Horizon Medicare Blue (PPO)

Medicare Advantage Plan for New Jersey

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHorizon Blue Cross Blue Shield of New Jersey
Plan IDH7971-1-0
CMS RatingNot Rated1
Plan TypePPO
Annual Deductible$405.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage

Plan Details

Costs and Other Important Information

Plan Year:
2018
Optional Supplemental Benefits
No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$10,000 In and Out-of-network $6,700 In-network $6,200 Out-of-network
Other health plan deductibles?
No
Health Plan Deductible
$900 annual deductible
Monthly Drug Plan Premium
$58.20
Monthly Health Plan Premium
$99.60

Benefits

Service
Cost
Inpatient hospital coverage
In-Network:
$150 for days 1 through 10
$0 for days 11 through 90
$0 for days 91 and beyond
Out-of-Network:
35% per stay
Outpatient hospital coverage
In-Network:
20% per visit
Out-of-Network:
35% per visit
Doctor visits
Primary:
In-Network:
$15 per visit
Out-of-Network:
35% per visit
Specialist:
In-Network:
$35 per visit
Out-of-Network:
35% per visit
Preventive care
In-Network:
$0 copay
Out-of-Network:
35%
Emergency care/Urgent care
Emergency:
$80 per visit (always covered)
Urgent care:
$25-35 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
In-Network:
$35 or 20%
Out-of-Network:
35%
Lab services:
In-Network:
$0 or 20%
Out-of-Network:
35%
Diagnostic radiology services (e.g., MRI):
In-Network:
$35 or 20%
Out-of-Network:
35%
Outpatient x-rays:
In-Network:
$35 or 20%
Out-of-Network:
35%
Mental health services
In-Network:
$150 for days 1 through 10
$0 for days 11 through 90
Out-of-Network:
35% per stay
Outpatient group therapy visit with a psychiatrist:
In-Network:
$35
Out-of-Network:
35%
Outpatient individual therapy visit with a psychiatrist:
In-Network:
$35
Out-of-Network:
35%
Outpatient group therapy visit:
In-Network:
$35
Out-of-Network:
35%
Outpatient individual therapy visit:
In-Network:
$35
Out-of-Network:
35%
Skilled Nursing Facility
In-Network:
$0 for days 1 through 20
$125 for days 21 through 100
Out-of-Network:
35% per stay
Rehabilitation services
Occupational therapy visit:
In-Network:
$35
Out-of-Network:
35%
Physical therapy and speech and language therapy visit:
In-Network:
$35
Out-of-Network:
35%
Ambulance
In-Network:
$250
Out-of-Network:
35%
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
In-Network:
$35
Out-of-Network:
35%
Routine foot care:
Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
In-Network:
20% per item
Out-of-Network:
35% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:
20% per item
Out-of-Network:
35% per item
Diabetes supplies:
In-Network:
$0 copay
Out-of-Network:
35% per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
In-Network:
20%
Out-of-Network:
35%
Other Part B drugs:
In-Network:
20%
Out-of-Network:
35%

Coverage Area for Horizon Medicare Blue (PPO)

StateNew Jersey
CountyOcean

Cost Sharing Information

All cost-sharing assumes in-network healthcare providers.

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offereds25% coinsuranceNot offered
Tier 2: Non-Preferred Generic
Tier 3: Preferred Brand Name
Tier 4: Non-Preferred Brand Name
Tier 5: Specialty Tier
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered25% coinsuranceNot offered
Tier 2: Non-Preferred Generic
Tier 3: Preferred Brand Name
Tier 4: Non-Preferred Brand Name
Tier 5: Specialty Tier

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Not Rated
Colorectal cancer screening
Not Rated
Annual flu vaccine
Not Rated
Improving or maintaining physical health
Not Rated
Improving or maintaining mental health
Not Rated
Monitoring physical ability
Not Rated
Adult BMI assessment
Not Rated

Managing Chronic Conditions

Special needs plan care management
Not Rated
Care for older adults – medication review
Not Rated
Care for older adults – functional status assessment
Not Rated
Care for older adults – Pain screening
Not Rated
Osteoporosis management in women who had a fracture
Not Rated
Diabetes care – eye exam
Not Rated
Diabetes care – kidney disease monitoring
Not Rated
Diabetes care – blood sugar controlled
Not Rated
Controlling blood pressure
Not Rated
Rheumatoid arthritis management
Not Rated
Reducing the risk of falling
Not Rated
Plan all-cause readmissions
Not Rated

Member Experience with Health Plan

Getting needed care
Not Rated
Getting appointments and care quickly
Not Rated
Customer service
Not Rated
Overall rating of health care quality
Not Rated
Overall rating of plan
Not Rated
Care Coordination
Not Rated

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Not Rated
Members choosing to leave the health plan
Not Rated
Beneficiary access and performance problems
Not Rated
Health plan quality improvement
Not Rated

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Not Rated
Call center – foreign language interpreter and TTY/TDD availability - Medical
Not Rated

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Not Rated
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Not Rated
Members choosing to leave the drug plan
Not Rated
Beneficiary access and performance problems
Not Rated
Drug plan quality improvement
Not Rated

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs
Not Rated

Drug Pricing and Patient Safety

MPF Price Accuracy
Not Rated
High risk medication
Not Rated
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate

Physician Finder

Physicians that accept Horizon Medicare Blue (PPO) for New Jersey

/
FOOT HEALTH CENTERS, P.A.
525 HIGHWAY 70
LAKEWOOD, NJ 08701
Details
FOOT HEALTH CENTERS, P.A.
Phone Number
(732) 367-8686
Office Locations
525 HIGHWAY 70
LAKEWOOD, NJ 08701
525 HIGHWAY 70 LAKEWOOD NJ, 08701

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