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.
State guides
Where MedCost appears in our state-by-state guide to the payer landscape:
Want to know if TierBench holds actual rate data for this payer?
See Payer CoverageContracting with this payer?
Book a 20-minute call and we'll walk through where your rates stand against the market — or explore the data yourself.