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2018 Medicare Advantage Plan Participation

Horizon Blue Cross Blue Shield of New Jersey is adding a new plan offering to our Medicare Advantage (MA) portfolio for the 2018 benefit year.

As previously announced, our new Horizon Medicare Blue Advantage (HMO) plan offering will use a subset of physicians and other health care professionals that participate in the Horizon Managed Care Network, as well as a subset of facilities in the Horizon Hospital Network.

Provider participation status in our new Horizon Medicare Blue Advantage (HMO) plan DOES NOT affect provider participation in other Horizon BCBSNJ MA plans.

As noted in the table below, Medicare-eligible beneficiaries enrolled in most of our 2018 MA plan offerings have in-network access to all Horizon Managed Care Network participating physicians and other health care professionals and all Horizon Hospital Network facilities.

Members enrolled in …

Have in-network access to …

  • Horizon Medicare Blue Value (HMO)
  • Horizon Medicare Blue Value with Rx (HMO)
  • Horizon Medicare Blue Choice w/Rx (HMO)
  • Horizon Medicare Blue Access Group (HMO-POS)
  • Horizon Medicare Blue Access Group w/Rx(HMO-POS)
  • Horizon Medicare Blue (PPO)
  • Horizon Medicare Blue Group (PPO)
  • Horizon Medicare Advantage NJ DIRECT10 (PPO)
  • Horizon Medicare Advantage NJ DIRECT15 (PPO)
  • ALL physicians and other health care professionals that participate in our Horizon Managed Care Network
  • ALL facilities in the Horizon Hospital Network
  • Horizon Medicare Blue Advantage (HMO)
    New for 2018
  • A subset of physicians and other health care professionals that participate in the Horizon Managed Care Network
  • A subset of facilities in the Horizon Hospital Network

If you have questions, please contact your Network Specialist or Network Hospital Specialist.


About Horizon Medicare Blue Advantage (HMO)

The new Horizon Medicare Blue Advantage (HMO) plan allows us to offer Medicare-eligible beneficiaries with access to high-quality health care and lower out-of-pocket costs for the low premiums ($0 plan premium in some counties) that these members have been seeking.

Beneficiaries who enroll in our new Horizon Medicare Blue Advantage (HMO) plan for coverage that will begin January 1, 2018:

  • Do not have out-of-network benefits, except in the case of an emergency. Any physicians, hospitals or other health care professionals not participating in the Horizon Medicare Blue Advantage (HMO) plan are considered out of network.
  • Are required to select a Primary Care Physician (PCP) that participates in the Horizon Medicare Blue Advantage (HMO) plan.
  • Do not require referrals for specialist services.

In what NJ counties is Horizon Medicare Blue Advantage (HMO) offered?

The Horizon Medicare Blue Advantage (HMO) plan is offered to Medicare-eligible beneficiaries that reside in Atlantic, Bergen, Cumberland, Essex, Hudson, Hunterdon, Mercer, Middlesex, Monmouth, Morris, Ocean, Somerset, Sussex, Union and Warren counties.

The Horizon Medicare Blue Advantage (HMO) plan will not be offered to Medicare-eligible beneficiaries that reside in Burlington, Camden, Cape May, Gloucester, Passaic and Salem counties. However, the beneficiaries who reside in these counties will continue to have access to other Horizon BCBSNJ MA plan options.

Where can I see who participates in the Horizon Medicare Blue Advantage (HMO) plan?

The participation status of hospitals, and physicians and other health care professionals in the Horizon Medicare Blue Advantage (HMO) plan may be viewed in our Doctor & Hospital Finder.

More information?

Registered NaviNet® users may review the Horizon Medicare Blue Advantage (HMO) Plan Frequently Asked Questions for more information. To access this information, log on to NaviNet.net, select Horizon BCBSNJ from the My Health Plans menu, and:

  • Mouse over References and Resources and select Provider Reference Materials.
  • Mouse over Products & Programs and select Products.
  • Select Horizon Medicare Blue Advantage (HMO).
Published on: December 5, 2017, 09:56 a.m. ET
Last updated on: December 6, 2017, 02:09 a.m. ET