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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 Burlington, Cumberland, Gloucester, Salem. 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. This plan offers savings on select medications, featuring no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs across standard pharmacies and mail order options. For Tier 2 generic drugs, copays start as low as $5 for a one-month supply via preferred mail order, or $10 at standard pharmacies. Tier 3 preferred brands require a $47 copay for a one-month supply, while Tier 4 non-preferred drugs require 40% coinsurance and Tier 5 specialty drugs require 30% coinsurance for a one-month supply.
Additional Benefits
Braven Medicare Choice (PPO) offers comprehensive medical coverage featuring no copay and no coinsurance for primary care, telehealth, and preventive services, while specialist visits require a $30 copay. For hospital care, members pay a $450 daily copay for days one through five of an inpatient stay, with no coinsurance. Emergency care is covered with a $115 copay, which is waived if you are admitted to the hospital within 24 hours. The plan also provides excellent supplemental benefits, including preventive dental care with no copay and a $200 annual allowance for eyewear. Routine hearing exams require a $30 copay, and skilled nursing facility care is available with no copay for the first 20 days. Additionally, members can take advantage of home health services with no copay and a $55 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Braven Medicare Choice (PPO) covers inpatient acute hospital stays with no coinsurance and a $450 copay per day for days 1 to 5, and inpatient psychiatric stays with no coinsurance and a $416 copay per day for days 1 to 5. There is no copay for remaining covered days, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Braven Medicare Choice (PPO) covers outpatient services with no coinsurance, featuring a $370 copay for outpatient hospital and observation services, and a $270 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $30 copay with no coinsurance, while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Braven Medicare Choice (PPO) with a $60 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Braven Medicare Choice (PPO) covers ambulance services with a $295 copay and no coinsurance for ground and air trips. Transportation services are partially covered, offering unlimited one-way bus or subway rides to any health-related location with no copay or coinsurance, while plan-approved health-related location transportation is not covered.
Emergency Services See details
Braven Medicare Choice (PPO) covers emergency services with a $115 copay and urgently needed services with a $30 copay, both featuring no coinsurance and waived copays if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum limit, with copays ranging from $115 to $295 and no coinsurance.
Primary Care See details
Braven Medicare Choice (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits, therapy services, and mental health sessions require a $30 copay and no coinsurance. Some chiropractic services are covered with a $15 copay and no coinsurance, but routine and other chiropractic services are not covered, and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Braven Medicare Choice (PPO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive services are partially covered with no copay and no coinsurance, but do not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, or therapeutic massage.
Hearing Services See details
Braven Medicare Choice (PPO) covers annual routine hearing exams with a $30 copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $299.00 to $1199.00 and no coinsurance, but inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Braven Medicare Choice (PPO) offers partially covered vision services, as other eye exam services are not covered under the plan. Routine eye exams are covered with a $0 to $30 copay and no coinsurance, while eyewear is covered with no copay, no coinsurance, and a $200 annual maximum benefit for contact lenses or eyeglass frames.
Dental Services See details
Dental services are partially covered by Braven Medicare Choice (PPO), with no copay and no coinsurance for preventive care like exams, cleanings, x-rays, and fluoride. Medicare-covered dental services require no copay and 20% coinsurance, while covered comprehensive services have no copay and 50% coinsurance up to a $1,000 annual limit. Other diagnostic and preventive services, 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 and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B insulin drugs have a copay of $0.00 to $35.00 and no coinsurance, while chemotherapy and other Part B drugs require no copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by Braven Medicare Choice (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Braven Medicare Choice (PPO) partially covers medical equipment with no copays, though prior authorization is required. Covered durable medical equipment, prosthetics, and medical supplies carry a 20% coinsurance, and diabetic supplies range from no coinsurance to 20% coinsurance, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Braven Medicare Choice (PPO), as lab services are not covered and prior authorization is required for all other services. Diagnostic procedures and tests require no coinsurance and a copay of $0 to $50, while radiological services range from no copay or coinsurance for diagnostic radiology, to a $20 copay with coinsurance for X-rays, and a 20% coinsurance with a copay for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Braven Medicare Choice (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Braven Medicare Choice (PPO) covers Cardiac Rehabilitation Services with no coinsurance. You will pay a $15 copay for cardiac, intensive cardiac, and pulmonary rehabilitation services, and a $20 copay for supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Braven Medicare Choice (PPO) covers Skilled Nursing Facility (SNF) care with no coinsurance, featuring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Braven Medicare Choice (PPO) partially covers other services with no copay and no coinsurance, including acupuncture, chronic illness meal benefits, and over-the-counter (OTC) items. While OTC items are covered up to $55 every three months via reimbursement, nicotine replacement therapy and naloxone are not covered.
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