2022 Braven Medicare Freedom (PPO)

Braven Medicare Freedom (PPO) H0885-002 is a 2022 Medicare Advantage Plan or Part-C by Braven Health available to residents in New Jersey. This plan includes additional prescription drug (Part-D) coverage. The Braven Medicare Freedom (PPO) has a monthly premium of $35.00 and has an in-network maximum out-of-pocket limit of $6,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $6,500 out-of-pocket. This can be a extremely nice safety net.

Braven Medicare Freedom (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Braven Health works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Braven Medicare Freedom (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Braven Health and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Braven Health except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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2022 Braven Health Medicare Advantage Plan Costs

Braven Medicare Freedom (PPO) Part-C Premium

Braven Health charges a $20.60 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

H0885-002 Part-D Deductible and Premium

Braven Medicare Freedom (PPO) has a monthly drug premium of $14.40 and a $100.00 drug deductible. This Braven Health plan offers a $14.40 Part-D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Braven Health above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $14.40 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

Braven Health Gap Coverage

In 2022 once you and your plan provider have spent $4430 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Braven Health plan does not offer additional coverage through the gap.

Premium Assistance

The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Braven Medicare Freedom (PPO) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $3.60 for 75% low income subsidy $7.20 for 50% and $10.80 for 25%.

H0885-002 Formulary or Drug Coverage

Braven Medicare Freedom (PPO) formulary is divided into Tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price. You can see complete 2022 Braven Medicare Freedom (PPO) H0885-002 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	NA	$0
Tier 2	NA	$10
Tier 3	NA	$47
Tier 4	NA	$100
Tier 5	NA	30%
Tier 6	NA	$0

*Initial Coverage Phase and 30 day supply

2021 Braven Medicare Freedom (PPO) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

No

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Comprehensive Dental

Diagnostic services	50% coinsurance
Diagnostic services	50% coinsurance (Out-of-Network)
Endodontics	50% coinsurance
Endodontics	50% coinsurance (Out-of-Network)
Extractions	50% coinsurance
Extractions	50% coinsurance (Out-of-Network)
Non-routine services	50% coinsurance (Out-of-Network)
Non-routine services	50% coinsurance
Periodontics	50% coinsurance
Periodontics	50% coinsurance (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	Not covered
Restorative services	50% coinsurance (Out-of-Network)
Restorative services	50% coinsurance

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	30% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI)	$0-150 copay
Diagnostic tests and procedures	$0-90 copay
Diagnostic tests and procedures	30% coinsurance (Out-of-Network)
Lab services	30% coinsurance (Out-of-Network)
Lab services	$0-30 copay
Outpatient x-rays	$25 copay
Outpatient x-rays	30% coinsurance (Out-of-Network)

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Doctor Visits

Primary	$0 copay
Primary	30% coinsurance per visit (Out-of-Network)
Specialist	30% coinsurance per visit (Out-of-Network)
Specialist	$20 copay per visit

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$40 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	$20 copay
Foot exams and treatment	30% coinsurance (Out-of-Network)
Routine foot care	Not covered

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Ground Ambulance

$225 copay or 30% coinsurance (Out-of-Network)
$225 copay

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Hearing

Fitting/evaluation	$0 copay
Fitting/evaluation	30% coinsurance (Out-of-Network)
Hearing aids	$0 copay (Out-of-Network)
Hearing aids	$0 copay
Hearing exam	$20 copay
Hearing exam	30% coinsurance (Out-of-Network)

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Inpatient Hospital Coverage

$300 per day for days 1 through 5 $0 per day for days 6 through 90 $0 per day for days 91 and beyond
30% per day for days 1 and beyond (Out-of-Network)

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Medical Equipment/Supplies

Diabetes supplies	30% coinsurance per item (Out-of-Network)
Diabetes supplies	$0 copay
Durable medical equipment (e.g., wheelchairs, oxygen)	30% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	30% coinsurance per item (Out-of-Network)

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Medicare Part B Drugs

Chemotherapy	20% coinsurance
Chemotherapy	30% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance
Other Part B drugs	30% coinsurance (Out-of-Network)

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Mental Health Services

Inpatient hospital - psychiatric	30% per day for days 1 through 90 (Out-of-Network)
Inpatient hospital - psychiatric	$300 per day for days 1 through 5 $0 per day for days 6 through 90
Outpatient group therapy visit	$40 copay
Outpatient group therapy visit	30% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$40 copay
Outpatient group therapy visit with a psychiatrist	30% coinsurance (Out-of-Network)
Outpatient individual therapy visit	$40 copay
Outpatient individual therapy visit	30% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit with a psychiatrist	30% coinsurance (Out-of-Network)

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MOOP

$9,500 In and Out-of-network $6,500 In-network

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Option

No

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

$275 copay per visit
30% coinsurance per visit (Out-of-Network)

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Preventive Care

$0 copay
30% coinsurance (Out-of-Network)

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Preventive Dental

Cleaning	$0 copay (Out-of-Network)
Cleaning	$0 copay
Dental x-ray(s)	$0 copay (Out-of-Network)
Dental x-ray(s)	$0 copay
Fluoride treatment	$0 copay (Out-of-Network)
Fluoride treatment	$0 copay
Oral exam	$0 copay (Out-of-Network)
Oral exam	$0 copay

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Rehabilitation Services

Occupational therapy visit	30% coinsurance (Out-of-Network)
Occupational therapy visit	$20 copay
Physical therapy and speech and language therapy visit	30% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	$20 copay

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Skilled Nursing Facility

30% per day for days 1 through 100 (Out-of-Network)
$0 per day for days 1 through 20 $178 per day for days 21 through 100

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Transportation

Not covered

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Vision

Contact lenses	$0 copay
Contact lenses	$0 copay (Out-of-Network)
Eyeglass frames	$0 copay (Out-of-Network)
Eyeglass frames	$0 copay
Eyeglass lenses	$0 copay (Out-of-Network)
Eyeglass lenses	$0 copay
Eyeglasses (frames and lenses)	$0 copay
Eyeglasses (frames and lenses)	$0 copay (Out-of-Network)
Other	Not covered
Routine eye exam	$0 copay
Routine eye exam	30% coinsurance (Out-of-Network)
Upgrades	Not covered

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Wellness Programs (e.g. fitness nursing hotline)

Covered

Ready to Enroll?

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1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for Braven Medicare Freedom (PPO)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.