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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 Burlington, Camden, Cumberland, Gloucester, Salem. 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:
Sign up for Braven Medicare Choice (PPO)
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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 you use. For example, generic drugs have a $10 copay at a standard pharmacy, while preferred generic drugs have a $5 copay when using mail order. Specialty tier drugs have no copay. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Braven Medicare Choice (PPO) plan offers a range of benefits, including inpatient and outpatient hospital services with varying copays. You'll have no copay for many services, such as home health and preventive services, and outpatient blood services include a waived deductible. The plan also covers primary care, hearing, vision, and dental services, with copays or coinsurance depending on the specific service. Additional benefits include ambulance services, emergency services, and coverage for medical equipment and home infusion services.
Inpatient Hospital See details
Inpatient Hospital coverage under the Braven Medicare Choice (PPO) plan includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a copay of $390 for days 1-5, and no copay for days 6-90, while Additional Days for Inpatient Hospital-Acute have no copay for days 91-999. For Inpatient Hospital Psychiatric, you'll pay 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 and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a copay of $355.00, ambulatory surgical center services have a copay of $250.00, and individual and group outpatient substance abuse sessions have a copay between $25.00 and $25.00. Outpatient blood services include an enhanced benefit with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Braven Medicare Choice (PPO) plan, but requires prior authorization. For this benefit, you will have a $60 copay.
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, and Transportation Services to any health-related location are covered via bus or subway. Transportation to a plan-approved health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by 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; all of these 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-$35 copay, and physician specialist services with a $25 copay. Mental health specialty services and psychiatric services have a $25 copay for individual and group sessions, while physical therapy and speech-language pathology services have a $20-$35 copay. The plan also covers additional telehealth benefits and opioid treatment program services with a $25 copay. Podiatry services are not covered.
Preventive Services See details
The Braven Medicare Choice (PPO) plan covers preventive services, including an annual physical exam and other preventive services not usually covered by Medicare plans. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, and telemonitoring services.
Hearing Services See details
Hearing Services are covered by the Braven Medicare Choice (PPO) plan. The plan covers routine hearing exams with a $25 copay, as well as fitting/evaluation for hearing aids with no copay, limited to one visit per year. Prescription hearing aids (all types) are covered with a copay between $299 and $1199 for two visits per year, while inner ear, outer ear, and over-the-ear prescription hearing aids, and OTC 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 and eyewear such as eyeglasses, lenses, and frames. The plan also covers contact lenses, with a maximum benefit coverage of $200 per year.
Dental Services See details
Braven Medicare Choice (PPO) offers dental services with 20% coinsurance for Medicare dental services. Other dental services include oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, and oral and maxillofacial surgery, with 50% coinsurance for restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery. Orthodontic services have a maximum benefit of $1000 per year, and prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered under the Braven Medicare Choice (PPO) plan. Medicare Part B Insulin Drugs have a copay between $0 and $35, while 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 under the Braven Medicare Choice (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered by the Braven Medicare Choice (PPO) plan, including Durable Medical Equipment with 20% coinsurance and no copay, Prosthetic Devices with 20% coinsurance and no copay, and Medical Supplies with 20% coinsurance and no copay; however, Durable Medical Equipment for use outside the home, and Diabetic Therapeutic Shoes/Inserts are not covered. Diabetic Supplies have a coinsurance between 0% and 20%, with no copay.
Diagnostic and Radiological Services See details
The Braven Medicare Choice (PPO) plan covers diagnostic and radiological services, including diagnostic procedures and tests with a copay between $0 and $50, and lab services with no copay. The plan also covers diagnostic and therapeutic radiological services, with a maximum copay of $175 for diagnostic services and 20% coinsurance for therapeutic services, as well as outpatient X-ray services with no copay.
Home Health Services See details
Home Health Services are covered by the Braven Medicare Choice (PPO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Braven Medicare Choice (PPO) plan, but the specific services are not covered. There is a copay for the services, but the exact amount is not specified.
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 covers over-the-counter items with a maximum benefit of $75.00 every three months. The plan also covers a meal benefit for chronic illnesses. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more are not covered.
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