Senior Market Product Overview

Medicare Advantage

For 2015, Horizon Blue Cross Blue Shield of New Jersey is offering a new patient-centered Medicare Advantage (MA) plan, Horizon Medicare Blue Patient-Centered w/Rx (HMO), for Medicare-eligible individuals. This plan uses a subset of health care professionals who participate in the Horizon Managed Care Network. There is lower member cost sharing to encourage members to preselect and use Primary Care Physicians (PCPs) affiliated with one of our patient-centered programs, including Patient-Centered Medical Homes (PCMHs) And Accountable Care Organizations (ACOs).

Horizon Medicare Blue Patient-Centered w/Rx (HMO) will be offered throughout New Jersey (excluding Burlington County) in four distinct services areas, Regions 1, 2, 3 and 4. Plan benefits are the same across Regions 2, 3 and 4. There are some benefit differences for the Horizon Medicare Blue Patient-Centered w/Rx (HMO) plan offered in Region 1. Regions 2, 3 and 4 offer Horizon Medicare Blue Patient-Centered w/Rx (HMO) at competitive monthly premiums. Region 1 offers a $0 premium Horizon Medicare Blue Patient-Centered w/Rx (HMO) plan. Members must reside in the counties shown to enroll in the respective product.

New Medicare Advantage Individual Products for 2015 New Jersey County Service Areas
Horizon Medicare Blue Patient-Centered w/Rx (HMO) Region 1: Essex, Hudson, Ocean, Salem, Warren
Horizon Medicare Blue Patient-Centered w/Rx (HMO) Region 2: Middlesex, Morris, Sussex, Union
Horizon Medicare Blue Patient-Centered w/Rx (HMO) Region 3: Bergen, Cape May, Mercer, Monmouth, Passaic, Somerset
Horizon Medicare Blue Patient-Centered w/Rx (HMO) Region 4: Atlantic, Camden, Cumberland, Gloucester, Hunterdon

Horizon BCBSNJ is renewing the following MA products for Medicare-eligible individuals. Members must reside in the counties shown to enroll in the respective product. Members will have access to Horizon BCBSNJ’s statewide Horizon Managed Care Network. There are no changes to the service areas, which were established for the 2014 plan year.

Medicare Advantage Individual Products New Jersey County Service Areas
Horizon Medicare Blue Value (HMO) Cape May, Essex, Hudson, Ocean, Salem, Union, Warren
Horizon Medicare Blue Value w/Rx (HMO) Cape May, Essex, Hudson, Ocean, Salem, Union, Warren.
Horizon Medicare Blue Choice w/Rx (HMO) Atlantic, Bergen, Burlington, Camden, Cumberland, Gloucester, Hunterdon, Mercer, Middlesex, Monmouth, Morris, Passaic, Somerset, Sussex
Horizon Medicare Blue (PPO) Sussex

Horizon Medicare Blue Access Group (HMO-POS) plans with and without prescription drug coverage are available to employer groups in New Jersey. Horizon BCBSNJ offers base group HMO-POS plans, and benefit riders are available for purchase to customize the plans for employer groups. Cost sharing and premiums will vary depending on the riders selected.

Medicare Advantage Group Products Service Area
Horizon Medicare Blue Access Group (HMO-POS) New Jersey
Horizon Medicare Blue Access Group w/Rx (HMO-POS) New Jersey

Our Horizon Medicare Blue Group (PPO) and Horizon Medicare Blue Group w/Rx (PPO) plans are available to employer groups to purchase to cover members in New Jersey and nationwide. These plans offer in- and out-of-network benefits. Horizon BCBSNJ offers a base group PPO plan, and benefit riders are available for purchase to customize the plan for employer groups. Cost sharing and premiums will vary depending on the riders selected.

Medicare Advantage Group Products Service Area
Horizon Medicare Blue Group (PPO) National
Horizon Medicare Blue Group w/Rx (PPO) National

Please note: Horizon Medicare Blue TotalCare (HMO SNP) is not offered in 2015.

Medigap

The following are Horizon BCBSNJ’s 2015 Medigap supplemental product offerings available in New Jersey. There are no changes from the prior year. Members can also enroll in a stand-alone Prescription Drug Plan (PDP) when choosing a Medigap product, if they want to have Part D prescription drug coverage.

Medigap Products
Horizon Contemporary Medigap Plan A Horizon Contemporary Medigap Plan K
Horizon Contemporary Medigap Plan G Horizon Contemporary Medigap Plan F
Horizon Contemporary Medigap Plan C Horizon Contemporary Medigap Plan N

Prescription Drug Plans

The following are Horizon BCBSNJ’s 2015 stand-alone PDP offerings. Members must reside in New Jersey to enroll in these products.

PDP Products Service Area
Horizon Medicare Blue Rx Standard (PDP) New Jersey
Horizon Medicare Blue Rx Enhanced (PDP) New Jersey

For 2015, Horizon BCBSNJ is introducing preferred cost sharing on its Horizon Medicare Blue Rx Standard (PDP) plan. Preferred cost sharing is a reduced out-of-pocket cost of at least $5 on each drug tier at select retail pharmacy chains. Standard cost sharing will apply at all other in-network pharmacies. Preferred cost sharing will be available at the following retail pharmacy chains:

  • CVS
  • Good Neighbor
  • Walgreens
  • Epic
  • Rite Aid

If Horizon BCBSNJ members or other New Jersey Medicare beneficiaries have questions or need help selecting a product, they may call 1-888-765-7142 or visit our website at Medicare.HorizonBlue.com.