Who they are
MedCost, LLC is not a traditional insurer but a regional PPO network and third-party-administration (TPA) services company, serving employers across North Carolina, South Carolina, and Virginia. It was purchased in mid-2025 by Health Plans Inc. (HPI) of Westborough, Massachusetts — a wholly owned subsidiary of Harvard Pilgrim Health Care, part of the Point32Health family. Its lineage runs from Wake Forest Baptist / Atrium origins, to Advocate Health (after the Atrium–Advocate Aurora merger), to HPI in 2025.
The behavioral health contracting entity
MedCost operates a rental-network model: facilities contract with MedCost's network, which self-funded employer plans then rent. That's why the MedCost name appears on claims from many different employers. Behavioral health arrangements vary by employer plan — some clients route behavioral health through dedicated behavioral health networks rather than MedCost's own network — so what a facility can contract for depends on the specific plan.
Websites & portals
- medcost.com
Network and TPA services site.
Scope
North Carolina, South Carolina, and Virginia.
Notable context
MedCost and Harvard Pilgrim now share a corporate parent (Point32Health, via HPI). The rental-network model is why one network name can appear across many different employers' plans. TierBench holds MedCost's negotiated rates, including the rented networks it publishes.
State guides
Where MedCost appears in our state-by-state guide to the payer landscape:
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