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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 Atlantic & Cape May. 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. Additionally, this plan comes with a Part B Premium reduction of $0.20. You must continue to pay paying your reduced 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 is met, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For instance, generic drugs have copays ranging from $5 to $47 depending on the pharmacy, while preferred brand drugs have a $100 copay. 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 with varying costs. Inpatient hospital stays have copays, while outpatient services have copays for specific services like hospital visits and substance abuse treatment. Emergency services and transportation are covered with copays, and primary care visits have copays depending on the type of service. Preventive services, hearing, vision, and dental services are included, with copays or coinsurance depending on the service. Home health and skilled nursing facility services are covered, and the plan also includes benefits such as acupuncture, OTC items, and a meal benefit for chronic illness.
Inpatient Hospital See details
The Braven Medicare Choice (PPO) plan covers inpatient hospital stays, including acute and psychiatric care. For inpatient hospital-acute, you pay a $370 copay for days 1-5, and no copay for days 6-90, with additional days (91-999) having no copay. Inpatient hospital psychiatric care has a $385 copay for days 1-5, and no copay for days 6-60. Non-Medicare-covered stays, upgrades, and additional days for psychiatric care are not covered.
Outpatient Services See details
Outpatient Services are covered by the Braven Medicare Choice (PPO) plan, including all outpatient hospital services, with a $340 copay for outpatient hospital and observation services, a $250 copay for Ambulatory Surgical Center (ASC) services, and a $20 copay for both individual and group sessions for outpatient substance abuse. Outpatient blood services are also covered, 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. This benefit has 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 have a $250 copay, and there is no coinsurance. Transportation Services to any health-related location are covered, with no copay, no coinsurance, and no limit on the number of trips.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Braven Medicare Choice (PPO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $25 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $110 copay, while Worldwide Emergency Transportation has a $250 copay. Worldwide Emergency Services has a maximum plan benefit coverage of $100,000.
Primary Care See details
Braven Medicare Choice (PPO) covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic services have a $15 copay, Physician Specialist Services have a $20 copay, and Physical Therapy and Speech-Language Pathology Services have a $20-$30 copay. Individual and Group Sessions for Mental Health and Psychiatric Services have a $20-$20 copay, while other health care professionals have a $0-$20 copay, and Opioid Treatment Program Services have a $20-$20 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Braven Medicare Choice (PPO) plan covers preventive services, including Medicare-covered preventive services and annual physical exams. Additional services like weight management programs, nutritional/dietary benefits, in-home support services, fitness benefits, remote access technologies, and home and bathroom safety devices are also covered. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, support for caregivers, additional smoking cessation counseling, enhanced disease management, telemonitoring services, and counseling services are not covered.
Hearing Services See details
Hearing services with the Braven Medicare Choice (PPO) plan include hearing exams with a $20 copay, and prescription hearing aids with a copay between $299 and $1199, depending on the type. Fitting/Evaluation for Hearing Aid is also covered, and Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, 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-$20, and eyewear. Eyewear includes contact lenses with a maximum plan benefit coverage of $200 every year, eyeglasses (lenses and frames) with one pair every year, eyeglass lenses with one pair every year, eyeglass frames with a maximum plan benefit coverage of $200 every year, and upgrades.
Dental Services See details
Braven Medicare Choice (PPO) covers dental services with 20% coinsurance for Medicare dental services, and other dental services are covered with no maximum plan benefit coverage. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered, and restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery are covered with 50% coinsurance. Orthodontic services are covered up to a maximum of $1000 per year, and 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, 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 under the Braven Medicare Choice (PPO) plan. You will pay a coinsurance between 20% and 20% for covered services.
Medical Equipment See details
Medical Equipment benefits are covered by the Braven Medicare Choice (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Prosthetics and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 0-20% coinsurance; Durable Medical Equipment for use outside the home and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Braven Medicare Choice (PPO) plan, including diagnostic procedures/tests with a copay between $0 and $50, lab services with no copay, and outpatient X-ray services with no copay. Diagnostic Radiological Services have a copay of at most $200, and Therapeutic Radiological Services have a coinsurance of at least 20%.
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. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered by the Braven Medicare Choice (PPO) plan, but the specific services are not covered. There is a copay for some 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 it has no limits on the number of treatments. The plan also covers Over-the-Counter (OTC) items with a maximum benefit of $75.00 every three months, and it covers a meal benefit for chronic illness. However, the plan does not cover 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), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services.
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