Harvard Pilgrim Health Care Insurance Review & Complaints (2023)

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Based in New England and associated with Harvard Medical School, Harvard Pilgrim Health Care is a large not-for-profit organization offering a range of health insurance options. Affordable Harvard Pilgrim Health Care health insurance is available for both individual and groups in both HMO and PPO formats. The company also writes Medicare and Medicaid plans.

What type of insurance is offered by Harvard Pilgrim Health Care?

The Dean of Harvard Medical School, creating the region’s first HMO, founded Harvard Pilgrim Health Care in 1969. The connection between the school and the health care system continues today, through the Harvard Pilgrim Health Care Institute’s teaching and research work. This work focuses on the health care system and its effect on individuals.

Harvard Pilgrim Health Care is a nonprofit that also provides many services to the community, including the Harvard Pilgrim Health Care Foundation, which offers services for low-income families in the area.

They offer a wide range of health care options. Health insurance individual and family plans are available in Massachusetts, Maine, and New Hampshire. While they have other services in Connecticut, individual insurance plans are not currently offered there. Medicare plans are only offered in Connecticut, and our Harvard Pilgrim Health Care Medicare review has more information. Most plans are HMO-POS, but through a partnership, they also offer PPO plans in some areas.

What types of health care plans are available?

For the purpose of this review, we selected the insurance plans available in the state of Massachusetts, where the company has its headquarters. All of the five insurance plans we found listed for the state are HMO plans. Harvard Pilgrim partners with United Health Group to provide PPO plans, but our search returned no such options in this state. There were, in fact, fewer plans to choose from than we expected from such a large insurance company. You can also find Massachusetts Medicare Advantage companies online by shopping around.

Standard Plans

There are three choices in the standard plans, with a range of insurance coverages and deductibles.

The Affordable HMO 25 has no deductible and a 0% coinsurance amount. The co-pays are $25 for a primary care visit and $40 for a specialist visit. Prescription drug cost-sharing starts at $25 for Tier 1 drugs.

The Best Buy HMO 2000 has a $2,000 individual deductible and a $4,000 family deductible. It has the same co-pays as the HMO 25, but a lower cost for prescriptions, starting at $5 for Tier 1 drugs.

The Core Coverage HMO 1750 has a lower deductible at $1,750 per person and $6,400 per family. Doctor visits are covered at a $35 co-pay for the first three visits. All other visits are subject to the deductible and a 20% coinsurance charge.

Best Buy Deductible Plans

The Best Buy plans are considered value plans with the option of higher deductibles in return for lower premiums.

The Best Buy 1000 plan is a Gold-level plan that offers the lowest deductibles, at $1,000 individual and $2,000 family. Primary care visits are $25, and specialist visits are $40. Prescription drugs with this plan start at a $5 co-pay for generic Tier 1 drugs.

The Best Buy HSA HMO 3100 is a Bronze level plan with deductibles of $3,100 individual and $6,200 family. There is no coverage for services other than preventative until after the deductible is met, and at that point, primary care visits have a $40 co-pay and specialist visits have a $65 co-pay. Prescription drug coverage starts at $5 for Tier 1 after the deductible is met.

Does the company have competitive insurance rates?

We used a Massachusetts zip code to obtain sample rates for the Harvard Pilgrim plans. The lowest-priced plan is the Best Buy 3100, which is also the only plan that requires deductibles to be met before medical coverage kicks in. It came in at $358.80 for a 30-year-old single person. The Affordable HMO 25 came in at $589.78 for the same person.

These rates cannot be compared to nationwide insurance costs accurately, but rank among the higher rates we have seen anywhere, particularly for a limited network HMO plan. That said, they do have lower deductibles than many other plans, with the cheapest plan still having deductibles that are half as much as many other insurance companies list on their low-cost Bronze plans.

Whether or not you find their prices manageable, having some sort of health plan and understanding how to buy health insurance can keep you from falling into financial ruin, so that you’re not paying for your medical bills on your own.

How are claims handled?

As an HMO, the company processes claims directly between their connected provider and the insurance branch. This usually means faster and easier claims processing.

They only payout of network claims in an emergency situation, and this may take longer to process. Claims handling is one of the few areas where the health insurance company ranked poorly on the NCQA rating system, which we will cover in the next section.

Are the ratings and consumer reviews positive?

Harvard Pilgrim Insurance currently has a B-rating with the Better Business Bureau (BBB). The lowered rating is the result of a failure to respond to five complaints. The total complaint count, however, is low at only 12 in the past three years and seven in the past 12 months which shows that the people that buy Harvard Pilgrim Health Care health insurance tend to be satisfied.

The National Committee for Quality Assurance gives Harvard Pilgrim Insurance a 5.0 ranking overall, with high ratings across the board in consumer satisfaction, treatment, and prevention services. Only a few low rankings vary given in the long list of areas surveyed, although one of them is claims handling with a 2.0 rating in that area. 5.0 is the highest-ranking available from the NCQA.

There is not a lot in the way of complaints about Harvard Pilgrim Insurance on a typical consumer review directory. We did find 13 reviews on Yelp, one of which is positive while the rest are negative. Most of the complaints refer to a refusal to pay claims and the cost of the insurance itself. Overall, the complaints do not raise any red flags and there certainly is not a high volume of complaints about customer service.

What’s the bottom line?

Harvard Pilgrim Insurance is connected with a prestigious medical school and offers low deductible plans, although those plans are relatively expensive in terms of monthly premiums. They have a very good reputation and rank well in most areas, making them well worth adding to the comparison shopping list for those looking for an HMO plan or trying to lower their average health insurance cost per month.