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Braven Medicare Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Braven Medicare Choice (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Braven Medicare Choice (PPO) in 2025, please refer to our full plan details page.
Braven Medicare Choice (PPO) is a PPO plan offered by Horizon Mutual Holdings, Inc available for enrollment in 2025 to people living in Eastern New Jersey. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Braven Medicare Choice (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Braven Medicare Choice (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Braven Medicare Choice (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $200.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $12000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $12000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Braven Medicare Choice (PPO) plan has a $200 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, you will pay a $10 copay for preferred generic drugs at a standard pharmacy, while specialty tier drugs have no copay. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Braven Medicare Choice (PPO) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services, including emergency and urgent care, have copays. Many services have a $0 copay, while others have copays or coinsurance, such as vision, dental, and hearing services. The plan also covers preventive services, primary care, and home health services. Additional benefits include coverage for ambulance and transportation, along with services like acupuncture and an over-the-counter allowance.
Inpatient Hospital See details
The Braven Medicare Choice (PPO) plan covers inpatient hospital stays, with a copay of $390 per day for days 1-5, and no copay for days 6-90 for Inpatient Hospital-Acute. Additional days for Inpatient Hospital-Acute have no copay. Inpatient Hospital Psychiatric has a copay of $385 for days 1-5, and no copay for days 6-60. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, as are additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a $370 copay, and observation services with a $370 copay. Ambulatory Surgical Center (ASC) Services have a $275 copay, and outpatient substance abuse services have a $30 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will have a $60 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Braven Medicare Choice (PPO) plan. Ground and air ambulance services each have a $250 copay, with no coinsurance. Transportation Services to any health-related location are covered, but transportation services to a plan-approved health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Braven Medicare Choice (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $30 copay, and Worldwide Emergency Transportation has a $250 copay; there is no coinsurance for any of these services.
Primary Care See details
The Braven Medicare Choice (PPO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $15 copay, physician specialist services have a $30 copay, and physical therapy and speech-language pathology services have a copay between $20 and $35. Routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered preventive services, annual physical exams, and other preventive services are covered. Some services, such as Health Education, In-Home Safety Assessment, and Counseling Services are not covered.
Hearing Services See details
Hearing services with the Braven Medicare Choice (PPO) plan include routine hearing exams with a $30 copay, fitting/evaluation for hearing aids, and prescription hearing aids with a copay between $299 and $1199 depending on the type of hearing aid. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
The Braven Medicare Choice (PPO) plan covers vision services, including eye exams with a copay of $0-$30. The plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a maximum benefit of $200 for contact lenses and eyeglass frames per year.
Dental Services See details
Braven Medicare Choice (PPO) covers dental services with 20% coinsurance for Medicare dental services. Other dental services are also covered, including oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments, with varying limitations and 50% coinsurance for restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery. Prosthodontics, removable, maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a copay between $0 and $35. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Braven Medicare Choice (PPO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits are covered, with Durable Medical Equipment (DME) and Prosthetic Devices covered at 20% coinsurance, while Medical Supplies have a 20% coinsurance. Diabetic Supplies are covered with no coinsurance up to 20%, while Durable Medical Equipment for use outside the home and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a maximum copay of $50, while Lab Services are not covered. Diagnostic Radiological Services have a maximum copay of $175, and Therapeutic Radiological Services have 20% coinsurance. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Braven Medicare Choice (PPO) plan. This benefit has no copay and no coinsurance, but requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Braven Medicare Choice (PPO) plan. However, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Braven Medicare Choice (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Braven Medicare Choice (PPO) plan covers acupuncture with no copay, and over-the-counter (OTC) items up to $70 every three months, and a meal benefit for chronic illnesses. The plan does not cover Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services.
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