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Horizon Medicare Insurance Review & Complaints: Health Insurance

Horizon Medicare is available in New Jersey through Horizon Blue Cross Blue Shield. Horizon Medicare Advantage and Supplement plans are available, and your Horizon Medicare quotes can range between $53-$160 per month. Horizon Medicare reviews are average, and the company has a B- rating with the Better Business Bureau.

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Eric Stauffer is a former insurance agent and banker turned consumer advocate. His priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best...

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UPDATED: Sep 16, 2020

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Horizon is a New Jersey Blue Cross Blue Shield (BCBS) licensee offering a full range of health insurance options. In addition to major medical plans for individuals and groups, they also offer Medicare options.

About Horizon

Horizon BlueCross BlueShield of New Jersey was born out of the merger of two older companies. The first was founded in 1932 under the name First Hospital Service Plan. The second, Medical-Surgical Plan of New Jersey, was founded in 1942. Both companies took on BCBS licensing and branding before their eventual merger in 1986; they operated as Blue Cross Blue Shield of New Jersey until 1998, when they took on the name Horizon.

Over the decades Horizon expanded into neighboring states, but eventually pulled their operations back and now serve solely New Jersey residents. Their products include PPO and HMO health plans, dental and vision, and a full range of Medicare plans as well.

Horizon still operates as an independent insurance company with a BCBS license. That means that although they use the BCBS name and logo, their plans are their own and may differ from those offered by other licensees.

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Horizon Medicare Plans

Horizon writes Medicare Advantage, Medicare Supplement, and Part D plans. In some cases, plan availability differs by county. To obtain plan information, we entered the zip code of the Horizon head office in Newark, NJ (Essex County).

Medicare Advantage

Although the main page lists several options for Medicare Advantage plans, our sample zip code returned only one option for 2019.

The Horizon Medicare Blue Advantage plan that came up is a $0 premium plan (above your regular Medicare premium) and is an HMO plan. There is a $10 copay for primary care visits and a $25 copay for specialist visits on this plan; inpatient hospital stays have a copay of $320 a day for the first five days.

This plan includes prescription drug coverage with a $250 deductible that applies to Tiers 3 and up only. Copays for prescriptions at a preferred pharmacy start at $1 for Tier 1 drugs. Tier 2 has a $9 copay, Tier 3 a $40 copay, and Tiers 4 and 5 have coinsurance percentages at 35% and 28% respectively.

Routine dental and vision, as well as hearing benefits, are also included with this plan.

Medicare Supplement

Horizon offers several of the standard letter-coded Medicare Supplement plans. They write Plan A, C, G, F, K, and N.

Plan A is the base plan and provides coverage for Original Medicare coinsurance amounts as well as the first three pints of blood annually. This base plan is a requirement for all insurance companies to offer, and from there each plan generally adds more coverage – although some plans only cover some of the coinsurance amount.

Plan F is the most comprehensive. It covers all of the out of pocket costs that are not covered by Medicare, including emergency medical care when traveling abroad. This plan is generally the most expensive. There is a high deductible version of this plan that reduces the monthly cost, but Horizon doesn’t offer it.

Plan N is generally a budget-friendly plan as well as it has copays for some services in return for a lower monthly premium.

While Horizon does not offer the full list of plans, they have a good selection that should meet the needs of most people.

Part D

There are two options for Part D prescription drug coverage available from Horizon.

The Standard plan has an annual deductible of $415; unlike some plans, this deductible does apply to all tiers. After the deductible, preferred pharmacy rates are $1 for Tier 1, $8 for Tier 2, $32 for Tier 3, and a 25% coinsurance for Tiers 4 and 5.

The Enhanced plan had no deductible. Copays and coinsurance amounts at a preferred pharmacy are the same with the exception of Tier 5, which has a 33% coinsurance amount.

Rates

We ran quotes for 2019 plans based on a 65-year-old female.

The supplement rates varied, with Plan A coming in at $115.81 a month and Plan F at $161.44 a month. The least expensive of the plans is Plan K, with a monthly rate of $53.86.

Rates for the Part D plans are $49.90 for the Standard option and $102 a month for the Enhanced option.

As noted above, we only returned one plan option for Medicare Advantage, which has no additional monthly premium – you do still have to pay your regular Part A and Part B Original Medicare premiums, however.

Since these rates only apply to New Jersey, and some only to Essex county, we unable to really provide a good comparison on them to other options. They do appear to be in line with the rates we have seen elsewhere for similar plans.

Claims

As is common to most health insurance companies, Horizon handles claims for medical care directly with providers. The insured should rarely if ever have involvement in the claims process. This is especially true of HMO plans where there is no out-of-network coverage that might complicate things.

There is a toll-free customer service number as well as a member login area on the site that should provide access to more information on claims status.

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Ratings and Consumer Reviews

Horizon has a B- rating with the Better Business Bureau (BBB), and there are 68 complaints on file there in the past three years with 16 of those closed in the past 12 months. The BBB lists failure to respond to two complaints and five complaints that were not resolved as the reasons for the lowered grade. The eight customer reviews on the BBB page provide a one-star rating overall.

The National Committee for Quality Assurance ranks Horizon’s Medicare plans at a 3.0 out of 5, which makes the company about average.

There are 67 reviews on Consumer Affairs, and of those 61 left a star rating that adds up to a total of one star out of five. The complaints are varied and include billing issues, denial of claims, and difficulty with in-network care.

While the complaint volume is not high for a large company like Horizon and the content of the complaints is pretty common for health insurance companies, it would be positive to see more attention to and responses to issues. It is worth noting that we did not find any customer complaints specifically about the Medicare plans.

The Bottom Line

Horizon’s rates are reasonable, although their selection is limited particularly when it comes to Medicare Advantage (at least in our sample area). The complaints listed do not raise a major red flag, but there does seem to be some work to do in terms of the company’s response. Overall, they are worth comparing to the other options out there, but only if you do not mind the limitations of an HMO and aren’t seeking a lot of selection for your Advantage plan.

For a list of companies that we recommend, visit our Best Insurance Companies page.

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Review Information

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About Eric Stauffer

Author: Eric StaufferI am a former insurance agent and banker turned consumer advocate. My priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best place to get it.

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