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Braven Medicare Choice Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Braven Medicare Choice Plus (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 Plus (PPO) in 2025, please refer to our full plan details page.
Braven Medicare Choice Plus (PPO) is a PPO plan offered by Horizon Mutual Holdings, Inc available for enrollment in 2025 to people living in Essex, Hudson, Union. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Braven Medicare Choice Plus (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 Plus (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 Plus (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 $175.00 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 Plus (PPO)
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Drug Coverage
The Braven Medicare Choice Plus (PPO) plan has an enhanced alternative drug benefit. The plan has a $175 deductible. In the initial coverage phase, after the deductible, you'll pay varying copays depending on the drug tier and pharmacy. For example, you may pay a $10 copay for preferred generic drugs at a standard pharmacy, or a $100 copay for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Braven Medicare Choice Plus (PPO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services, and ambulance services. It also covers primary care visits with no copay, and offers hearing, vision, and dental services with varying copays and coinsurance. This plan provides additional benefits like home health services, and over-the-counter items.
Inpatient Hospital See details
The Braven Medicare Choice Plus (PPO) plan covers inpatient hospital stays, including services not usually covered by Medicare, with a copay of $380 for days 1-5 and no copay for days 6-90. Additional days for inpatient hospital-acute have no copay, while non-Medicare-covered stays and upgrades for inpatient hospital-acute are not covered. Inpatient hospital psychiatric stays have a copay of $385 for days 1-5 and no copay for days 6-90, and additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, with a $360 copay for outpatient hospital services and observation services, and a $275 copay for Ambulatory Surgical Center (ASC) services. Outpatient Substance Abuse Services are covered, with a $20 copay for both individual and group sessions, and Outpatient Blood Services are covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Braven Medicare Choice Plus (PPO) plan, but requires prior authorization. You will pay a $60 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Braven Medicare Choice Plus (PPO) plan. Ground and air ambulance services have a $250 copay, with no coinsurance. Transportation Services to any health-related location are covered, including bus/subway transportation.
Emergency Services See details
Emergency Services are covered, with a $110 copay, and no coinsurance. Urgently Needed Services are covered, with a $30 copay, and no coinsurance. Worldwide Emergency Services are covered, including Worldwide Emergency Coverage and Worldwide Urgent Coverage with a $110 copay and Worldwide Emergency Transportation with a $250 copay; all have no coinsurance, with a maximum plan benefit coverage of $100,000.
Primary Care See details
The Braven Medicare Choice Plus (PPO) plan covers primary care physician services with no copay, and chiropractic services with a $15 copay. Occupational therapy services have a copay between $15 and $35, and physician specialist services have a $20 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $20 copay for individual and group sessions, and other health care professionals have a copay between $0 and $20. Physical therapy and speech-language pathology services have a copay between $15 and $35. Additional telehealth benefits are also covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services with no copay, annual physical exams, additional preventive services, kidney disease education services, and other preventive services. Some preventive services are not covered, including Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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, Telemonitoring Services, and Counseling Services. The plan also covers weight management programs, nutritional/dietary benefits, in-home support services, fitness benefits up to $350 per year, remote access technologies, and home and bathroom safety devices.
Hearing Services See details
Hearing services are covered, including hearing exams with a $20 copay. Routine hearing exams and fitting/evaluation for hearing aids are covered once per year. Prescription hearing aids (all types) are covered with a copay between $299 and $1199, and are covered twice per year, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a copay of $0-$20, and for eyewear with a maximum plan benefit coverage amount. Contact Lenses and Eyeglass Frames have a maximum plan benefit coverage amount of $250 every year, while Eyeglasses (lenses and frames), Eyeglass lenses, and Eyeglass frames are limited to 1 pair every year.
Dental Services See details
Dental Services include a 20% coinsurance for Medicare dental services. Other dental services include oral exams (3 per year), dental x-rays (bitewing x-rays covered once every 6 months, and full mouth x-rays covered once every 3 years), prophylaxis (cleaning) (3 per year), fluoride treatments (2 per 6 months), restorative services with a 50% coinsurance, adjunctive general services with a 50% coinsurance, endodontics with a 50% coinsurance, periodontics with a 50% coinsurance, and oral and maxillofacial surgery with a 50% coinsurance. Orthodontic Services are covered up to a maximum of $1000 per year. Prosthodontics, maxillofacial prosthetics, implant services, and prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Braven Medicare Choice Plus (PPO) plan and require prior authorization. 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 by the Braven Medicare Choice Plus (PPO) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance; however, Durable Medical Equipment for use outside the home and Diabetic Therapeutic Shoes/Inserts are not covered. Diabetic Supplies are covered with 0-20% coinsurance.
Diagnostic and Radiological Services See details
The Braven Medicare Choice Plus (PPO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a copay between $0 and $50. Outpatient X-ray services have no copay, and therapeutic radiological services have a 20% coinsurance. Lab services are not covered.
Home Health Services See details
Home Health Services are covered by the Braven Medicare Choice Plus (PPO) plan with no copay or coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the plan does not cover any of the sub-services, so in practice, this benefit is not covered. There is a copay for some services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Braven Medicare Choice Plus (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered SNF stays, and non-Medicare-covered stays, are not covered.
Other Services See details
The Braven Medicare Choice Plus (PPO) plan covers acupuncture and a meal benefit for chronic illnesses, with no copay or coinsurance. This plan also offers over-the-counter items with a maximum benefit of $80 every three months, but does not cover nicotine replacement therapy or Naloxone. However, this 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, and Self-Directed Personal Assistance Services.
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