Horizon Medicare Blue Solutions Predictable copays and coordinated care is available to Medicare beneficiaries receiving Medicaid from the state.
Horizon Medicare Blue Solutions is a Special Needs Plan that coordinates and manages care specifically for Medicare beneficiaries who also receive Medicaid from the state. You no longer have to worry about navigating the complexities of the health care system alone. Your care will be coordinated for you by your primary care physician who has access to one of the largest networks of participating doctors and hospitals in New Jersey.
The plan offers predictable, low copayments for doctor's visits and 100% coverage for Medicare-covered hospital stays. In addition, you can expect copayments as low as $0 for many generic and brand medications. (Copayments vary depending on your level of Medicaid eligibility.)
Horizon Medicare Blue Solutions (Enhanced Plan) Pay no monthly premium and no cost-sharing for comprehensive services if you are a Medicare beneficiary with full Medicaid coverage.
This plan offers comprehensive benefits with no cost-sharing for Medicare beneficiaries who also have full Medicaid coverage. Horizon's Enhanced plan provides comprehensive medically necessary services including preventive, primary, acute and specialty medical care, behavioral health, extended care, home care, and transportation services all with no cost sharing and no monthly plan premium*.
And you can have peace of mind knowing that prescription drugs are covered 100% — including Medicaid-covered prescription and over-the-counter drugs not covered under Medicare.
Since Horizon Medicare Blue Solutions (Enhanced Plan) is designated as a Medicare Advantage Special Needs Plan, no restrictions apply on when you can enroll or disenroll. So your satisfaction is "guaranteed."
Our Medicare Advantage Special Needs Plans provide more coverage than Original Medicare and most Medicare Supplement plans combined!
PLUS...these preventive health care services help keep you healthy...
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To contact Horizon Healthcare of New Jersey, Inc., call customer service at 1-800-224-1234 (TTY/TDD users: 1-800-852-7899) Monday - Friday, 8:30 am - 5:00 pm.
You have the right to get a summary of information about the appeals and grievances that members have filed against our plan in the past. To get this information, call Member Services at 1-800-365-2223 (TTY/TDD: 1-800-855-2881), Monday through Wednesday and Friday, 8:00 am - 6:00 pm; Thursday, 9:00 am - 6:00 pm.
All health plans in the Medicare program agree to stay with the program for a full year at a time. Each year, the plans decide whether to continue for another year. Even if a Medicare health plan leaves the program, you will not lose Medicare coverage. If a plan decides not to continue, it must send you a letter at least 90 days before your coverage will end. The letter will explain your options for health care coverage in your area and give you information about your right to get Medicare supplemental insurance coverage. You can choose another health plan if one is available, or you can receive care from the Original Medicare Plan.
If Horizon Healthcare of New Jersey, Inc. ever denies your claim or a service, we will explain our decision to you. You always have the right to appeal and ask us to review the claim or service that was denied. If a decision was not made in your favor, your appeal will be reviewed by an independent organization that works for Medicare.
Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 of each calendar year. Please contact Horizon Healthcare of New Jersey, Inc. for details.
Horizon Medicare Blue Solutions and Horizon Medicare Blue Solutions (Enhanced Plan) are managed care plans issued by Horizon Healthcare of New Jersey, Inc., which is an MA organization with a Medicare contract with the Centers for Medicare & Medicaid Services (CMS). Horizon Healthcare of New Jersey, Inc. is a subsidiary of Horizon Blue Cross Blue Shield of New Jersey. Both companies are independent licensees of the Blue Cross and Blue Shield Association. Availability of coverage beyond the end of the current contract year is not guaranteed.
The geographic service area for our plan is the following counties in New Jersey: Atlantic, Bergen, Burlington, Camden, Cape May, Cumberland, Essex, Gloucester, Hudson, Hunterdon, Mercer, Middlesex, Monmouth, Morris, Ocean, Passaic, Salem, Somerset, Sussex, Union and Warren.
If you obtain routine care from out-of-plan providers, neither Medicare nor Horizon will be responsible for the costs. While you are a member of our Plan, you may use either network providers or out-of-network providers. However, your out-of-pocket costs may be higher if you use out-of-network providers, except for emergency care or out-of-area dialysis services.
*You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.