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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 Atlantic & Cape May. 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. Beneficiaries enjoy 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 drugs, copays start at just $5 for a one-month supply via preferred mail order or $10 at standard pharmacies. Tier 3 preferred brand drugs carry a $47 copay for a one-month supply through both standard pharmacies and mail-order options. For higher-tier prescriptions, you will pay a 40% coinsurance for Tier 4 non-preferred drugs and a 30% coinsurance for Tier 5 specialty drugs. This straightforward pricing structure helps you clearly plan your prescription medication expenses.
Additional Benefits
The Braven Medicare Choice (PPO) plan provides strong coverage for core medical needs, featuring no copays or coinsurance for primary care visits, telehealth, preventive care, and home health services. Specialist visits, mental health sessions, and routine eye or hearing exams are available with affordable copays of up to $25. For inpatient hospital stays, members pay daily copays for the first five days with no coinsurance, while emergency room services require a $115 copay that is waived upon admission. In addition to medical care, the plan offers dental, vision, and hearing benefits, including preventive dental cleanings with no copay and a $200 annual allowance for eyewear. Other essential services like durable medical equipment, dialysis, and comprehensive dental care are covered with no copay and coinsurance ranging from 20% to 50%. Members also benefit from unlimited acupuncture, a meal program, and a $55 quarterly over-the-counter allowance with no copay or coinsurance.
Inpatient Hospital See details
Braven Medicare Choice (PPO) covers inpatient hospital services with no coinsurance, requiring a $450 daily copay for days 1 through 5 of acute stays and a $416 daily copay for days 1 through 5 of psychiatric stays, with no copay for subsequent days. The benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Braven Medicare Choice (PPO) with no coinsurance for all services, though copays and prior authorizations vary. You will pay a $345 copay for outpatient hospital and observation services, a $260 copay for ambulatory surgical center services, a $25 copay for outpatient substance abuse sessions, and no copay or deductible for outpatient blood services.
Partial Hospitalization See details
Braven Medicare Choice (PPO) covers partial hospitalization benefits with a $60 copay and no coinsurance. Prior authorization is required to receive 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 per trip. 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 Choice (PPO) covers emergency services with a $115 copay and urgently needed services with a $35 copay, both featuring no coinsurance and waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent care, and emergency transportation are also covered with no coinsurance and copays of $115, $115, and $345 respectively, up to a $100,000 maximum benefit. These cost shares do not count toward any plan-level deductible.
Primary Care See details
Braven Medicare Choice (PPO) offers primary care physician services and telehealth benefits with no copay and no coinsurance, while specialist visits, mental health, and psychiatric services require a $25 copay and no coinsurance. Physical, speech, and occupational therapies have a $30 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Braven Medicare Choice (PPO) offers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and glaucoma screenings. 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, wigs, alternative therapies, therapeutic massage, adult day health, home-based palliative care, caregiver support, smoking cessation, disease management, telemonitoring, and counseling.
Hearing Services See details
Hearing services are partially covered by Braven Medicare Choice (PPO), which offers one routine hearing exam and fitting evaluation per year for a $25 copay and no coinsurance. Up to two prescription hearing aids are covered annually with no coinsurance and a copay ranging from $299.00 to $1199.00, though OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Braven Medicare Choice (PPO) with no deductibles or coinsurance, though other eye exam services are not covered. Routine eye exams are covered once yearly with a $0 to $25 copay, and eyewear is covered with no copay and no coinsurance up to a $200 annual limit for frames or contact lenses.
Dental Services See details
Braven Medicare Choice (PPO) offers partially covered dental services, including preventive care like cleanings and exams with no copay and no coinsurance, and Medicare-covered dental with no copay and a 20% coinsurance. Comprehensive services like restorative and endodontics have no copay and a 50% coinsurance up to a $1,000 annual limit, though implants, orthodontics, prosthodontics, other diagnostic, and other preventive services are not covered.
Home Infusion bundled Services See details
Braven Medicare Choice (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 require 0% to 20% coinsurance and no copay.
Dialysis Services See details
Dialysis services are covered under the Braven Medicare Choice (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Braven Medicare Choice (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, requiring prior authorization. Diabetic equipment is partially covered with no copay and 0% to 20% coinsurance for diabetic supplies, though diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Braven Medicare Choice (PPO) covers diagnostic procedures and tests with no coinsurance and copays from $0 to $60, though lab services are not covered. Diagnostic radiological services have no copay or coinsurance, while outpatient X-rays require a $20 copay plus coinsurance, and therapeutic radiology requires a copay and at least 20% coinsurance.
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
Cardiac Rehabilitation Services are offered by Braven Medicare Choice (PPO) with no coinsurance, but in practice only some services are covered. Standard cardiac rehabilitation (with a $10 copay), intensive cardiac rehabilitation (with a $10 copay), pulmonary rehabilitation (with a $15 copay), and supervised exercise therapy for peripheral artery disease (with 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, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Braven Medicare Choice (PPO) covers other services with no copays and no coinsurance, including unlimited acupuncture, a chronic illness meal benefit, and a $55 quarterly over-the-counter (OTC) reimbursement allowance. The OTC benefit is partially covered, as nicotine replacement therapy and naloxone are not covered.
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