and mental health counseling.
Doctor On Demand
Harvard Pilgrim offers Doctor On Demand, a service that lets you speak to a licensed medical professional through a smartphone app or web portal at any time of the day. Doctor On Demand is geared toward less serious illnesses and injuries, such as colds, flu, hives, urinary tract infections, allergies and migraines.
The service isn't equipped to help with broken bones, chest pains and other more serious issues. Other common uses for Harvard Pilgrim's Doctor On Demand include mental health counseling, preventive services and chronic health condition management.
IVF
Unlike most insurance companies, Harvard Pilgrim covers in vitro fertilization (IVF), one of the most common treatments for those with issues getting pregnant. According to the American Society for Reproductive Medicine, an IVF treatment costs $12,400 on average. Harvard Pilgrim offers assistance with IVF and other fertility treatments in some states.
Mental health counseling
Many Harvard Pilgrim plans will help pay for therapy. Consult your plan's fine print, or speak with a company representative to see if mental health coverage is included in your Harvard Pilgrim policy.
Does Harvard Pilgrim cover dental checkups and eye exams?
Many Harvard Pilgrim health plans cover dental and vision checkups either as part of the plan or for an extra cost. However, you should check with your salesperson before you make a purchase since not all plans have this coverage.
Customer reviews and complaints
Harvard Pilgrim has built a strong reputation for customer service and satisfaction. However, earlier this year a data breach put millions of Harvard Pilgrim plan holders at risk for identity fraud.
Harvard Pilgrim data breach
In March 2023, Harvard Pilgrim experienced a ransomware cybersecurity attack that put upward of 2.5 million user profiles at risk. Although Harvard Pilgrim has taken appropriate measures to combat the data breach, fallout from the incident is ongoing.
Victims of the data breach have organized a class action lawsuit against the regional health insurance company.
Harvard Pilgrim receives less than one-third the number of customer complaints as a similar-sized health insurance company, according to the National Association of Insurance Commissioners (NAIC). This indicates high levels of customer satisfaction.
Harvard Pilgrim Health Care ranked second in J.D. Power's 2022 Massachusetts customer satisfaction survey for group plan health insurance.
The insurer has a 4.5/5 star rating from the National Committee for Quality Assurance (NCQA). This reflects an overall high level of care and service. The NCQA singled out Harvard Pilgrim for its prevention services. The patient experience and treatment categories earned 3.5/5 star scores signaling slightly above-average quality levels.
Frequently asked questions
What is Harvard Pilgrim Health Care?
Harvard Pilgrim Health Care (HPHC) is a regional health insurance company that operates in New Hampshire, Maine, Massachusetts and Connecticut. Although Harvard Pilgrim is not a part of Harvard University, the two organizations have a long-standing relationship.
Is Harvard Pilgrim good insurance?
Yes, Harvard Pilgrim has consistently earned high ratings from customer surveys and from third-party organizations like the National Committee for Quality Assurance (NCQA). You can pick from a number of individual health plans that cover a range of coverage areas and price points.
What happened to Harvard Pilgrim Health Care?
Between March and April of 2023, Harvard Pilgrim's sensitive data files were exposed in a cyberattack. Harvard Pilgrim has taken steps to combat problems stemming from the data breach, but identity theft is still an ongoing concern for victims of the attack.
Methodology
We used data made available through the Centers for Medicare & Medicaid Services (CMS) to compare the 2023 monthly rates, deductibles and out-of-pocket maximums for Harvard Pilgrim Health Care and its competitors. Expanded Bronze premiums weren't included because data is not available.
Rankings and survey data taken from the NCQA, the NAIC, KFF and J.D. Power were also used in the creation of this review.