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Braven Medicare Freedom (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Braven Medicare Freedom (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Braven Medicare Freedom (PPO) in 2026, please refer to our full plan details page.
Braven Medicare Freedom (PPO) is a PPO plan offered by Horizon Mutual Holdings, Inc available for enrollment in 2025 to people living in West and South New Jersey. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Braven Medicare Freedom (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 Freedom (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 Freedom (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $40.00. 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:
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Drug Coverage
The Braven Medicare Freedom (PPO) prescription drug plan features an annual drug deductible of $250. You can benefit from no copay on Tier 1 preferred generic drugs and Tier 6 select care drugs across standard pharmacies and mail-order services. Tier 2 generic drugs are also highly affordable, with copays starting at $4 for a one-month supply through preferred mail order and $8 at standard pharmacies. For higher-tier medications, Tier 3 preferred brand drugs require a $47 copay for a one-month supply at standard pharmacies and mail-order options. Tier 4 non-preferred drugs have a 39% coinsurance, and Tier 5 specialty drugs carry a 30% coinsurance for a one-month supply at standard pharmacies. These structured copays and coinsurance rates provide clear, predictable costs for your prescription needs under this Medicare Advantage plan.
Additional Benefits
The Braven Medicare Freedom (PPO) plan offers robust medical coverage with no copay and no coinsurance for primary care, telehealth, and preventive services, while specialist visits require a $20 copay. Emergency care is covered with a $115 copay, which is waived if admitted, and urgent care has a $40 copay. For hospital stays, inpatient care requires a $425 daily copay for the first five days and no copay thereafter, while outpatient hospital services carry a $375 copay. This plan also includes valuable supplemental benefits, featuring preventive dental and routine vision exams with no copay, along with up to a $250 annual allowance for eyewear. Hearing exams have a $20 copay, and prescription hearing aids are available with copays ranging from $299 to $1,199. Additionally, members benefit from no copay for the first 20 days of skilled nursing facility care and a $70 quarterly over-the-counter allowance with no copay or coinsurance.
Inpatient Hospital See details
Braven Medicare Freedom (PPO) covers inpatient hospital services with no coinsurance, requiring a $425 daily copay for days 1-5 of acute stays (no copay for days 6 and beyond) and a $416 daily copay for days 1-5 of psychiatric stays (no copay for days 6-90). Prior authorization is required, and certain services such as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Braven Medicare Freedom (PPO) covers outpatient services with no coinsurance, including outpatient hospital and observation services for a $375 copay and ambulatory surgical center services for a $275 copay. Outpatient substance abuse individual and group sessions are covered with a $20 copay and no coinsurance, while outpatient blood services are available with no copay and no coinsurance.
Partial Hospitalization See details
Braven Medicare Freedom (PPO) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Braven Medicare Freedom (PPO) covers ground and air ambulance services with a $330 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered, providing unlimited one-way bus or subway rides to any health-related location with no copay and no coinsurance, while transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Braven Medicare Freedom (PPO) covers emergency services with a $115 copay and urgently needed services with a $40 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 benefit with no coinsurance and copays ranging from $115 to $330.
Primary Care See details
Braven Medicare Freedom (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits, mental health, psychiatric, and opioid treatment services require a $20 copay with no coinsurance. Physical, occupational, and speech therapy have a $25 copay with no coinsurance, but podiatry and routine chiropractic services are not covered.
Preventive Services See details
Braven Medicare Freedom (PPO) preventive services are partially covered with no copay and no coinsurance for annual physical exams, kidney disease education, and other screenings. While select additional benefits like nutritional counseling and fitness programs are included, services such as health education, in-home safety assessments, personal emergency response systems, and medical nutrition therapy are not covered.
Hearing Services See details
Braven Medicare Freedom (PPO) covers hearing services, including one annual routine hearing exam and one fitting evaluation for a $20 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $299 to $1,199 for up to two devices per year, while inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Braven Medicare Freedom (PPO), as other eye exam services are not covered under the plan. Routine eye exams are covered with a $0 to $20 copay and no coinsurance, while eyewear is covered with no copay, no coinsurance, and no deductible, up to a $250 annual maximum limit for contact lenses or eyeglass frames.
Dental Services See details
Braven Medicare Freedom (PPO) partially covers dental services, offering Medicare dental with no copay and 20% coinsurance, and preventive services like cleanings and exams with no copay and no coinsurance. Comprehensive services including restorative care, endodontics, periodontics, and oral surgery are covered with no copay and 50% coinsurance up to a $1,000 yearly limit, while other diagnostic or preventive services, prosthodontics, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Braven Medicare Freedom (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 and other Part B drugs require a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Dialysis services are covered under the Braven Medicare Freedom (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered by Braven Medicare Freedom (PPO) with no copays, requiring a 20% coinsurance for durable medical equipment, prosthetic devices, 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 partially covered by Braven Medicare Freedom (PPO), with lab services excluded from coverage. Covered diagnostic tests require prior authorization with no coinsurance and a copay ranging from no copay to $60, while radiological services require prior authorization and vary from no copay for diagnostic radiology to a 20% coinsurance for therapeutic radiology and a $25 copay for X-rays.
Home Health Services See details
Braven Medicare Freedom (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Braven Medicare Freedom (PPO) covers Cardiac Rehabilitation Services with no coinsurance, though only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $15 copay.
Skilled Nursing Facility (SNF) See details
Braven Medicare Freedom (PPO) covers Skilled Nursing Facility (SNF) care with no coinsurance and no mandatory three-day prior hospital stay, though prior authorization is required. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Braven Medicare Freedom (PPO) covers acupuncture, chronic illness meal benefits, and over-the-counter (OTC) items with no copay and no coinsurance. The OTC benefit provides up to $70 every three months via reimbursement, though nicotine replacement therapy and naloxone are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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