Harbor Health Elder Service Plan, Dual Eligible (PACE)
H2218 - 001 - 0
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Harbor Health Elder Service Plan, Dual Eligible (PACE) is a Medicare Advantage Plan by Elder Service Plan of Harbor Health Services, Inc.
Harbor Health Elder Service Plan, Dual Eligible (PACE) is a Medicare Advantage PACE plan by Elder Service Plan of Harbor Health Services, Inc.
IMPORTANT: Harbor Health Elder Service Plan, Dual Eligible (PACE) is a PACE plan. Program of All-Inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program for people who are 55 or older, live in the service area of a PACE organization, need a nursing home-level of care (as certified by your state), and are able to live safely in the community with help from PACE.
This page features plan details for 2024 Harbor Health Elder Service Plan, Dual Eligible (PACE) H2218 – 001 – 0 available in Norfolk,Suffolk, Plymouth,Bristol & Middlesex cty.
IMPORTANT: This page features the 2024 version of this plan. See the 2025 version using the link below:
No 2025 version found. You can use the location links below to find 2025 plans in your area.
Locations
Harbor Health Elder Service Plan, Dual Eligible (PACE) is offered in the following locations.
Plan Overview
Harbor Health Elder Service Plan, Dual Eligible (PACE) offers the following coverage and cost-sharing.
| Insurer: | Elder Service Plan of Harbor Health Services, Inc |
| Health Plan Deductible: | $0.00 |
| MOOP: | Not Applicable |
| Drugs Covered: | Yes |
Ready to sign up for Harbor Health Elder Service Plan, Dual Eligible (PACE) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
Premium Breakdown
Harbor Health Elder Service Plan, Dual Eligible (PACE) has a monthly premium of $381.10. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.| Part B | Part C | Part D | Part B Give Back | Total |
|---|---|---|---|---|
| $174.70 | $0.00 | $381.10 | $0.00 | $ |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
- You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.
Drug Info
Harbor Health Elder Service Plan, Dual Eligible (PACE) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
| Drug Deductible: | $ |
| Initial Coverage Limit: | $ |
| Catastrophic Coverage Limit: | $8,000.00 |
| Drug Benefit Type: | |
| Additional Gap Coverage: | |
| Formulary Link: | Formulary Link |
Part D Premium Reduction
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.
The table below shows how the LIS impacts the Part D premium of this plan.
| Part D | LIS Full |
|---|---|
| $381.10 | $0.00 |
Initial Coverage Phase
After you pay your $ drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $. Once you reach that amount, you will enter the next coverage phase.
30 Day
60 Day
90 Day
30 Day
60 Day
90 Day
Gap Coverage Phase
30 Day
90 Day
30 Day
90 Day
| Tier | Cost |
|---|---|
| All other tiers (Generic) | 25% |
| All other tiers (Brand-name) | 25% |
Catastrophic Coverage Phase
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
Harbor Health Elder Service Plan, Dual Eligible (PACE) also provides the following benefits.
| $0 |
| In-network | No |
| Not Applicable |
| No |
| In-network | No |
| Not Applicable (Not applicable.) (Not applicable.) |
| Primary | Not Applicable (Not applicable.) (Not applicable.) |
| Specialist | Not Applicable (Not applicable.) (Not applicable.) |
| $0 copay (Not applicable.) (Not applicable.) |
| Emergency | Not Applicable (Not applicable.) (Not applicable.) |
| Urgent care | Not Applicable (Not applicable.) (Not applicable.) |
| Diagnostic tests and procedures | Not Applicable (Not applicable.) (Not applicable.) |
| Lab services | Not Applicable (Not applicable.) (Not applicable.) |
| Diagnostic radiology services (e.g., MRI) | Not Applicable (Not applicable.) (Not applicable.) |
| Outpatient x-rays | Not Applicable (Not applicable.) (Not applicable.) |
| Hearing exam | Not Applicable (Not applicable.) (Not applicable.) |
| Fitting/evaluation | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Hearing aids – inner ear | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Hearing aids – outer ear | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Hearing aids – over the ear | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Oral exam | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Cleaning | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Fluoride treatment | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Dental x-ray(s) | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Non-routine services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Diagnostic services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Restorative services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Endodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Periodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Extractions | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Routine eye exam | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Contact lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Eyeglasses (frames and lenses) | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Eyeglass frames | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Eyeglass lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Upgrades | Not covered (Not applicable.) (Not applicable.) |
| Occupational therapy visit | Not Applicable (Not applicable.) (Not applicable.) |
| Physical therapy and speech and language therapy visit | Not Applicable (Not applicable.) (Not applicable.) |
| Not Applicable (Not applicable.) (Not applicable.) |
| Not covered (Not applicable.) (Not applicable.) |
| Foot exams and treatment | Not Applicable (Not applicable.) (Not applicable.) |
| Routine foot care | Not covered (Not applicable.) (Not applicable.) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | Not Applicable (Not applicable.) (Not applicable.) |
| Prosthetics (e.g., braces, artificial limbs) | Not Applicable (Not applicable.) (Not applicable.) |
| Diabetes supplies | Not Applicable (Not applicable.) (Not applicable.) |
| Not covered (Not applicable.) (Not applicable.) |
| Chemotherapy | Not Applicable (Not applicable.) (Not applicable.) |
| Other Part B drugs | Not Applicable (Not applicable.) (Not applicable.) |
| Part B Insulin drugs | Not Applicable (Not applicable.) (Not applicable.) |
| Not Applicable (Not applicable.) (Not applicable.) |
| Inpatient hospital – psychiatric | Not Applicable (Not applicable.) (Not applicable.) |
| Outpatient group therapy visit with a psychiatrist | Not Applicable (Not applicable.) (Not applicable.) |
| Outpatient individual therapy visit with a psychiatrist | Not Applicable (Not applicable.) (Not applicable.) |
| Outpatient group therapy visit | Not Applicable (Not applicable.) (Not applicable.) |
| Outpatient individual therapy visit | Not Applicable (Not applicable.) (Not applicable.) |
| $0 copay per stay (Not applicable.) (Not applicable.) |
Ready to sign up for Harbor Health Elder Service Plan, Dual Eligible (PACE) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
Table of Contents
Need more information on Harbor Health Elder Service Plan, Dual Eligible (PACE)? See 2025 Harbor Health Elder Service Plan, Dual Eligible (PACE) at MedicareAdvantageRX.com.
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