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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 Mercer, Hunterdon. 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. For example, in the initial coverage phase, you may pay a $10 copay for a preferred generic at a standard pharmacy. For specialty drugs, there is no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, and you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Braven Medicare Choice (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays for different services. Emergency services and ambulance services are covered with copays, and primary care, preventive, hearing, vision, and dental services are also included, some with copays and some with no copay. Additional benefits include home health services with no copay, and coverage for medical equipment with coinsurance. The plan also covers skilled nursing facility stays with a copay. Other services such as acupuncture and an over-the-counter items benefit are available, and some services require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $380 per day for days 1-5, and no copay for days 6-90 for Inpatient Hospital-Acute; Inpatient Hospital Psychiatric has a copay of $385 per day for days 1-5, and no copay for days 6-60. Additional days for Inpatient Hospital-Acute have no copay, while Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute, and Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a $360 copay, observation services with a $360 copay, ambulatory surgical center services with a $275 copay, and outpatient substance abuse services with a $25 copay for individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered with a $60 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Braven Medicare Choice (PPO) plan. Both ground and air ambulance services have a $250 copay, with no coinsurance. Transportation services to any health-related location are covered, including bus and subway, with no copay or coinsurance.
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 have a $30 copay, and Worldwide Emergency Transportation has a $250 copay; all services have no coinsurance.
Primary Care See details
The Braven Medicare Choice (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $20-$30 copay, physician specialist services with a $25 copay, and mental health specialty services with a $25 copay for individual and group sessions. The plan also covers physical therapy and speech-language pathology services with a $20-$30 copay, and opioid treatment program services with a $30 copay. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Braven Medicare Choice (PPO) plan covers various preventive services, including annual physical exams, with no copay. Additional services, such as fitness benefits, are covered up to $300 per year. Some preventive services, including health education, in-home safety assessments, and counseling services, are not covered.
Hearing Services See details
Hearing services are covered, including routine hearing exams with a $25 copay. Prescription hearing aids are covered, but inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
The Braven Medicare Choice (PPO) plan covers vision services, including eye exams with a copay of $0-$25. The plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Contact lenses are covered up to $200 per year, and eyeglasses (frames) are covered up to $200 per year.
Dental Services See details
The Braven Medicare Choice (PPO) plan covers dental services with 20% coinsurance for Medicare Dental Services. Other Dental Services include oral exams (3 visits per year), dental x-rays (bitewing x-rays covered once every 6 months, full mouth x-rays covered once every 3 years), prophylaxis (cleaning) (3 visits per year), fluoride treatment (2 visits every 6 months), with no copay. Restorative, Adjunctive General, Endodontics, Periodontics, and Oral and Maxillofacial Surgery services are covered with 50% coinsurance. Orthodontic services are covered up to a maximum of $1000 per year. 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 by Braven Medicare Choice (PPO), including Medicare Part B Insulin Drugs with a copay between $0 and $35, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%. Prior authorization is required.
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 by Braven Medicare Choice (PPO), including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires prior authorization, while Prosthetic Devices and Medical Supplies also have a 20% coinsurance. Diabetic Supplies have no coinsurance, while Diabetic Therapeutic Shoes/Inserts and DME for use outside the home are not covered.
Diagnostic and Radiological Services See details
The Braven Medicare Choice (PPO) plan covers Diagnostic and Radiological Services, including Diagnostic Procedures/Tests with a copay between $0 and $50, and Diagnostic Radiological Services with a copay up to $175. Therapeutic Radiological Services have a 20% coinsurance, while Outpatient X-Ray Services have no copay. Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the Braven Medicare Choice (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Braven Medicare Choice (PPO) covers Cardiac Rehabilitation Services, however, the plan does not cover the services in practice. There is a copay for some Cardiac and Pulmonary Rehabilitation Services, but the specific cost is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by 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.
Other Services See details
The Braven Medicare Choice (PPO) plan covers acupuncture with no copay and no coinsurance, and also provides an Over-the-Counter (OTC) Items benefit with a maximum of $70 every three months. This plan also offers a meal benefit for chronic illnesses. Other services such as Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and others are not covered.
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