Written by Michael LaPick
Healthcare Writer
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Harvard Pilgrim Health Care Review
Harvard Pilgrim Health Care, now part of Point32Health following its merger with Tufts Health Plan, remains a leading nonprofit insurer in New England.
Coverage AreasACA plans are available in Massachusetts, Maine, and New Hampshire, with nationwide and global coverage provided through employer and retiree plans like Access America and Medicare Enhance.
Plan TypesACA plans are available in MA, ME, and NH; employer-sponsored HMO, PPO, POS, and HDHP plans are offered across New England with national reach, while STM, Medicaid, and student health plans are not offered.
Key Takeaways
- Regional Strength: ACA and Medicare plans mainly in Massachusetts, Maine, and New Hampshire, with national reach through Access America and Medicare Enhance.
- Good Quality: High NCQA ratings, strong telehealth, and wellness programs, plus global emergency coverage on select plans.
- Some Drawbacks: Premiums are rising, plan options are limited outside New England, and members report billing and claims frustrations.
Harvard Pilgrim Health Care
Harvard Pilgrim Health Care, now part of Point32Health following its merger with Tufts Health Plan, remains a leading nonprofit insurer in New England. As of 2026, it offers a mix of under-65 and Medicare options in Massachusetts, Maine, New Hampshire, and other Northeast states. While its ACA footprint is regionally limited, Harvard Pilgrim provides national access through its Access America employer product and Medicare Enhance for retirees.
Pros and Cons
Pros
- Regional strength in New England for ACA and employer plans
- National and global coverage via Access America and Medicare Enhance
- High NCQA quality ratings and robust wellness/telehealth programs
- Broad provider choice with tiered and POS options
- Global emergency coverage included for select plans
Cons
- No ACA plans outside core New England states
- Premium increases across multiple markets (e.g., 8.8% in MA)
- Customer complaints on billing issues and out-of-network claims
- No short-term or student health plans available
- Limited plan variety outside employer and retiree markets
Coverage Area (2026)
United States
ACA plans are available in Massachusetts, Maine, and New Hampshire. Employer group and retiree options (Access America, Medicare Enhance) offer nationwide coverage.
International
Global emergency coverage is included in Access America and Medicare Enhance plans.
Provider Network
Robust networks across New England with national access through employer products. Tiered HMO/POS plans offer varying cost levels based on provider choice.<
Plan Types Offered (2026)
Under-65 (Individual & Family)
- ACA Marketplace Plans
Available in: Massachusetts (HMO, PPO, Connector plans), Maine (HMO, CSR plans), and New Hampshire (HMO plans). - Short-Term Medical (STM)
Not offered. - Employer-Sponsored Plans
Available in all six New England states with national coverage via Access America. Plans include HMO, PPO, POS, HDHP, and wellness add-ons. - Student Health Plans
Not separately listed. - Medicaid
Not offered under the Harvard Pilgrim brand.
Medicare (65+)
- Medicare Enhance (Supplement)
This carrier offers Nationwide Medicare Supplement-style (Medigap) coverage with global emergency care. - Medicare Advantage (Stride)
HMO/HMO-POS plans with dental, vision, and wellness benefits are included and available in select New England markets. - Part D Prescription Drug Plans
Integrated through CVS SilverScript with Medicare Enhance. - Retiree Group Medicare
Offered to employer-sponsored retirees via Access America and Medicare Enhance plans.
Recent Changes in Cost and Options (2026)
Premiums and Rate Changes
Average ACA premium increase in Massachusetts was 8.8% for 2025–2026 due to medical inflation.
Out-of-Pocket Costs
Deductibles and copays have risen alongside premiums. Tiered HMO and Explorer POS plans provide lower-cost options with narrower networks.
Medicare Advantage Updates
Stride MA plans continue in select counties with added vision and dental perks.
Plan Enhancements
Ongoing investment in telehealth via Doctor On Demand, digital claims tools, and wellness programs.
Network Agreements
No major changes in provider contracts. National access continues via employer and retiree offerings.
Consumer Experience Snapshot
Complaint Index
NAIC complaint index remains below average, but member reviews cite delays with reimbursements and administrative hurdles.
Satisfaction Scores
NCQA ratings consistently high; specific satisfaction data varies by plan and region.
A team of licensed insurance agents are here to help you compare plans
Methodology
Our Health Insurance Rating Methodology scores insurers across five main categories, each rated on a scale of 1 to 10. The overall score is the average of: Coverage Breadth and Accessibility, Plan Variety and Customization, Affordability and Value, Innovation and Care Quality, and Consumer Experience and Transparency. Categories assess provider reach, plan diversity, cost structure, care delivery, and member service experiences based on public data, filings, and expert analysis.
Bottom Line
Harvard Pilgrim Health Care is a strong regional option in New England for ACA, employer, and Medicare plans, especially for those who value digital access and wellness support. Access America and Medicare Enhance offer flexibility and nationwide reach for group members and retirees. However, rising costs and administrative complaints are pain points. Individuals should weigh plan benefits against affordability and local support availability before enrolling.
Best for
New England residents, national employer groups, and Medicare retirees seeking quality care and global emergency access.
Not ideal for
Those needing ACA coverage outside New England or seeking short-term or Medicaid plans.
Disclaimer
The views and opinions expressed are those of the authors and do not necessarily reflect the official policy or position of HealthCareInsider.com or HealthCare, Inc.
Thank you for your feedback!
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