Harvard Pilgrim Health Care (HPHC) is a not-for-profit health services organization founded by doctors more than fifty years ago. Since 2021, Harvard Pilgrim has operated as part of Point32Health, the parent company formed by the merger of Harvard Pilgrim and Tufts Health Plan. The Harvard Pilgrim brand continues to be used for commercial health plans across the region.
Harvard Pilgrim offers individual and family health plans to members in Maine, Massachusetts, New Hampshire, Connecticut, and Rhode Island, along with employer group plans and Medicare options.
They also offer business health insurance plans for employers, as well as Medicare plans, with the two main options being Medicare Advantage StrideSM plans and Medicare Supplement plans.
There are many types of plans for individuals, families, and employers that Harvard Pilgrim offers. The amount and type of coverage available will depend on the type of plan that someone is enrolled in.
Read on to learn more about the plans offered by Harvard Pilgrim, whether they cover therapy, how much it costs, and how to find an in-network therapist.
Key takeaways
- Harvard Pilgrim covers counseling and psychotherapy as part of its core health plan benefits — but the specifics depend on your plan type.
- Harvard Pilgrim refers to mental health coverage as “behavioral health care,” which includes therapy for emotional, behavioral, and substance use concerns.
- In-network providers cost less than out-of-network, and some plan types require a referral from your primary care provider before seeing a therapist.
- Harvard Pilgrim individual and family plans are available in Maine, Massachusetts, and New Hampshire.
What types of plans does Harvard Pilgrim offer?
The main types of plans that Harvard Pilgrim offers are:
- Health Maintenance Organization (HMO): Within Harvard Pilgrim’s network of providers, you choose a primary care provider (PCP) who refers you to specialty care.
- Preferred Provider Organization (PPO): Coverage is provided for in-network services as well as out-of-network services, for a higher cost. You don’t need a primary care provider, nor do you need to be referred for specialty care.
- Limited Network (e.g., Focus NetworkSM and ElevateHealthSM): Provides access to a smaller network of providers for a lower cost.
- Tiered Network (e.g., ChoiceNet and Maine’s ChoiceSM): You pay a different amount depending on what ‘tier,’ or category, that a certain provider falls under.
- Deductible/Consumer-Driven Health Plans (CDHP) (e.g., Best Buy): You must pay a deductible (a certain amount of your own out-of-pocket money) before Harvard Pilgrim begins to pay for services.
Does Harvard Pilgrim cover therapy?
Counseling and psychotherapy for behavioral health care and substance use disorder services are usually part of the core health plan benefits of Harvard Pilgrim. Harvard Pilgrim uses the term “behavioral health care” instead of “mental health care” because it addresses behaviors and habits in addition to mental and emotional wellbeing.
Your insurance coverage will depend on the type of plan that you have. It’s important to know how your plan works so that you know what types of services and health care providers you have access to. Your Schedule of Benefits (SOB) and Benefit Handbook are parts of your insurance plan documents that can provide details on services, treatment options, and fees for your specific plan.
Did you know?
The Mental Health Parity and Addiction Equity Act (MHPAEA) requires health insurers, including Harvard Pilgrim, to cover mental health and substance use disorder services on the same terms as medical and surgical services. This means your copay, deductible, and coverage limits for therapy cannot be more restrictive than those for comparable physical health visits. If you believe your plan is treating mental health care differently, you have the right to request a parity analysis from your insurer.
What types of mental health providers does Harvard Pilgrim cover?
Whether a certain provider’s services are covered depends on your specific plan and whether the provider is in-network or out-of-network. In-network providers are those who officially participate in the Harvard Pilgrim network, whereas out-of-network providers are not part of the Harvard Pilgrim network. Usually, it will cost less to see a provider who is in-network. Some plans will also provide coverage for out-of-network providers. Coverage also depends on whether or not your plan requires a referral from your primary care provider.
Harvard Pilgrim’s network of behavioral health providers includes clinicians, counselors, and therapists from a variety of specialties including psychiatrists, marriage and family therapists, social workers, substance use counselors, and applied behavioral analysts. Depending on your plan, some types of therapy or therapists may or may not be covered, particularly for Applied Behavioral Analysis.
You may be asked to sign a consent form that allows your behavioral health provider to communicate with your primary care provider about your treatment plan.
What types of mental health care does Harvard Pilgrim cover?
The covered services for mental health care and behavioral health treatment with Harvard Pilgrim may vary depending on your specific plan.
Outpatient therapy is the most common type of mental health care treatment. Outpatient therapy may be provided virtually or through in-person office visits. Outpatient therapy may include talk therapy, prescription drugs, virtual visits, group therapy or family therapy sessions, or community self-help or support group programs. A variety of mental health conditions or issues may be addressed through these types of therapy, such as depression, anxiety, substance abuse, ADHD, or preventive care.
Services that provide more immediate or intense assessments or treatments may also be covered by your health plan, such as inpatient hospitalization, partial hospitalization, residential programs, intensive outpatient programs, emergency room visits, or urgent care.
How much does Harvard Pilgrim Health Care cost?
The cost and coverage provided by Harvard Pilgrim varies depending on the specific plan you have. You may pay more if you want to be able to visit out-of-network providers, if you want coverage for more services, or if you see providers that are in a higher priced tier or category.
In addition to the different types of plans offered by Harvard Pilgrim, there may be different categories within each type of plan (e.g., Bronze, Silver, or Gold HMO or PPO plans) that may vary depending on the premium, deductible, and pocket costs you wish to pay. Here are what those terms mean, as well as other terms related to insurance costs:
- Premium: The amount you pay every month for your health insurance coverage.
- Deductible: A fixed amount of money that you must pay out of your own pocket before you are eligible for reimbursement of fees from Harvard Pilgrim. For example, if your annual deductible is $2,000, you must pay a cumulative total of $2,000 for services you use. After you’ve paid this amount, Harvard Pilgrim will start to help to pay.
- Coinsurance: The fixed percentage of the cost of a service that you pay out of your own pocket. For instance, a plan with coinsurance may require you to pay 20% of a service fee, and Harvard Pilgrim will pay the other 80%. Usually, coinsurance is paid after the annual deductible amount has been paid.
- Copayment: A dollar amount that you pay out of your own pocket, which may vary depending on the type of service used (e.g., prescription drugs, primary care visits, or specialist visits).
- Cost sharing: What you pay out of your own pocket for services used. Deductibles, coinsurance, and copayments are all considered part of cost sharing.
- Out-of-pocket maximum: The maximum amount of cost sharing, or money that you must pay out of your own pocket (from deductibles, copayments, and coinsurance), that you must pay every year for covered services. After this amount is met, Harvard Pilgrim will cover all additional costs at no charge to you.
How do I know what I’ll actually pay per therapy session with Harvard Pilgrim?
The most reliable way is to use Grow Therapy’s cost estimator — enter your Harvard Pilgrim plan details and it will show you your estimated out-of-pocket cost per session before you book anything.
You can also call the member services number on the back of your Harvard Pilgrim ID card and ask specifically: “What is my copay or coinsurance for outpatient mental health visits with an in-network provider?” Have your member ID ready. If you have a deductible that hasn’t been met yet, your cost per session will typically be higher until you reach that threshold — after which you’ll pay only your coinsurance or copay.
How to find a Harvard Pilgrim in-network therapist
It’s important to take care of your mental wellbeing, whether you are currently experiencing a mental illness or if you want to take proactive steps to improve your mental health in general.
At Grow Therapy, we believe everyone should have access to and can benefit from quality mental health care. We have a large and growing network of therapists that are ready to support you. To find a therapist who accepts Harvard Pilgrim Health Care, check out our search tool and select “Harvard Pilgrim” under the insurance company category.
You can also use our cost estimator to see how much you’ll be expected to pay per therapy session with your Harvard Pilgrim plan.
Final thoughts
Harvard Pilgrim’s behavioral health coverage is generally comprehensive, but the specifics vary enough between plan types that it’s worth taking five minutes to check your own plan before you start searching for a therapist. The cost estimator above is the fastest way to do that.
If you’re in Maine, Massachusetts, or New Hampshire and ready to find support, Grow Therapy’s network includes licensed therapists who accept Harvard Pilgrim across all major plan types. Filtering by insurance, specialty, and availability means you can find a match without the back-and-forth of calling individual offices.
