Meet the New Jersey’s health care leaders that are bringing a whole new approach to Medicare
Introducing Braven Health
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Welcome! We are very excited to share information with you about our 2021 Braven Health Medicare Advantage Plans!
During this presentation, we will discuss exactly what is Braven Health? We will review your Health Care Options as a Medicare beneficiary. We will take a deeper dive into our 2021 Braven Health Medicare Advantage Plans. And I will share with you some extra savings and advantages available with our Braven Health Medicare Advantage plans.
So what is Braven Health?
Braven Health is a NJ Medicare plan built in partnership by two of NJ’s top health care leaders:
Horizon Blue Cross Blue Shield of New Jersey, which brings nearly 90 years of experience working to clear a path for members to get the care they need; and Hackensack Meridian Health, New Jersey’s largest, most comprehensive health system, which is included in our fast growing network. Now it’s very important to understand that as a Braven Health member you are in no way limited to using only Hackensack Meridian Health providers; on the contrary, our partnership with Hackensack Meridian Health simply means that you will have the opportunity to see not only Horizon BCBSNJ providers, but Hackensack Meridian Health providers included in our network as well — which allows you the broadest possible network access.
Our Medicare Advantage plans are your gateway to the Braven Health experience, including:
Before we get into the specifics of our Braven Health Medicare Advantage plans, let’s take a moment to discuss the options available to you for your health care as a Medicare Beneficiary.
Before you enroll into any plan it’s good to understand the Parts of Medicare. Now you may already be a Medicare beneficiary with a pretty good understanding of how it all works. Or perhaps Medicare is newer to you. Either way, a quick review is always a good idea. There are basically 4 parts to Medicare: Part A, which is your hospital coverage; Part B, which is your Medical coverage; Part D which covers your prescription drugs; and Part C, which is Medicare Advantage.
So Medicare Part C, or Medicare Advantage, actually combines your Part A Hospital coverage, your Part B Medical coverage, and your Part D Prescription Drug coverage conveniently into one plan called a Medicare Advantage Prescription Drug plan.
Now you may have had prescription drug coverage under an employer plan for example, which probably worked a little differently than Medicare Part D Prescription Drug coverage works. So let’s take a moment to look at exactly how the prescription drug portion of your Medicare Advantage plan works.
There are different drug stages for your Part D prescription drug coverage. Each stage determines the cost of your medications.
Stage 1 is your Deductible Stage. If your plan has a deductible, you would pay the full discounted cost of your medication up to the deductible amount.
Once your deductible has been satisfied, you would move into the Initial Coverage stage. During this stage, you will pay a small amount toward the cost of your medications in the form of copays or coinsurance until you reach the initial coverage limit.
You would then enter what is called the Coverage Gap, also known as the donut hole. During this stage, your out-of-pocket costs may be higher for certain medications.
Once your out of pocket limit is reached, you will move into the Catastrophic Coverage stage. At this point your plan will pay most of the cost of your medications.
Now that we have a better understanding of how Medicare Advantage combines your Hospital, Medical and Prescription Drug coverage, and how the prescription portion of your Medicare Advantage plan works, let’s take a closer look at our 2021 Braven Health Medicare Advantage plans.
There are three Medicare Advantage plan options for 2021:
Our PPO plans include in-network access to the Blue Medicare Advantage PPO network outside of NJ in 43 states — as well as flexible out-of-network benefits either within or outside of NJ.
As previously mentioned, all of our Medicare Advantage plans provide access to an extensive network of high-quality doctors, specialists, and hospitals near you that includes — but does not limit you to — the entire Hackensack Meridian Health system as well.
Our choice of Medicare Advantage plans include:
Now there are certain eligibility requirements to qualify for a Braven Health Medicare Advantage plan. You must have Medicare Part A and Part B. And you must reside in the service area for the Braven Health Medicare Advantage Plan you wish to enroll in.
So let’s begin by discussing our Braven Medicare Choice PPO and Braven Medicare Freedom PPO plans. The service area for both of these plans includes the following counties:
Now keep in mind that the service area only references the county you must live in in order to be eligible for your selected Braven Health plan, in this case the Braven Medicare Choice or Braven Medicare Freedom PPO. However the doctors and/or health care professionals that you will have access to are not limited only to the county you live in. You will have in-network access to providers and hospitals across the entire state of NJ, and outside of NJ as well. And you will also have the option of out of network coverage at a higher cost share.
Now that you know where the plans are actually offered, let’s explore our network in greater detail.
In NJ, our large PPO network includes:
So what does this mean? Let’s say you travel on vacation to Florida, which happens to be one of the 43 states that participates in our national Medicare Advantage PPO network. If you were to see a provider who participates in Florida’s Medicare Advantage PPO network, your claims would be paid in-network, the same as if you had seen a participating provider in NJ. So our Medicare Advantage PPO Visitor Traveler Program essentially gives you in-network access to over 613,000 providers and 4,100 hospitals outside of NJ, in addition to our extensive network in NJ.
Now, let’s take a closer look at our Braven Medicare Choice (PPO). This plan includes:
Now here are the Medical benefit details for our Braven Medicare Choice (PPO) plan.
You will notice 2 columns indicating in network cost share and out of network cost share. Note that for most benefits, if there is an out of network cost share, it is a flat co-pay.
So you’ll see $0 dollar monthly premium; $0 medical deductible; which means that you go right into benefits; your PCP in network visit is $0, your specialist visit is $20 in network, out of network, $10 for your PCP, $30 for your specialist. Your annual physical exam, your Telehealth, your routine vision, hearing and dental are all $0 in network. Vision and hearing $30 out of network. Emergency copay $90 whether in or out of network. Your inpatient maximum out of pocket per admission is $1600. And your overall plan maximum out of pocket is $6700 in network, $10,000 out of network.
Now here are the prescription details for our Braven Medicare Choice (PPO) plan. Remember you will need to satisfy your deductible first before benefits will begin. For this plan, the prescription deductible is $150 and is only applicable for Tiers 3, 4 and 5, which are the preferred brand, non-preferred drug and specialty tiers. So if your prescription falls under Tiers 1 or 2, preferred generic or generic, you would pay no deductible and go right into your initial coverage benefits. Note that for a Tier 1 preferred generic drug the cost sharing would be $0 whether you fill your prescription at a pharmacy or via mail order. Also note that Tiers go from the least to most expensive medications, with Tier 5 specialty being the most expensive. So you will see that the cost sharing, in turn, increases as the Tiers go up.
Next, let’s take a closer look at our Braven Medicare Freedom (PPO). Now this plan includes:
Now here are the medical benefit details for our Braven Medicare Freedom (PPO) plan.
Again you will notice 2 columns indicating in network cost share, and out of network cost share. Note that for many benefits, if there is an out of network cost share, it will usually be 30% coinsurance.
$35 monthly premium, no medical deductible which again brings you right into your benefits. $0 for your PCP visit in network; $20 for your specialist visit; out of network 30%. Your annual physical, your routine vison and hearing, your dental as well as your telehealth, $0 in network; your vision and hearing 30% out. Your maximum out of pocket for your hospital stay is $1500 per admission in network, 30% coinsurance out of network. Maximum out of pocket for the plan, $6500 in network, $9500 out of network. And of course your emergency care copay is $90 whether in or out of network, and that is worldwide.
Now here are the prescription details for our Braven Medicare Freedom (PPO) plan. For this plan, the deductible is $100 and again is only applicable for Tiers 3, 4 and 5, which are the preferred brand, non-preferred drug and specialty tiers. So once again if your prescription falls under Tiers 1 or 2, preferred generic or generic, you would pay no deductible and go right into your initial coverage benefits. Note that for a Tier 1 preferred generic drug the cost sharing is also $0 whether you fill your prescription at a pharmacy or via mail order. And again you will see that cost sharing increases as the Tiers go up.
Finally, let’s take a closer look at our Braven Medicare Plus (HMO). The service area for this plan includes the following counties:
Note that Passaic County is not included for Braven Medicare Plus (HMO). Also recall as I explained earlier that the service area only references the county you must live in in order to be eligible for your selected Braven Health plan, in this case, the Braven Medicare Plus HMO. Now while you must use physicians, health care professionals and facilities that participate in the Braven Medicare Plus HMO plan, these providers are not limited only to the county you live in. With this plan you will have access to in-network providers and hospitals across the entire state of NJ.
Our Braven Medicare Plus (HMO) plan includes:
Here are the medical benefit details for our Braven Medicare Plus (HMO) plan. Notice there is only one column, indicating in network benefits only, with plenty of benefits at $0 cost share.
Monthly premium $0; no medical deductible, bringing you right into benefits; your PCP visit is $0, specialist visit is $20, your physical, your Telehealth, your vision, dental, hearing all $0. Worldwide emergency $90; your inpatient maximum out of pocket is $1625 per admission. Flat $195 for ambulatory surgical center; your maximum out of pocket for this plan is $6500.
Here are the prescription details for our Braven Health Medicare Plus (HMO) plan. Note that for this plan there is no prescription deductible, which means that you would go right into your initial coverage benefits no matter what tier your medications fall into. Note again $0 cost sharing for preferred generic drugs whether filling your prescription at the pharmacy or via mail order. And similar to our PPO plans, the higher the tier, the higher the cost of the medication, which means the higher your cost share.
Now let’s elaborate a bit more on some of those great additional benefits that are included in our 3 Braven Health Medicare Advantage plans.
The Annual Physical Exam is $0 copay in-network on all plans and includes:
Our routine Dental benefit includes:
And also note that on our PPO Products, out-of-network dental coverage is available at the same cost share as in-network, however you will receive the best value by utilizing a participating dental provider.You can find a list of all participating providers right on this Braven Health website by clicking the ‘Find A Doctor’ tab on the home page.
Now you heard me mention Comprehensive dental coverage a few times when describing our plans. So exactly what is that? Well in addition to routine dental coverage, the comprehensive dental benefit includes 50% coverage up to an $800 maximum amount annually for services like restorative, endodontics, periodontics, and simple extractions. Again, you would get the most value by utilizing a participating dental provider for these services.
The Annual Flex Benefit includes reimbursement of up to $200 annually for:
And you could receive up to $200 toward any of these single items or a combination of any or all of these items.
Our Hearing Benefits include:
For Braven Medicare Plus (HMO) the routine hearing exam & hearing aid services must be coordinated through HearUSA.
Our Vision Benefits include:
Now are you ready to hear about even more extra savings and advantages to keep you healthy? I’m excited to tell you!
So what is this OTC Benefit card all about? Our Braven Health plans feature the over the counter (also known as OTC) Benefit Card. Every three months, you will receive at least $70 in credits towards the purchase of various personal health items such as denture cream, first aid kits, walking canes and a lot more, from participating retailers like:
Once you’re enrolled you can see a full list of participating retailers by visiting OTCnetwork.com
You will also receive reimbursement of up to $200 a year towards any gym and/or yoga studio membership of your choosing.
Now our meal plan offers you more ways to get the care you need right from home. So following an inpatient hospital discharge to your home, you may be eligible to receive up to 28 nutritious meals delivered right to your home over a 14 day period — that’s 2 meals a day — to help you recover from your illness. Meals must be coordinated by your care manager and they must be consistent with the established treatment plan for your illness.
You’ve also heard me mention Telehealth a few times during this presentation. So this benefit gives you 24/7 access to online doctor and therapist visits using your phone, tablet or computer — all for a $0 copay with Braven Health’s care online program.
In addition, our 24 Hour Nurse Line gives you access to caring, registered nurses who have an average of 15 years of clinical experience for immediate answers to your health questions anytime, from anywhere — 24 hours a day.
Pillpack, an Amazon company, allows you to get your prescriptions, your over-the-counter medications and your vitamins packaged according to your doctor’s instruction, into individual packets by the times of day you take them. So no more fiddling around with pill boxes — it’s all done for you. There is no additional cost to sign up and shipping is free.
AllianceRx Walgreens Prime allows you to get up to a 90-day supply delivered right to you, anywhere in the United States. Again, shipping is always free.
Now, if you would like to learn more about whether a Braven Health Medicare Advantage plan is right for you, please call us at 1-833-713-1313. Our licensed representatives are available Monday thru Friday from 8a.m. to 6p.m. and would be more than happy to speak with you and answer any questions you might have.
Thank you so much for watching our presentation. We look forward to speaking with you soon!
Braven Health is New Jersey born and raised. We know New Jersey health care, and we’ll be your guide to everything our top health systems have to offer. We’re looking out for New Jersey families, finding ways to get better care to more people and improve the overall health of our great state.