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Comparison


STEP 1.
Choose your Medicare Advantage health plan...


  Horizon Medicare Blue Value (MA)
Our HMO Plan		 Horizon Medicare Blue Access (MA)
Our POS Plan
  In Network In Network Out of Network
Choice of health care specialists Must use network health care specialists Must use network health care specialists Your choice
Annual deductible $0
$10,000 maximum (out-of-pocket limit)		 $0
No out-of-pocket limit		 $900
$6,200 maximum (out-of-pocket limit)
Hospital coverage $150 copay per day for days 1-10.
$1,500 out-of-pocket limit every stay		 $75 copay per day for days 1-10.
$750 out-of-pocket limit every stay		 65% coverage
Outpatient hospital services/surgery $35 - $125 copay $35 - $125 copay 65% coverage
Doctor office visits $15 PCP copay, $35 specialist copay $15 PCP copay, $35 specialist copay 65% coverage
Emergency care (worldwide) 100% coverage after $50 copay; copay waived if admitted within 24 hours 100% coverage after $50 copay;
copay waived if admitted within 24 hours		 100% coverage after $50 copay;
copay waived if admitted within 24 hours
Skilled nursing facility $0 copay days 1-15;
$85 copay days 16-30;
$110 copay days 31-100		 $0 copay days 1-5
$50 copay days 6-20;
$100 copay days 21-100		 65% coverage
Home health care $35 copay $35 copay 65% coverage
Diagnostic tests, X-rays and lab services $0 - $1251 copay, depending on the services $0 - $1251 copay, depending on the services 65% coverage
Durable medical equipment 80% coverage 80% coverage 65% coverage
Routine physical exams $15 copay for one routine exam per year $15 copay for one routine exam per year 65% coverage
Immunizations (Flu, Pneumonia and Hepatitis B Vaccine - for those with Medicare who are at risk) $0 copay for Flu and Pneumonia Vaccine;
$15 copay for Hepatitis B Vaccine		 $0 copay for Flu and Pneumonia Vaccine;
$15 copay for Hepatitis B Vaccine		 65% coverage
Routine vision services $15 - $35 copay for annual routine eye exam;
$100 reimbursement for eyewear every two years		 $15 - $35 copay for annual routine eye exam;
$100 reimbursement for eyewear every two years		 65% coverage
Dental services $0 copay for one oral exam, one cleaning every six months and one dental X-ray every three years $0 copay for one oral exam, one cleaning every six months and one dental X-ray every three years Not covered
Hearing services2 $15 - $35 copay for annual routine hearing exam;
$750 hearing aid allowance every three years		 $15 - $35 copay for annual routine hearing exam;
$750 hearing aid allowance every three years		 65% coverage
Premium $0 health plan premium to pay and
a $38 reduction on your Medicare Part B premium3		 $26.303

Please note: This is only a partial listing of benefits. For a complete listing of plan benefits, please see the Summary of Benefits.

1 All lab services must be performed by LabCorp or AtlantiCare.
2 Must use a HEARx facility or participating audiologists in counties where there are no HEARx facilities for in-network benefits.
3 You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicare or by another third party.


STEP 2:
Choose your Medicare Advantage with prescription drug plan.

Even if you don't take many prescription drugs now, your needs could change down the road. That's why Horizon Healthcare of New Jersey, Inc. offers you the choice of six Medicare Advantage with prescription drug plans.


Rx Standard (Part of a Horizon MA-PD)

Deductible $295
Annual drug costs up to $2,700 Generic Preferred Brand Brand Specialty
$7 copayment $36 copayment $72 copayment 25% coinsurance
After annual drug costs reach $2,700 (up to a total of $4,350 out-of-pocket drug costs) You pay 100% for one-month supply
After annual drug costs exceed $4,350 You pay the greater of a $2.40 copayment for generic (including brand drugs treated as generic) and $6.00 copayment for all other drugs or 5% coinsurance.
Premium when you choose Horizon Medicare Blue Value with Rx Standard coverage $0**
Premium when you choose Horizon Medicare Blue Access with Rx Standard coverage $65.30**


Rx Enhanced (Part of a Horizon MA-PD)

Deductible $0
Annual drug costs up to $2,700 Generic Preferred Brand Brand Specialty
$4 copayment $36 copayment $72 copayment 33% coinsurance
After annual drug costs reach $2,700 (up to a total of $4,350 out-of-pocket drug costs) $4 copayment for generics for one-month supply.
You pay 100% for all other prescriptions
After annual drug costs exceed $4,350 You pay the greater of a $2.40 copayment for generic (including brand drugs treated as generics) and $6.00 copayment for all other drugs or 5% coinsurance.
Premium when you choose Horizon Medicare Blue Value with Rx Enhanced coverage $30.50**
Premium when you choose Horizon Medicare Blue Access with Rx Enhanced coverage $95.60**


Rx Plus (Part of a Horizon MA-PD)

Deductible $0
Annual drug costs up to $2,700 Generic Preferred Brand Brand Specialty
$0 copayment $36 copayment $72 copayment 33% coinsurance
After annual drug costs reach $2,700 (up to a total of $4,350 out-of-pocket drug costs) $0 copayment for generics for one-month supply.
You pay 100% for all other prescriptions
After annual drug costs exceed $4,350 You pay the greater of a $2.40 copayment for generic (including brand drugs treated as generic) and $6.00 copayment for all other drugs or 5% coinsurance.
Premium when you choose Horizon Medicare Blue Value with Rx Plus coverage $37.50**
Premium when you choose Horizon Medicare Blue Access with Rx Plus coverage $102.70**

**You must continue to pay your Medicare Part B premium if not otherwise paid for by Medicaid or by another third party.
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Last Updated: December 22, 2008