Horizon NJ TotalCare (HMO D-SNP) is a Medicare Advantage (Part C) Special Needs Plan by Horizon Blue Cross Blue Shield of New Jersey.
This page features plan details for 2024 Horizon NJ TotalCare (HMO D-SNP) H8298 – 001 – 0 available in New Jersey.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Horizon NJ TotalCare (HMO D-SNP) is offered in the following locations.
Horizon NJ TotalCare (HMO D-SNP) offers the following coverage and cost-sharing.
Special Needs Plan Type: | Dual-Eligible |
Conditions Covered: |
Insurer: | Horizon Blue Cross Blue Shield of New Jersey |
Health Plan Deductible: | $0.00 |
MOOP: | |
Drugs Covered: | Yes |
Ready to sign up for Horizon NJ TotalCare (HMO D-SNP) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
8am – 11pm EST. 7 days a week
Part B | Part C | Part D | Part B Give Back | Total |
---|---|---|---|---|
$174.70 | $0.00 | $0.00 | $0.00 | $174.70 |
Horizon NJ TotalCare (HMO D-SNP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Deductible: | $545.00 |
Initial Coverage Limit: | $5,030.00 |
Catastrophic Coverage Limit: | $8,000.00 |
Drug Benefit Type: | Basic |
Additional Gap Coverage: | No |
Formulary Link: | Formulary Link |
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.
The table below shows how the LIS impacts the Part D premium of this plan.
Part D | LIS Full |
---|---|
$0.00 | $0.00 |
NOTE: The Inflation Reduction Act of 2022 has expanded full subsidy eligibility under the LIS program to individuals with incomes up to 150% of the Federal Poverty Level. People who qualify for Extra Help generally will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug.
After you pay your $545.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00. Once you reach that amount, you will enter the next coverage phase.
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
25% | 25% |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
25% | 25% |
After your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00, you will pay no more than the amounts below for any drug tier until you reach $8,000.00.
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
Generic drugs | ||||
Brand-name drugs |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
Generic drugs | ||||
Brand-name drugs |
Drug Type | Cost Share |
---|---|
Generic drugs | 25% |
Brand-name drugs | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs.
Horizon NJ TotalCare (HMO D-SNP) also provides the following benefits.
$0 |
In-network | No |
$8,850 In-network |
No |
In-network | No |
$0 copay (Authorization is required.) (Referral is not required.) |
Primary | $0 copay (Not applicable.) (Not applicable.) |
Specialist | $0 copay (Authorization is required.) (Referral is not required.) |
$0 copay (Authorization is not required.) (Referral is not required.) |
Emergency | $0 copay (Not applicable.) (Not applicable.) |
Urgent care | $0 copay (Not applicable.) (Not applicable.) |
Diagnostic tests and procedures | $0 copay (Authorization is required.) (Referral is not required.) |
Lab services | $0 copay (Authorization is required.) (Referral is not required.) |
Diagnostic radiology services (e.g., MRI) | $0 copay (Authorization is required.) (Referral is not required.) |
Outpatient x-rays | $0 copay (Authorization is required.) (Referral is not required.) |
Hearing exam | $0 copay (Authorization is not required.) (Referral is not required.) |
Fitting/evaluation | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Hearing aids – inner ear | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Hearing aids – outer ear | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Hearing aids – over the ear | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Oral exam | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Cleaning | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Fluoride treatment | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Dental x-ray(s) | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Non-routine services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Diagnostic services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Restorative services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Endodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Periodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Extractions | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Prosthodontics, other oral/maxillofacial surgery, other services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Routine eye exam | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Contact lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Eyeglasses (frames and lenses) | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Eyeglass frames | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Eyeglass lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Upgrades | Not covered (Not applicable.) (Not applicable.) |
Occupational therapy visit | $0 copay (Authorization is required.) (Referral is not required.) |
Physical therapy and speech and language therapy visit | $0 copay (Authorization is required.) (Referral is not required.) |
$0 copay (Not applicable.) (Not applicable.) |
Not covered (Not applicable.) (Not applicable.) |
Foot exams and treatment | $0 copay (Authorization is not required.) (Referral is not required.) |
Routine foot care | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Durable medical equipment (e.g., wheelchairs, oxygen) | $0 copay (Authorization is required.) (Not applicable.) |
Prosthetics (e.g., braces, artificial limbs) | $0 copay (Authorization is required.) (Not applicable.) |
Diabetes supplies | $0 copay (Authorization is required.) (Not applicable.) |
Covered (Authorization is not required.) (Referral is not required.) |
Chemotherapy | $0 copay (Authorization is required.) (Not applicable.) |
Other Part B drugs | $0 copay (Authorization is required.) (Not applicable.) |
Part B Insulin drugs | $0 copay (Authorization is required.) (Not applicable.) |
$0 copay (Authorization is required.) (Referral is not required.) |
Inpatient hospital – psychiatric | $0 copay (Authorization is required.) (Referral is not required.) |
Outpatient group therapy visit with a psychiatrist | $0 copay (Authorization is not required.) (Referral is not required.) |
Outpatient individual therapy visit with a psychiatrist | $0 copay (Authorization is not required.) (Referral is not required.) |
Outpatient group therapy visit | $0 copay (Authorization is not required.) (Referral is not required.) |
Outpatient individual therapy visit | $0 copay (Authorization is not required.) (Referral is not required.) |
$0 copay (Authorization is required.) (Referral is not required.) |
Ready to sign up for Horizon NJ TotalCare (HMO D-SNP) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
8am – 11pm EST. 7 days a week
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