Horizon Medicare

New Jersey’s Horizon Blue Cross Blue Shield (BCBSNJ) has had history since 1932, when the First Hospital Service Plan was formed as the Associated Hospitals of Essex County, Inc. as a prepayment plan utilized by many area hospitals. This would later become the country’s inaugural Blue Cross Plan. They provide those in New Jersey with various healthcare plans. They are currently serving over 3.6 million members. Some of their plan types consist of: Horizon HMO, Horizon Point of Service, Horizon Preferred Provider Organization, Horizon Direct Access Open Access, Horizon Medical Savings Account, and other, more traditional indemnity plans

Horizon offers the choice of two affordable prescription drug plans. They have worked with their network of retail pharmacies to be able to provide addition discounts on your prescriptions.

Horizon’s Medicare Blue Rx Standard plan has coverage that starts after you reach the $295 deductible. One characteristic of this policy is the low $7 copay for generic prescriptions. Our list of preferred medications has a copay of $37 and brand drugs that we do not prefer have a copay of $74. When your final yearly prescription medications add up to more than $2,700, you are responsible for paying 100% of the costs at Horizon’s special negotiated rate until you reach the maximum limit for out of pocket expenses of $4,350. After you’ve reached the out of pocket maximum, you will only pay $2.40 for every generic prescription or preferred drug and $6 for any other medication, or cover 5% of the drug price, whichever cost is greater.

Horizon Medicare Blue Rx Plus is a plan without a deductible and without acopay for generic medications, with $37 copayment for preferred prescriptions, and $74 for non-preferred brand name medications. . When you reach the annual prescription cost of $2,700 you still pay nothing for generic prescriptions, but pay the full cost for any other medications until you reach the maximum out of pocket expense limit $4,350. At that point the costs drop to just $2.40 for generic and preferred drugs and $6 for any other drug, or five percent of the drug cost, whichever amount is greater.

Horizon also offers two choices for affordable Medicare Advantage options. Horizon Medicare Blue Value (MA) HMO Plan uses in network healthcare providers with no annual deductible, and a total out of pocket maximum $10,000. Doctor visits have a set $15 copay with a $35 copay for specialists. Worldwide emergency care is available to be covered 100% after a $50 copay. Some dental is covered as well as some vision coverage.

The other choice is Horizon Medicare Blue Access (MA) POS plan has no annual deductible and no out of pocket limit if you stay within the network. The network doctor visits have a set $15 copay with a $35 copay for specialists. Some dental is covered as well as some vision coverage.

If you chose to go outside the network, your annual deductible will be $900, with an out of pocket limit set at $6,200. This also covers 65% of hospital coverage, outpatient hospital services and surgery. Skilled nursing facilities and doctor office visits are also 65% coverage. Dental is also not covered out of network.

Horizon also offers a Medicare Advantage Special Needs Plan (SNP) for those who qualify. Horizon Medicare Blue Solutions is available to those who can receive Medicare Part A and are enrolled in Medicare Part B, who live in New Jersey, and they must receive Medicaid from the state. They must use network healthcare specialists. The cost-sharing amounts are determined by the level of Medicaid you are receiving, with an out of pocket limit of $3,250. The doctor visits, hospital stays, and outpatient services that are covered by Medicare have no copay. All other services require a low copayment.