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Braven Medicare Choice (PPO) - H0885 001
$0.00 Monthly Premium
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Braven Medicare Choice (PPO) - H0885 001
$0.00 Monthly Premium
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Braven Medicare Choice (PPO) - H0885 001
$0.00 Monthly Premium
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Braven Medicare Choice (PPO) - H0885 001
$0.00 Monthly Premium
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Braven Medicare Choice (PPO) - H0885 001
$0.00 Monthly Premium
Enroll Now
Braven Medicare Choice (PPO) - H0885 001
$0.00 Monthly Premium
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Highlights

Medicare Star Rating
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Annual Medical Deductible

$0

$0

$0

$0

$0

$0

Out-of-Pocket Maximum

In-network: $7,550

Any provider: $11,300

In-network: $7,550

Any provider: $11,300

In-network: $7,550

Any provider: $11,300

In-network: $7,550

Any provider: $11,300

In-network: $7,550

Any provider: $11,300

In-network: $7,550

Any provider: $11,300

Office Visit for Primary Doctor

In-network: $0 copay

Out-of-network: $0 copay

In-network: $0 copay

Out-of-network: $0 copay

In-network: $0 copay

Out-of-network: $0 copay

In-network: $0 copay

Out-of-network: $0 copay

In-network: $0 copay

Out-of-network: $0 copay

In-network: $0 copay

Out-of-network: $0 copay
Office Visit for Specialist

In-network: $10 copay

Out-of-network: $35 copay

In-network: $10 copay

Out-of-network: $35 copay

In-network: $10 copay

Out-of-network: $35 copay

In-network: $10 copay

Out-of-network: $35 copay

In-network: $10 copay

Out-of-network: $35 copay

In-network: $10 copay

Out-of-network: $35 copay
Inpatient Hospital Coverage

Inpatient hospital acute

In-network

  • Up to 90 days covered
  • $340 per day for days 1 - 4
  • $0 per day for days 5 - 90

Out-of-network

40% coinsurance

Inpatient hospital psychiatric

In-network

  • Up to 90 days covered
  • $250 per day for days 1 - 6
  • $0 per day for days 7 - 90

Out-of-network

40% coinsurance

Inpatient hospital acute

In-network

  • Up to 90 days covered
  • $340 per day for days 1 - 4
  • $0 per day for days 5 - 90

Out-of-network

40% coinsurance

Inpatient hospital psychiatric

In-network

  • Up to 90 days covered
  • $250 per day for days 1 - 6
  • $0 per day for days 7 - 90

Out-of-network

40% coinsurance

Inpatient hospital acute

In-network

  • Up to 90 days covered
  • $340 per day for days 1 - 4
  • $0 per day for days 5 - 90

Out-of-network

40% coinsurance

Inpatient hospital psychiatric

In-network

  • Up to 90 days covered
  • $250 per day for days 1 - 6
  • $0 per day for days 7 - 90

Out-of-network

40% coinsurance

Inpatient hospital acute

In-network

  • Up to 90 days covered
  • $340 per day for days 1 - 4
  • $0 per day for days 5 - 90

Out-of-network

40% coinsurance

Inpatient hospital psychiatric

In-network

  • Up to 90 days covered
  • $250 per day for days 1 - 6
  • $0 per day for days 7 - 90

Out-of-network

40% coinsurance

Inpatient hospital acute

In-network

  • Up to 90 days covered
  • $340 per day for days 1 - 4
  • $0 per day for days 5 - 90

Out-of-network

40% coinsurance

Inpatient hospital psychiatric

In-network

  • Up to 90 days covered
  • $250 per day for days 1 - 6
  • $0 per day for days 7 - 90

Out-of-network

40% coinsurance

Inpatient hospital acute

In-network

  • Up to 90 days covered
  • $340 per day for days 1 - 4
  • $0 per day for days 5 - 90

Out-of-network

40% coinsurance

Inpatient hospital psychiatric

In-network

  • Up to 90 days covered
  • $250 per day for days 1 - 6
  • $0 per day for days 7 - 90

Out-of-network

40% coinsurance
Prescription Drug Deductible

$300 (applies to Tier 3 ,4 and 5)

$300 (applies to Tier 3 ,4 and 5)

$300 (applies to Tier 3 ,4 and 5)

$300 (applies to Tier 3 ,4 and 5)

$300 (applies to Tier 3 ,4 and 5)

$300 (applies to Tier 3 ,4 and 5)

Your drugs

Prescription Drug Deductible Add Your drugs Add Your drugs Add Your drugs Add Your drugs Add Your drugs Add Your drugs
Annual Prescription Deductible

$0 for Tier 1

$350 for Tiers 2-5

$0 for Tier 1

$350 for Tiers 2-5

$0 for Tier 1

$350 for Tiers 2-5

$0 for Tier 1

$350 for Tiers 2-5

$0 for Tier 1

$350 for Tiers 2-5

$0 for Tier 1

$350 for Tiers 2-5
Tier 1: Preferred Generic Drugs

Preferred Pharmacy Network

Cost Sharing (30 days)

$1 copay



Standard Network Pharmacy

Cost Sharing (30 days)

$16 copay



Preferred Mail Orde

Pharmacy (90 days)

$3 copay



Standard Mail Order

Pharmacy (90 days)

$48 copay

Preferred Pharmacy Network

Cost Sharing (30 days)

$1 copay



Standard Network Pharmacy

Cost Sharing (30 days)

$16 copay



Preferred Mail Orde

Pharmacy (90 days)

$3 copay



Standard Mail Order

Pharmacy (90 days)

$48 copay

Preferred Pharmacy Network

Cost Sharing (30 days)

$1 copay



Standard Network Pharmacy

Cost Sharing (30 days)

$16 copay



Preferred Mail Orde

Pharmacy (90 days)

$3 copay



Standard Mail Order

Pharmacy (90 days)

$48 copay

Preferred Pharmacy Network

Cost Sharing (30 days)

$1 copay



Standard Network Pharmacy

Cost Sharing (30 days)

$16 copay



Preferred Mail Orde

Pharmacy (90 days)

$3 copay



Standard Mail Order

Pharmacy (90 days)

$48 copay

Preferred Pharmacy Network

Cost Sharing (30 days)

$1 copay



Standard Network Pharmacy

Cost Sharing (30 days)

$16 copay



Preferred Mail Orde

Pharmacy (90 days)

$3 copay



Standard Mail Order

Pharmacy (90 days)

$48 copay

Preferred Pharmacy Network

Cost Sharing (30 days)

$1 copay



Standard Network Pharmacy

Cost Sharing (30 days)

$16 copay



Preferred Mail Orde

Pharmacy (90 days)

$3 copay



Standard Mail Order

Pharmacy (90 days)

$48 copay

More

Tier 1: Preferred Generic Drugs

Preferred Pharmacy Network

Cost Sharing (30 days)

$1 copay



Standard Network Pharmacy

Cost Sharing (30 days)

$16 copay



Preferred Mail Orde

Pharmacy (90 days)

$3 copay



Standard Mail Order

Pharmacy (90 days)

$48 copay

Preferred Pharmacy Network

Cost Sharing (30 days)

$1 copay



Standard Network Pharmacy

Cost Sharing (30 days)

$16 copay



Preferred Mail Orde

Pharmacy (90 days)

$3 copay



Standard Mail Order

Pharmacy (90 days)

$48 copay

Preferred Pharmacy Network

Cost Sharing (30 days)

$1 copay



Standard Network Pharmacy

Cost Sharing (30 days)

$16 copay



Preferred Mail Orde

Pharmacy (90 days)

$3 copay



Standard Mail Order

Pharmacy (90 days)

$48 copay

Preferred Pharmacy Network

Cost Sharing (30 days)

$1 copay



Standard Network Pharmacy

Cost Sharing (30 days)

$16 copay



Preferred Mail Orde

Pharmacy (90 days)

$3 copay



Standard Mail Order

Pharmacy (90 days)

$48 copay

Preferred Pharmacy Network

Cost Sharing (30 days)

$1 copay



Standard Network Pharmacy

Cost Sharing (30 days)

$16 copay



Preferred Mail Orde

Pharmacy (90 days)

$3 copay



Standard Mail Order

Pharmacy (90 days)

$48 copay

Preferred Pharmacy Network

Cost Sharing (30 days)

$1 copay



Standard Network Pharmacy

Cost Sharing (30 days)

$16 copay



Preferred Mail Orde

Pharmacy (90 days)

$3 copay



Standard Mail Order

Pharmacy (90 days)

$48 copay
Company Name Medicare Choice (PPO) - H0885 001
$0.00 Monthly Premium
Enroll Now
Company Name Medicare Choice (PPO) - H0885 001
$0.00 Monthly Premium
Enroll Now
Company Name Medicare Choice (PPO) - H0885 001
$0.00 Monthly Premium
Enroll Now
Add Plan
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