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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 2026, 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 4 out of 5 stars in 2026.
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 $225.00 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 Plus (PPO)
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Drug Coverage
The Braven Medicare Choice Plus (PPO) plan features an annual prescription drug deductible of $225. Under this plan, members enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs at standard pharmacies and through mail order. Tier 2 generic medications are also highly affordable, costing $10 for a one-month supply at standard pharmacies or just $5 through preferred mail order. For Tier 3 preferred brand drugs, the plan features a consistent $47 copay for a one-month supply. Higher-tier medications are subject to coinsurance, with Tier 4 non-preferred drugs requiring a 45% coinsurance and Tier 5 specialty drugs requiring a 30% coinsurance for a one-month supply at standard pharmacies.
Additional Benefits
The Braven Medicare Choice Plus (PPO) plan offers affordable coverage with no copay and no coinsurance for primary care, preventive services, and home health care. For inpatient hospital stays, members pay a $450 daily copay for the first five days, followed by no copay for unlimited additional days. Outpatient hospital services require a $375 copay, while emergency room visits have a $115 copay that is waived upon hospital admission. Specialist visits and mental health services carry a $25 copay, while routine vision exams and preventive dental care are covered with no copay. Comprehensive dental services are covered up to a $1,000 annual maximum with no copay and 50% coinsurance, and hearing aids require a copay ranging from $299 to $1,199. Members also benefit from a $50 quarterly over-the-counter reimbursement and unlimited acupuncture with no copay and no coinsurance.
Inpatient Hospital See details
Braven Medicare Choice Plus (PPO) covers inpatient acute hospital stays with no coinsurance and a $450 copay per day for days 1 through 5, followed by no copay for unlimited additional days. Inpatient psychiatric stays are also covered with no coinsurance and a $416 copay per day for days 1 through 5, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Braven Medicare Choice Plus (PPO) covers outpatient hospital and observation services with a $375 copay and no coinsurance, and ambulatory surgical center services with a $275 copay and no coinsurance. Outpatient substance abuse sessions carry a $25 copay and no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Braven Medicare Choice Plus (PPO) covers partial hospitalization services with a $60.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Braven Medicare Choice Plus (PPO) covers ground and air ambulance services with a $305 copay and no coinsurance, subject to prior authorization. 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
Emergency services are covered by Braven Medicare Choice Plus (PPO) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, while urgently needed services require a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 lifetime maximum with no coinsurance and copays ranging from $115 to $305.
Primary Care See details
Braven Medicare Choice Plus (PPO) provides primary care and telehealth services with no copay and no coinsurance, while specialist, therapy, and mental health services require a $25 copay and no coinsurance. Chiropractic care is partially covered with a $15 copay and no coinsurance, but podiatry services are not covered.
Preventive Services See details
Braven Medicare Choice Plus (PPO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. 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, additional smoking cessation counseling, enhanced disease management, telemonitoring, and counseling services.
Hearing Services See details
Hearing services are partially covered by Braven Medicare Choice Plus (PPO), featuring a $25 copay and no coinsurance for annual routine exams and fitting evaluations, and a $299 to $1,199 copay with no coinsurance for up to two prescription hearing aids per year. OTC hearing aids and specific prescription styles—including inner ear, outer ear, and over the ear—are not covered.
Vision Services See details
Braven Medicare Choice Plus (PPO) offers partially covered vision services, which exclude other eye exam services. Covered routine eye exams have a $0 to $25 copay and no coinsurance, while eyeglasses and contact lenses have no copay, no coinsurance, and a $250 yearly maximum benefit.
Dental Services See details
Braven Medicare Choice Plus (PPO) covers Medicare dental services with no copay and 20% coinsurance, and preventive services like exams, cleanings, and x-rays with no copay and no coinsurance. Comprehensive dental services are partially covered up to a $1,000 annual maximum with no copay and 50% coinsurance, but other diagnostic or preventive services, prosthodontics, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Braven Medicare Choice Plus (PPO) with no copay, though prior authorization is required. Part B insulin drugs carry a copay of $0 to $35 and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Braven Medicare Choice Plus (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Braven Medicare Choice Plus (PPO) partially covers medical equipment with no copay, requiring a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies, and no coinsurance to 20% coinsurance for diabetic supplies. Prior authorization is required for these services, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Braven Medicare Choice Plus (PPO) with prior authorization, though lab services are not covered. Diagnostic tests require no coinsurance and copays ranging from no copay to $60, while radiological services range from no copay for diagnostic radiology, a $25 copay with coinsurance for X-rays, to a copay and minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by the Braven Medicare Choice Plus (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Braven Medicare Choice Plus (PPO) with no coinsurance, though only some services are covered. Standard cardiac, intensive cardiac, and pulmonary rehabilitation services are not covered and require a $15 copay, while SET for PAD services are not covered and require a $20 copay.
Skilled Nursing Facility (SNF) See details
Braven Medicare Choice Plus (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and a three-day inpatient hospital stay is not required before admission, though additional days beyond the standard Medicare limit are not covered.
Other Services See details
Braven Medicare Choice Plus (PPO) covers other services with no copay and no coinsurance, including unlimited acupuncture, chronic illness meal benefits, and a $50 quarterly over-the-counter (OTC) reimbursement. This benefit is partially covered, as nicotine replacement therapy, naloxone, and other additional services are not covered.
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