2022 Horizon Medicare Blue Access (PPO)

Horizon Medicare Blue Access (PPO) H7971-003 is a 2022 Medicare Advantage Plan or Part-C by Horizon Blue Cross Blue Shield of New Jersey available to residents in New Jersey. This plan includes additional prescription drug (Part-D) coverage. The Horizon Medicare Blue Access (PPO) has a monthly premium of $36.00 and has an in-network maximum out-of-pocket limit of $6,700 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $6,700 out-of-pocket. This can be a extremely nice safety net.

Horizon Medicare Blue Access (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.

Horizon Blue Cross Blue Shield of New Jersey works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Horizon Medicare Blue Access (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Horizon Blue Cross Blue Shield of New Jersey 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 Horizon Blue Cross Blue Shield of New Jersey except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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2022 Horizon Blue Cross Blue Shield of New Jersey Medicare Advantage Plan Costs

Horizon Medicare Blue Access (PPO) Part-C Premium

Horizon Blue Cross Blue Shield of New Jersey charges a $2.70 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.

H7971-003 Part-D Deductible and Premium

Horizon Medicare Blue Access (PPO) has a monthly drug premium of $15.80 and a $250.00 drug deductible. This Horizon Blue Cross Blue Shield of New Jersey plan offers a $15.80 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 $17.50 this Premium covers any enhanced plan benefits offered by Horizon Blue Cross Blue Shield of New Jersey 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 $33.30 . 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.

Horizon Blue Cross Blue Shield of New Jersey 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 Horizon Blue Cross Blue Shield of New Jersey 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 Horizon Medicare Blue Access (PPO) medicare insurance offers a $17.50 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $21.40 for 75% low income subsidy $25.40 for 50% and $29.30 for 25%.

H7971-003 Formulary or Drug Coverage

Horizon Medicare Blue Access (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 Horizon Medicare Blue Access (PPO) H7971-003 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	NA	$0
Tier 2	NA	$10
Tier 3	NA	$40
Tier 4	NA	40%
Tier 5	NA	28%

*Initial Coverage Phase and 30 day supply

2021 Horizon Medicare Blue Access (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	Not covered
Endodontics	Not covered
Extractions	Not covered
Non-routine services	Not covered
Periodontics	Not covered
Prosthodontics, other oral/maxillofacial surgery, other services	Not covered
Restorative services	$0 copay (Out-of-Network)
Restorative services	$0 copay

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Deductible

$900 annual deductible

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	$0-40 copay or 0-20% coinsurance
Diagnostic radiology services (e.g., MRI)	35% coinsurance (Out-of-Network)
Diagnostic tests and procedures	$0-40 copay or 0-20% coinsurance
Diagnostic tests and procedures	35% coinsurance (Out-of-Network)
Lab services	$0 copay or 20% coinsurance
Lab services	35% coinsurance (Out-of-Network)
Outpatient x-rays	35% coinsurance (Out-of-Network)
Outpatient x-rays	$40 copay or 20% coinsurance

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Doctor Visits

Primary	$5 copay per visit
Primary	35% coinsurance per visit (Out-of-Network)
Specialist	$40 copay per visit
Specialist	35% coinsurance per visit (Out-of-Network)

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$25-40 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	35% coinsurance (Out-of-Network)
Foot exams and treatment	$40 copay
Routine foot care	Not covered

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Ground Ambulance

35% coinsurance (Out-of-Network)
$250 copay

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Hearing

Fitting/evaluation	35% coinsurance (Out-of-Network)
Fitting/evaluation	$0 copay
Hearing aids	$0 copay (Out-of-Network)
Hearing aids	$0 copay
Hearing exam	$40 copay
Hearing exam	35% coinsurance (Out-of-Network)

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Inpatient Hospital Coverage

35% per stay (Out-of-Network)
$295 per day for days 1 through 6 $0 per day for days 7 through 90 $0 per day for days 91 and beyond

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Medical Equipment/Supplies

Diabetes supplies	35% coinsurance per item (Out-of-Network)
Diabetes supplies	$0 copay
Durable medical equipment (e.g., wheelchairs, oxygen)	35% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	35% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item

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Medicare Part B Drugs

Chemotherapy	35% coinsurance (Out-of-Network)
Chemotherapy	20% coinsurance
Other Part B drugs	35% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance

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Mental Health Services

Inpatient hospital - psychiatric	35% per stay (Out-of-Network)
Inpatient hospital - psychiatric	$295 per day for days 1 through 6 $0 per day for days 7 through 90
Outpatient group therapy visit	35% coinsurance (Out-of-Network)
Outpatient group therapy visit	$40 copay
Outpatient group therapy visit with a psychiatrist	$40 copay
Outpatient group therapy visit with a psychiatrist	35% coinsurance (Out-of-Network)
Outpatient individual therapy visit	35% coinsurance (Out-of-Network)
Outpatient individual therapy visit	$40 copay
Outpatient individual therapy visit with a psychiatrist	35% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$40 copay

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MOOP

$10,000 In and Out-of-network $6,700 In-network $6,200 Out-of-network

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Option

No

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

35% coinsurance per visit (Out-of-Network)
20% coinsurance per visit

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Preventive Care

35% coinsurance (Out-of-Network)
$0 copay

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Preventive Dental

Cleaning	$0 copay
Cleaning	$0 copay (Out-of-Network)
Dental x-ray(s)	$0 copay (Out-of-Network)
Dental x-ray(s)	$0 copay
Fluoride treatment	Not covered
Oral exam	$0 copay (Out-of-Network)
Oral exam	$0 copay

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Rehabilitation Services

Occupational therapy visit	$40 copay
Occupational therapy visit	35% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	$40 copay
Physical therapy and speech and language therapy visit	35% coinsurance (Out-of-Network)

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Skilled Nursing Facility

35% per stay (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 (Out-of-Network)
Contact lenses	$0 copay
Eyeglass frames	$0 copay
Eyeglass frames	$0 copay (Out-of-Network)
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	35% coinsurance (Out-of-Network)
Routine eye exam	$0 copay
Upgrades	Not covered

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Wellness Programs (e.g. fitness nursing hotline)

Covered

Ready to Enroll?

Click Here

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

Coverage Area for Horizon Medicare Blue Access (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.