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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 2026, 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 Mercer. This plan received an overall rating of 4 out of 5 stars in 2026.
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 $250.00 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:
Sign up for Braven Medicare Choice (PPO)
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Drug Coverage
The Braven Medicare Choice (PPO) plan features an annual prescription drug deductible of $250. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs across standard pharmacies and mail-order services. For Tier 2 generic medications, standard pharmacy copays range from $10 to $30 depending on the supply, while preferred mail order offers savings with copays starting at just $5. Tier 3 preferred brand drugs require a flat copay of $47 for a one-month supply at both pharmacies and mail-order options. Higher-tier medications are subject to coinsurance, with Tier 4 non-preferred drugs requiring a 45% coinsurance and Tier 5 specialty drugs requiring 30% coinsurance for a one-month supply at standard pharmacies.
Additional Benefits
The Braven Medicare Choice (PPO) plan offers robust coverage with no copay and no coinsurance for primary care, telehealth, preventive services, and home health care. For specialist visits, patients pay a $30 copay, while inpatient hospital stays require a $450 daily copay for the first five days and no copay thereafter. Outpatient hospital services feature a $375 copay, and emergency room visits have a $115 copay, which is waived if you are admitted within 24 hours. This plan also includes key supplemental benefits, such as preventive dental and routine vision exams with no copay, plus up to a $200 annual allowance for eyewear. Hearing exams require a $30 copay, with covered prescription hearing aids carrying a copay ranging from $299 to $1,199. Additionally, skilled nursing facility stays require no copay for the first 20 days, and members receive up to $50 every three months for over-the-counter items.
Inpatient Hospital See details
Braven Medicare Choice (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required, and upgrades or non-Medicare-covered stays are not covered. For acute stays, you pay a $450 daily copay for days 1 through 5 and no copay for days 6 and beyond, while psychiatric stays require a $416 daily copay for days 1 through 5 and no copay for days 6 to 90, with additional psychiatric days not covered.
Outpatient Services See details
Braven Medicare Choice (PPO) outpatient services are covered with no coinsurance, featuring a $375 copay for outpatient hospital and observation services and a $275 copay for ambulatory surgical center services. Outpatient substance abuse services require a $30 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Braven Medicare Choice (PPO) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
Braven Medicare Choice (PPO) covers ground and air ambulance services with a $345 copay and no coinsurance, subject to prior authorization. Unlimited one-way transportation to any health-related location via bus or subway is also covered with no copay and no coinsurance, though transportation specifically to plan-approved health-related locations is not covered.
Emergency Services See details
Braven Medicare Choice (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency services are covered up to a $100,000 maximum with no coinsurance and copays ranging from $115 to $345.
Primary Care See details
Braven Medicare Choice (PPO) covers primary care and telehealth visits with no copay and no coinsurance, while specialist, therapy, and mental health services require a $30 copay and no coinsurance. Although some chiropractic services are covered with a $15 copay and no coinsurance, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Braven Medicare Choice (PPO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, alternative therapies, therapeutic massage, adult day health, home-based palliative care, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, and counseling services.
Hearing Services See details
Braven Medicare Choice (PPO) provides partially covered hearing services, featuring one annual routine exam and fitting evaluation for a $30 copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and a copay ranging from $299 to $1,199, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Braven Medicare Choice (PPO) provides vision services, featuring partially covered eye exams with a $0 to $30 copay and no coinsurance for routine annual exams, while other eye exam services are not covered. Eyewear is also covered with no copay, no coinsurance, and up to a $200 annual maximum benefit for contact lenses or eyeglass frames.
Dental Services See details
Braven Medicare Choice (PPO) partially covers dental services, offering preventive care like cleanings and exams with no copay and no coinsurance, and Medicare-covered dental services with no copay and a 20% coinsurance. Comprehensive services like restorative, endodontics, periodontics, and oral surgery have no copay and 50% coinsurance up to a $1,000 annual maximum, but other diagnostic, other preventive, prosthodontics, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Braven Medicare Choice (PPO) covers home infusion bundled services with no copay, subject to prior authorization and step therapy. Covered Medicare Part B insulin drugs have a copay of $0 to $35 and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Braven Medicare Choice (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Braven Medicare Choice (PPO) partially covers medical equipment with no copays, featuring a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies, and no coinsurance to 20% coinsurance for diabetic supplies. Diabetic therapeutic shoes and inserts are not covered, and prior authorization is required for covered equipment.
Diagnostic and Radiological Services See details
Braven Medicare Choice (PPO) covers diagnostic and radiological services with prior authorization, though lab services are not covered. Diagnostic tests and procedures have no coinsurance and range from no copay to a $60 copay, while radiological services feature no copay for diagnostic radiology, a $30 copay for X-rays, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Braven Medicare Choice (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under the Braven Medicare Choice (PPO) plan. Although some services are covered, specific programs such as cardiac, intensive cardiac, and pulmonary rehabilitation (each requiring a $15 copay), along with SET for PAD services (requiring a $20 copay), are not covered.
Skilled Nursing Facility (SNF) See details
Braven Medicare Choice (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization is required and a prior three-day hospital stay is not. There is no copay for days 1 through 20, and a $218 copayment for days 21 through 100, with no coverage for additional days beyond the standard Medicare limit.
Other Services See details
Braven Medicare Choice (PPO) covers acupuncture and chronic illness meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items are partially covered up to $50 every three months via reimbursement with no copay or coinsurance, while Nicotine Replacement Therapy and Naloxone are not covered.
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