By Liz Nolan
REGION – Healthcare can be complicated and expensive, especially for those eligible for Medicare. Boston-based eternalHealth’s founder Pooja Ika is determined to offer a more affordable and comprehensive Medicare Advantage option, while focusing on the member experience.
eternalHealth is a new Medicare-approved, private start-up healthcare plan currently covering Worcester, Middlesex and Suffolk counties with expansion plans for 2024. It is the first new health plan since 2013.
“The market needed change,” said Ika. “It needed products that are light years ahead of where we are now. We are looking forward to being able to gain membership and offer a different option for the people of Massachusetts, one that is shaped around their needs.”
Simplicity, cost savings and ease of mind
Often, people with Original Medicare require additional supplemental coverage at an additional cost and the need to deal with separate entities to get that coverage.
“eternalHealth will be a one-stop shop,” said Ika. “We cover everything Medicare covers plus more, including but not limited to pharmacy, hearing, vision, dental coverage, grocery dollars, and a fitness benefit.”
The Annual Enrollment Period (AEP) is October 15 through December 7 and four unique plans will be offered giving members flexibility and choice. Plans with $0 premiums, $0 PCP copays, and low out-of-pocket costs are available.
“This coming enrollment period is our real entry to the market,” said Ika.
She encourages eligible residents to view the website and learn about the different plans. Self-enrollment can quickly and easily be done online. People can also inquire about eternalHealth through an insurance broker or speak to one of the company’s licensed representatives directly.
eternalHealth operates on a cloud-based web platform, which ultimately reduces administrative costs. Those cost savings are passed on to its members. The platform enables all stakeholders from members and doctors to the health insurance company to make informed healthcare decisions based on making information more accessible.
Medicare beneficiaries, who are affected by inflation and have less intense medical needs, can choose to enroll into eternalHealth’s Give Back PPO this AEP, and expect to receive money back into their Social Security checks in 2023.
Ika said that year after year, eternalHealth’s mission is to offer sustainable products with reduced out-of-pocket costs, while simultaneously making their benefits richer. This is accomplished as a result of the cost savings eternalHealth is able to capture through the use of its platform.
The options eternalHealth offers is ideal timing for a lot of people aging into Medicare.
“Inflation is hitting us in different ways,” said Ika. “Low-income and senior populations, who are on fixed incomes are hit the hardest.”
Importance of building community relationships
The business has just under 20 employees and the philosophy according to Ika is that “when you are a member of eternalHealth, it’s like your family is running your health plan.”
Building relationships with members and the communities it serves is important to eternalHealth, as it emphasizes it’s a company to be trusted with transparency and integrity.
One community partner and familiar face is former Red Sox player David Ortiz, who optimizes those characteristics.
“I first met David through the David Ortiz Children’s Fund,” said Ika. “He is very aligned with our mission and vision and shares a lot of the same values. He is personable and great at building relationships. David is making healthcare accessible to children, and in our own right, we are trying to make healthcare more accessible for the Medicare population. His foundation does great work, and he is a true partner to spread the message.”
Commitment to members
Ika’s interest in healthcare is not a new one. She grew up in Southborough with parents involved in health care. She would often accompany her mother, a primary care physician, to work and realized that healthcare is individualized and catered. Her father is on the technical end of healthcare. She learned “the importance of building a team of people who are passionate about the vision and mission of the company, and whose commitment goes beyond themselves to leave a lasting impact.”
Ika realizes that on the insurance side, there’s room for improvement. She strives to build personal and unique relationships with eternalHealth’s members.
“We are on the complicated, confusing journey with them,” she said. “On the insurance side of healthcare, we have to catch up. The only way to do that is to be more flexible. We need to be able to pivot to meet the needs of the state’s population. We are the catalyst for change; pushing other insurers who have been in the market for years to rethink their approach.”
More information on eternalHealth can be found on their website at www.eternalHealth.com or by calling 800-831-5967 (TTY 711).