not present
| Product Type | Product Marketing Name | Referral Required |
| HMO | Horizon Medicare Blue Value (HMO) | No |
| HMO | Horizon Medicare Blue Value w/Rx (HMO) | No |
| HMO | Horizon Medicare Blue Choice w/Rx (HMO) | No |
| HMO | Horizon Medicare Blue Advantage (HMO) ... | No |
...
Horizon Medicare Blue Advantage (HMO)
- Primary Care Physician (PCP) selection is required.
- No referrals.
- Certain services/supplies require prior authorization.
- Routine vision, hearing and dental benefits are included.
Do you need a referral for Medicare Advantage plans?
Depending on what type of Medicare Advantage plan you have, you may need a referral from your primary care physician before you can see a specialist covered by your plan. Insurance carriers who have been contracted by Medicare to offer recipients Part C options may offer different types of plans.
Are there any out-of-network benefits with Horizon Medicare?
No out-of-network benefits, except in cases of medical emergencies. BlueCard® (out-of-area) coverage is not included. The Horizon Medicare Blue Advantage (HMO) plan uses a subset of physicians and other health care professionals who participate in the Horizon Managed Care Network, as well as a subset of facilities in the Horizon Hospital Network.
What is the horizon Medicare blue Advantage plan?
The Horizon Medicare Blue Advantage (HMO) plan uses a subset of physicians and other health care professionals who participate in the Horizon Managed Care Network, as well as a subset of facilities in the Horizon Hospital Network.
Are referrals required for Aetna Medicare Advantage HMO members?
Referrals are not required for Medicare Advantage HMO members. As of January 1, 2020, all Aetna Medicare Advantage health maintenance organization (HMO) members in Washington have direct access to in-network Medicare HMO network providers. We no longer require primary care providers to submit referral requests to us.
Does Horizon NJ Direct require referrals?
Referrals are not required for members enrolled in Horizon HMO Access, Horizon Direct Access, NJ DIRECT10, NJ DIRECT15, NJ DIRECT1525, NJ DIRECT2030, Horizon Advantage EPO, OMNIA Health Plans, Horizon Medicare Blue Access Group (HMO-POS), Horizon Medicare Blue Access Group w/Rx (HMO POS), Horizon Medicare Blue (PPO), ...
Is Horizon NJ Health the same as Horizon Blue Cross Blue Shield?
Headquartered in West Trenton, N.J., Horizon NJ Health, is a wholly-owned subsidiary of the Horizon Blue Cross Blue Shield of New Jersey, an independent licensee of the Blue Cross Blue Shield Association. Learn more at www.horizonNJhealth.com.
Does Horizon Blue Cross Blue Shield of NJ require referrals?
Referrals are required for members enrolled in Horizon POS plans to receive coverage at an in-network benefit level. Referrals are not valid for out-of-network services.
Is NJ Horizon Medicare?
Horizon NJ TotalCare (HMO D-SNP) is an HMO Medicare Advantage Dual Eligible Special Needs plan with a Medicare contract and a contract with the State of New Jersey Medicaid Program.
Is Horizon Omnia bronze a good plan?
OMNIA BRONZE Bronze plans, on average, pay for 60% of the covered medical expenses; members pay 40%, and money-saving subsidies may be available. The OMNIA Bronze Plan is a good choice if the member doesn't expect to use a lot of medical services.
Is Horizon Omnia a good plan?
We recommend buying the lowest priced plan with a good network, the Horizon Omnia Bronze H.S.A. This way they can cover their employees with the lowest possible premium, but give them good benefits by reimbursing the employees as the claims are incurred. Platinum benefits for Bronze prices.
Do I need a referral?
When might I need a referral? Your health professional might refer you to someone else if: they believe you need expertise that the other person has. they believe you need treatment that the other person can give.
What is Horizon EPO plan?
The Horizon Advantage EPO plans provide integrated medical and pharmacy benefits, including wellness and emergency care. Although members are not required to select a Primary Care Physician (PCP), there are lower out-of-pocket costs when care is coordinated through a PCP.
What type of plan is Horizon Omnia silver?
premium non-HSA Silver planThe OMNIA Silver Plan is our lowest premium non-HSA Silver plan and offers a mid-level monthly premium and out-of-pocket costs when compared to other OMNIA Health Plans. Silver plans, on average, pay for 70% of the covered medical expenses; you pay 30%, and money-saving subsidies may be available.
Is Horizon NJ Health Good?
Horizon NJ Health received the best overall compliance score and had the highest ratings in: Childhood Immunizations. Well Child visits (includes adolescents) Comprehensive Eye Exams at 72%, well above the national average of 53%
Is Horizon NJ total care a Medicaid plan?
Horizon NJ TotalCare (HMO D-SNP) is an HMO Medicare Advantage Dual Eligible Special Needs plan with a Medicare contract and a contract with the State of New Jersey Medicaid Program.
What is Horizon NJ Direct?
Horizon Direct Access is a managed care plan that gives members referral-free access to many health care services and programs and one of the largest national doctor networks in the nation.
Health Maintenance Organization (HMO) Plans
In most cases you have to get a referral to see a specialist in HMO Plans. Certain services, like yearly screening mammograms, don't require a referral.
Preferred Provider Organization (PPO) Plans
In most cases, you don't have to get a referral to see a specialist in PPO Plans. If you use plan specialists, your costs for covered services will usually be lower than if you use non-plan specialists.
Special Needs Plans (SNPs)
In most cases, you have to get a referral to see a specialist in SNPs. Certain services don't require a referral, like these:
What are the exceptions to HMO rules?
Exceptions to these rules are typically made for emergency reasons or if there are no in-network providers and facilities close enough to the enrollee to treat their needs. When you enroll in an HMO, you usually have to choose a primary care doctor who will give you a referral to see a specialist if need be.
What is an HMO?
Health Maintenance Organization (HMO) HMOs base their coverage policies around a strictly defined network of health providers and facilities — there may be little to no coverage for services received by providers or at facilities outside of this network.
Does Medicare offer Part C?
Insurance carriers who have been contracted by Medicare to offer recipients Part C options may offer different types of plans. Understanding how these plans structure their network and cost-sharing obligations can help you make the choice that’s right for you.
REFERRING TO A SPECIALIST
If a PCP determines a patient needs care from a specialist, the PCP should refer the patient to a specialty care physician or other health care professional participating in the Horizon Managed Care Network. Visit our Online Doctor & Hospital Finder, HorizonBlue.com/directory to confirm the participation status of specific physicians.
EXTENDED REFERRALS
A patient’s PCP may obtain authorization from our Medical Management Department to allow the specialist to exercise authority and control care provided for a chronic condition ( e.g., HIV, cancer, diabetes and transplants). This includes performing tests and treatment and referring to other specialists, hospitals and facilities, as necessary.
ELECTRONIC REFERRAL REQUIREMENT
Horizon BCBSNJ requires that all referrals are created electronically through either NaviNet.net or our IVR system. We do not accept paper referrals.
Does Aetna have an HMO?
As of January 1, 2020, all Aetna Medicare Advantage health maintenance organization (HMO) members in Washington have direct access to in-network Medicare HMO network providers.
Is Aetna Inc. responsible for the content of its websites?
Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Continue. You are now leaving the Aetna website. Links to various non-Aetna sites are provided for your convenience only.
What is Medicare Advantage?
Medicare Advantage. When it comes to choosing a plan, determine what’s most important to you.
Can you choose a Medicare Advantage plan?
However, you can choose a Medicare Advantage plan that includes Medicare prescription drug benefits. CLOSE ×. Medicare Advantage. To get you the best quote enter the information below to see the options available to you.