Harvard Pilgrim Health Care is dropping its Medicare Advantage businesses in Massachusetts and Maine, a move that will force more than 11,000 people to find new coverage next year.
In Massachusetts, about 9,500 members of the company’s StrideSm (HMO) plan will have to choose another insurer, according to a statement issued Friday in response to questions from the Globe. The change will affect about 1,600 members in Maine, where Harvard Pilgrim will continue to offer Medicare supplement plans.
Harvard Pilgrim merged with Tufts Health Plan at the start of the year, and they operate under parent company Point32Health. Tufts Medicare Preferred HMO plan has a larger network of doctors and other providers, and similar benefits, according to Point32Health’s statement.
Still, some Harvard Pilgrim Medicare customers may find that their doctors aren’t in the Tufts network.
“If Tufts doesn’t incorporate Harvard’s full network of doctors, some Harvard members may have to scramble to find another insurer that does, or switch to a Medicare supplement plan,” said Edgar Dworsky, founder and editor of Consumer World.
Medicare Advantage plans offer Medicare coverage for hospital care, doctors, and drugs through private insurers, using their provider networks. There are about 337,000 Medicare Advantage members in Massachusetts. Tufts is the largest Medicare Advantage insurer in the state, according to AHIP, an association of health care providers. Medicare supplement plans cover some costs not covered my Medicare.
Harvard Pilgrim’s decision affects only its Medicare Advantage plans in Massachusetts and Maine, not its other products. And it will remain a Medicare Advantage carrier in New Hampshire, where Harvard Pilgrim’s plans have 11,000 customers and Tufts doesn’t compete.
“We are not exiting either state,” Point32Health said.
In Massachusetts, Harvard Pilgrim will be contacting members about its exit from Medicare Advantage and pitch the Tufts plan. It noted that the Tufts Medicare plan is one of only two in the country to receive the top rating from the Centers for Medicare and Medicaid Services for six years in a row.