Horizon NJ TotalCare (HMO D-SNP)

Horizon NJ TotalCare (HMO D-SNP) is a HMO D-SNP plan offered by Horizon Mutual Holdings, Inc available for enrollment in 2025 to people living in New Jersey. This plan received an overall rating of 4 out of 5 stars in 2026.

It's important to know that Horizon NJ TotalCare (HMO D-SNP) 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 Horizon NJ TotalCare (HMO D-SNP).

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.

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:

Drug Coverage

The Horizon NJ TotalCare (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. Knowing this deductible amount is essential for estimating your yearly healthcare expenses with this plan. Specific drug coverage tier details, including individual copayments and coinsurance rates for different medication categories, are currently not available for this plan. To fully understand your potential out-of-pocket costs, it is recommended to review the plan's specific formulary to see how your personal prescriptions are covered.

Additional Benefits

The Horizon NJ TotalCare (HMO D-SNP) plan offers comprehensive medical coverage, typically requiring no copayments alongside a standard 20% coinsurance for most outpatient, specialist, emergency, and diagnostic services. For inpatient hospital stays, members are responsible for a $1,300 copay per stay with no coinsurance. Additionally, essential services like home health care and telehealth visits are fully covered with no copay and no coinsurance. While the plan covers Medicare-approved dental, vision, and diagnostic hearing services with no copay and 20% coinsurance, routine exams and wear for these categories are generally excluded. Members also benefit from a $315 monthly allowance for over-the-counter items and chronic illness meals with no copay or coinsurance. Many covered services, including outpatient care, medical equipment, and skilled nursing facility stays, require prior authorization before receiving care.