Health Plan RadarIn this article we rank New Jersey Medicare Advantage plans based on our evaluation of government 5-star quality scores.
Read more →Horizon NJ TotalCare (HMO D-SNP)
by Horizon Blue Cross Blue Shield of New Jersey
2026 Medicare-Medicaid Dual Eligible D-SNP plan available in New Jersey
Plan ID H8298-001-0
Additional coverage:
RxHearingVisionDental
Medicare-Medicaid Dual Eligible D-SNP HMO $0 premium 4.0 Overall
Monthly plan premium $0 / mo
Annual deductible $0 / yr
Max out-of-pocket · in-network $9,250 / yr
Drug deductible $615 / yr
4.0 Overall Government Star Rating 2026 · out of 5 stars
Ready to enroll online?
Find your plan and self-enroll online
Enroll online →
We are now sending you to our trusted partner,
Medicare Enrollment
https://medicareenrollment.com
Support Our Senior 65+ Partner
Get Sign Up Help
Quote · Compare · Enroll
Speak with a licensed
insurance agent
(888) 763-2752 insurance agent
TTY 711
Medicare Advantage Plans Medicare Prescription Drug Plans Medicare Supplement Insurance Plans
Mon-Fri: 8am-9pm ET
Plan Overview
Horizon NJ TotalCare (HMO D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in New Jersey and offered by the health insurance company Horizon Blue Cross Blue Shield of New Jersey. This plan's network type is HMO, which determines the in-network doctors who accept the plan and whether a referral is needed.
Plan Name Horizon NJ TotalCare (HMO D-SNP)
Insurance Carrier Horizon Blue Cross Blue Shield of New Jersey
Plan Type Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)
Network Type HMO
Cost Summary
Horizon NJ TotalCare (HMO D-SNP) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out-of-pocket cost sharing of $9,250. The most common costs people evaluate when choosing a plan are listed here; a full list of benefit costs is defined below.
Monthly Premium $0 / mo
Health portion of premium $0
Drug portion of premium $0
Annual Deductible $0 / yr
Max Out-of-Pocket · in-network $9,250 / yr
Primary doctor visit $0 copay
Specialist visit $0 copay
ER visit $0 copay
Ambulance $0 copay
Additional Benefits and Coverage
Horizon NJ TotalCare (HMO D-SNP) is a Medicare Advantage plan which includes Medicare Part D prescription drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Horizon NJ TotalCare (HMO D-SNP) includes coverage for hearing, vision, dental.
Part D Prescription Drug Coverage Yes
Dental Yes
Vision Yes
Hearing Yes
Nationwide Coverage No
Other benefits
Fitness benefit Limited coverage
Over-the-counter drug benefits Limited coverage
In-home support services Not covered
Home & bathroom safety devices Not covered
Meals for short duration Limited coverage
Annual physical exams Not covered
Telehealth Limited coverage
Medical Benefits
Doctor Services
Primary doctor visit In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Specialist visit In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Tests, labs & imaging
Diagnostic tests & procedures In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Lab services In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Diagnostic radiology services (like MRI) In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Outpatient x-rays In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Emergency care $0 copay
Urgent care $0 copay
Hospital Services
Inpatient hospital coverage Tier 1
$0 per stay
$0 per stay
Outpatient hospital coverage In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Skilled nursing facility
Skilled nursing facility Tier 1
$0 per day for days 1-20
$217 per day for days 21-100
$0 per day for days 1-20
$217 per day for days 21-100
Preventive services
Preventive services In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Ambulance
Ground ambulance In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Therapy services
Occupational therapy visit In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Physical therapy & speech & language therapy visit In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Mental health services
Outpatient group therapy with a psychiatrist In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Outpatient individual therapy with a psychiatrist In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Outpatient group therapy visit In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Outpatient individual therapy visit In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Opioid treatment services
Opioid treatment services Covered
Other services
Durable medical equipment (like wheelchairs & oxygen) In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Prosthetics (like braces, artificial limbs) In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Diabetes supplies In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Prescription drugs (Part D benefits)
Drug tier standard retail · 1-month supply Initial coverage Catastrophic
Generic Drugs 25% coinsurance 0% coinsurance
Brand Name Drugs 25% coinsurance 0% coinsurance
Part B drugs
Chemotherapy drugs In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Other Part B drugs In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Medicare star rating
Each year the federal government rates Medicare Advantage and Part D plans on a 5-star system covering quality of care, chronic-condition management, member experience, and customer service. For 2026, Horizon NJ TotalCare (HMO D-SNP) earned an overall rating of 4.0 stars — better than New Jersey's state average of 3.3 stars.
Rating category This plan State average
Overall star rating ★ 4.0 3.3
Health plan quality
Summary rating of health plan quality ★ 3.5 3.2
Staying healthy: screenings, tests & vaccines ★ 3.0 2.8
Managing chronic (long-term) conditions ★ 4.0 3.2
Member experience with health plan ★ 3.0 3.5
Member complaints & changes in performance ★ 4.0 3.7
Health plan customer service ★ 4.0 4.0
Drug plan quality
Summary rating of drug plan quality ★ 4.5 3.8
Drug plan customer service ★ 4.0 4.8
Member complaints & changes in performance ★ 5.0 4.0
Member experience with the drug plan ★ 5.0 4.0
Drug safety & accuracy of drug pricing ★ 4.0 3.5
Extra Benefits
Hearing
Hearing exam Not covered
Fitting/evaluation Not covered
Hearing aids - prescription Not covered
Hearing aids - over the counter Not covered
Preventive dental
Oral exam Not covered
Cleaning Not covered
Fluoride treatment Not covered
Dental x-rays Not covered
Comprehensive dental
Restorative services Not covered
Endodontics Not covered
Periodontics Not covered
Prosthodontics, removable Not covered
Prosthodontics, fixed Not covered
Maxillofacial prosthetics Not covered
Implant services Not covered
Oral and maxillofacial surgery Not covered
Orthodontics Not covered
Adjunctive general services Not covered
Vision
Routine eye exam Not covered
Contact lenses Not covered
Eyeglasses (frames & lenses) Not covered
Eyeglass frames (only) Not covered
Eyeglass lenses (only) Not covered
Upgrades Not covered
Plan documents & tools
When can I sign up for Medicare?
Enter your birthday month and year to see when you can enroll in each part of Medicare.
Related Articles
Health Plan Radar Health Plan RadarA summary of new and returning health insurance companies offering Medicare Advantage Plans (Part C) and Medicare Prescription Drug Plans (Part D) in New Jersey.
Read more →