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    Horizon Medicare Advantage

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Introduction
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Overview

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Have your choice of money-saving plans from a name you know and trust.

Horizon Healthcare of New Jersey, Inc. offers you a choice of two Medicare Advantage plans and four Medicare Advantage Prescription Drug plans. Horizon Healthcare of New Jersey, Inc. understands that different Medicare beneficiaries have different needs. Your choice of plans includes an option with a $0 premium as well as options that include medical and Medicare Part D prescription drug coverage.

Horizon Medicare Blue Access (HMO-POS) gives you the freedom to go to any health care provider. Coverage is typically greater when you stay in the network, but the choice is yours to make. And you don't need a referral.

Our Medicare Advantage plans provide more coverage than Original Medicare and most Medicare Supplement plans combined!

  • Inpatient hospitalization
  • Outpatient hospital services
  • Doctor office visits
  • Diagnostic tests, X-rays and lab services
  • Emergency room care
  • Urgently needed care
  • Skilled nursing facility care
  • Outpatient mental health care
  • And more!

PLUS...these preventive health care services to help keep you healthy...

  • Annual physical exams
  • Immunizations
  • Chiropractic services
  • Hearing services
  • Vision services
  • Podiatry services
  • And more!

You're automatically entitled to a Silver&Fit® membership at no additional cost beyond your monthly premium!
As a Horizon Medicare Advantage member, you can enjoy the Silver&Fit® Fitness Program at no additional cost beyond your monthly premium. You'll have the opportunity to get fit, make new friends and participate in fun events. The Silver&Fit® Fitness Program includes:

  • Free membership at a participating fitness club in your area
  • Available home fitness programs
  • Free newsletter, including topics on nutrition, exercise, weight management and more
  • Access to SilverandFit.com – a full-service, comprehensive web site that includes health tracking tools, an online health coach, wellness tips, meal planning information and more

  • (Please check with your physician before starting a fitness program.)

If you qualify for extra help with your Medicare Prescription Drug Plan costs, your premium and drug costs will be lower. When you join a Horizon Healthcare of NJ, Inc. Medicare Advantage - Prescription Drug Plan, Medicare will tell us how much extra help you are getting. Then, we will let you know the amount you will pay. If you aren't getting any extra help, you can see if you qualify by calling:

  • 1-800-MEDICARE (1-800-633-4227). (TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week), or
  • Your state Medicaid office or
  • The Social Security Administration at 1-800-772-1213 between 7 am and 7 pm, Monday through Friday. (TTY/TDD users should call 1-800-325-0778.)

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 - 8:00 pm.

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.

The MA and MA-PD plans are managed care plans issued by Horizon Healthcare of New Jersey, Inc., which is a Medicare Advantage organization with a Medicare contract with the Centers for Medicare & Medicaid Services (CMS). Availability of coverage beyond the end of the current contract year is not guaranteed. 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.

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.

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.

®Silver&Fit is provided by American Specialty Health Networks, Inc. and Healthyroads, Inc., subsidiaries of American Specialty Health Incorporated (ASH). All programs and services are not available in all areas. Silver&Fit and the Silver&Fit logo are federally registered trademarks of ASH.

The service area for this 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.

The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. Additional information about benefits is available to assist you in making a decision about your coverage. This is an advertisement; for more information, contact the plan.

*The $0 monthly health plan premium applies only to the Horizon Medicare Blue Value (HMO) plan.

You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

Please note, if you decide to switch to premium withhold or move from premium withhold to direct bill, it could take up to three months for it to take effect and you will ultimately be held responsible for those premiums.

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Last Updated: July 22, 2010