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Braven Medicare Freedom (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Braven Medicare Freedom (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Braven Medicare Freedom (PPO) in 2026, please refer to our full plan details page.
Braven Medicare Freedom (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 4 out of 5 stars in 2026.
It's important to know that Braven Medicare Freedom (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 Freedom (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 Freedom (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $40.00. 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 $300.00 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 $13900.00 (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 $13900.00 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 Freedom (PPO) plan features an annual drug deductible of $300. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs whether you use a standard pharmacy, preferred mail order, or standard mail order. For Tier 2 generic drugs, copays start as low as $4 for a one-month supply through preferred mail order, while standard pharmacies and standard mail orders charge an $8 copay. For Tier 3 preferred brand drugs, you will pay a flat $47 copay for a one-month supply across standard pharmacies and mail-order options. Higher-tier medications are subject to coinsurance, with Tier 4 non-preferred drugs requiring a 40% coinsurance and Tier 5 specialty drugs requiring a 29% coinsurance for a one-month supply at standard pharmacies.
Additional Benefits
The Braven Medicare Freedom (PPO) plan delivers comprehensive healthcare coverage featuring no copay for primary care, telehealth, and routine preventive services. For specialized medical needs, members pay a $30 copay for specialist visits and a $115 copay for emergency room visits, which is waived if admitted. Inpatient hospital stays require a $425 daily copay for acute care days 1 through 5, with no copay for subsequent days and no coinsurance. Supplemental benefits include preventive dental care with no copay, routine eye exams with a $0 to $30 copay, and a $200 annual allowance for eyewear. Members also benefit from a $75 quarterly allowance for over-the-counter items, no-copay acupuncture, and unlimited public transit rides to health-related locations. Hearing coverage includes routine exams and up to two prescription hearing aids per year with copays between $299 and $1,199.
Inpatient Hospital See details
Braven Medicare Freedom (PPO) covers inpatient hospital services with no coinsurance, requiring prior authorization. You will pay a $425 daily copay for acute care days 1 through 5 and a $416 daily copay for psychiatric care days 1 through 5, with no copay for subsequent days. This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Braven Medicare Freedom (PPO) covers outpatient hospital and observation services with a $375 copay and no coinsurance, and ambulatory surgical center services with a $275 copay and no coinsurance. Outpatient substance abuse sessions require a $30 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Braven Medicare Freedom (PPO) covers partial hospitalization services with a $60 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Braven Medicare Freedom (PPO), with ground and air ambulance rides requiring a $300 copay and no coinsurance. Transportation services are partially covered, offering unlimited one-way bus or subway rides to any health-related location with no copay and no coinsurance, though transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Braven Medicare Freedom (PPO) covers emergency services with a $115 copay and urgently needed services with a $35 copay, both with no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency coverage is also available up to a $100,000 limit with no coinsurance, requiring a $115 copay for emergency or urgent care and a $300 copay for emergency transportation.
Primary Care See details
Braven Medicare Freedom (PPO) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services carry a $30 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, though routine and other chiropractic services are not covered, and podiatry services are not covered.
Preventive Services See details
Braven Medicare Freedom (PPO) offers preventive services, including annual physical exams, kidney disease education, and diabetes self-management training, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance for weight management, nutritional counseling, and home safety devices, while services like health education, alternative therapies, personal emergency response systems, and telemonitoring are not covered.
Hearing Services See details
Braven Medicare Freedom (PPO) provides partially covered hearing services, including an annual routine hearing exam and fitting for a $30 copay and no coinsurance. Up to two prescription hearing aids are covered per year with copays ranging from $299 to $1,199 and no coinsurance, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services under the Braven Medicare Freedom (PPO) are partially covered, offering one annual routine eye exam with a $0 to $30 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing a $200 maximum annual benefit for contact lenses or eyeglass frames.
Dental Services See details
Braven Medicare Freedom (PPO) covers preventive dental services like cleanings and exams with no copay and no coinsurance, while Medicare-covered dental services require no copay and a 20% coinsurance. Select comprehensive services are covered up to a $1,000 annual limit with no copay and 50% coinsurance, but prosthodontics, implants, orthodontics, and certain diagnostic and preventive services are not covered.
Home Infusion bundled Services See details
Braven Medicare Freedom (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin is covered with a $0 to $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance of 0% to 20%.
Dialysis Services See details
Braven Medicare Freedom (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Braven Medicare Freedom (PPO) partially covers medical equipment with no copay for durable medical equipment, prosthetics, and diabetic supplies, though prior authorization is required and a 20% coinsurance applies (0% to 20% coinsurance for diabetic supplies). Diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Braven Medicare Freedom (PPO), as lab services are not covered. Under this plan, prior authorization is required for diagnostic procedures, which have no coinsurance and a $0 to $50 copay, and radiological services, which feature a $0 copay for diagnostic radiology, a $30 copay for X-rays, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered under the Braven Medicare Freedom (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Braven Medicare Freedom (PPO) covers some Cardiac Rehabilitation Services with no coinsurance, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation (each with a $15 copay), and supervised exercise therapy for peripheral artery disease services (with a $20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Braven Medicare Freedom (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Braven Medicare Freedom (PPO) covers other services including acupuncture, meal benefits for chronic illness, and over-the-counter (OTC) items with no copay and no coinsurance. While acupuncture and meals have no maximum benefit limits, the OTC benefit is limited to $75 every three months via reimbursement and does not cover nicotine replacement therapy or naloxone.
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