Open enrollment starts Oct. 15, federal rules give members of an ending plan through February to switch and Braven's state filings show a loss each year from 2021 through 2025.
Nearly 50,000 people on Medicare have to pick new coverage for 2027 because Braven Health, the insurer Horizon Blue Cross Blue Shield of New Jersey owns with two hospital systems, is ending its Medicare Advantage plans Dec. 31.
Braven's plans, private plans that contract with the federal government to provide Medicare benefits, enrolled 49,836 people in September, according to the federal Centers for Medicare & Medicaid Services.
In Ocean County, 11,804 people belong to one of them, Braven Medicare Choice. Another 6,366 are in the same plan in Monmouth County, and Braven has members in all 21 counties, the CMS data show.
"Like many Medicare Advantage plans across the country, Braven Health faced market conditions that compromised our ability to continue providing members with the high quality coverage and service they deserve," Thomas Wilson, a spokesman for Braven and Horizon, said Oct. 2. "Faced with the choice to offer a plan that does not reflect our core values or withdraw from the market, Braven Health made the difficult choice to not offer Medicare Advantage plans after Dec. 31, 2026."
CMS says 72 Medicare Advantage plans are available in New Jersey for 2027, compared with 85 this year.
Horizon itself will sell two Medicare Advantage plans next year, CMS plan data show.
One serves people with both Medicare and Medicaid. The other, new for 2027, serves only people with certain heart conditions or diabetes in seven counties and has a 2,000-member enrollment cap.
The plans end Dec. 31, but members can switch through February
Medicare's open enrollment runs Oct. 15 to Dec. 7.
Braven's transition page tells members that Dec. 31 "is the last day to enroll in another Medicare coverage option for 2027, otherwise you'll have Original Medicare without prescription drug coverage on January 1, 2027."
Federal guidance gives members of an ending plan more room. Their special enrollment period starts Dec. 8 and "ends the last day of the following February," CMS's 2027 enrollment guidance says.
Braven's largest plan had 1,638 members who get Extra Help, the federal low-income subsidy for drug costs, in CMS's 2026 subsidy file.
CMS moves such members of ending plans into a stand-alone drug plan in late October, its guidance says, at random if the departing company offers no qualifying plan. Members can still pick a Medicare Advantage plan themselves.
Members who switch to Original Medicare, the traditional government program, also gain a guaranteed right to buy a Medicare supplement policy, known as Medigap, until 63 days after their Braven coverage ends. Insurers cannot turn them down or charge them more because of their health, under federal law and state rules.
The right does not cover people who pick another Medicare Advantage plan, Medicare's Medigap guide says.
Horizon charges a 65-year-old woman $179.94 a month for Medigap Plan G, according to the state's September rate chart.
Braven's transition page does not mention the special enrollment period through February, the Medigap guarantee, Extra Help, the state's free counseling program or 1-800-MEDICARE.
It lists a Horizon number for that company's supplement, drug and special needs plans and a line to a licensed sales representative for other plan options.
Wilson said Oct. 4 that Braven would provide members "targeted communications and personalized outreach" during open enrollment.
State rules require a company ending a Medicare Advantage plan to tell members about their Medigap rights when it notifies them of the termination.
Braven says members should have received a letter. The letter is not posted on its site. Horizon told doctors in an Oct. 5 notice that Braven sent each member a nonrenewal letter in early October.
In December 2002, some Medicare HMO plans were preparing to end their contracts at year's end. The New Jersey Department of Banking and Insurance told supplement insurers that those plans' members had "a guaranteed right by Federal law to buy any Medigap policy" from a set list.
That bulletin covered a different exit in a different era. The department's 2025 and 2026 bulletins and press releases say nothing about Braven.
Federal rules give a member who is midway through a course of treatment at least 90 days in a new Medicare Advantage plan to continue it, even with a doctor outside the plan's network.
Horizon called Braven its "best example" of statewide coverage
Horizon and Hackensack Meridian Health announced Braven in 2020 as New Jersey's first health plan owned jointly by an insurer and health care providers. RWJBarnabas Health later joined as a co-owner.
By October 2022, Braven said, its network took in the entire Hackensack Meridian and RWJBarnabas systems. It expanded to all 21 counties for 2023.
Horizon held Braven up as an example at an Oct. 6, 2022, state hearing on its request to reorganize. The company told regulators that some out-of-state, for-profit competitors had limited their service areas or narrowed their networks.
"The best example of this commitment is Braven's expansion into all 21 counties," Horizon said in its remarks. "Our reorganization will put us on better financial and operational footing to continue to deliver statewide coverage."
The Department of Banking and Insurance approved the reorganization that November. Its order requires at least one Horizon insurer to keep offering individual health coverage in every county and sets no condition on Medicare Advantage.
A separate 2021 order, which approved RWJBarnabas' stake, bars the hospital system's member of Braven's board from voting for any material change in the company's general plan of operations without the insurance commissioner's prior approval. The order sets no end date.
The department's public index of orders lists none involving Braven since 2021, and whether anyone sought the commissioner's approval for the exit is not public. The Department of Banking and Insurance did not respond to questions.
Braven reported a loss each year from 2021 through 2025
Braven lost $38 million in 2021, its first year of coverage, according to the annual statements it files with the state.
Its net loss was $94.8 million in 2022 and $113.4 million in 2023. The 2024 loss came to $123.1 million in an amended filing.
In 2025, Braven lost $177.3 million on $814.1 million in revenue. Its hospital, medical and other costs ran at 113.1 percent of premiums that year, the filing shows.
The company took in $216.1 million in new capital in 2025, and its filing puts its paid-in and contributed surplus at $660.3 million by year's end.
Notes to that statement, issued March 1, say management assessed whether the company could continue as a going concern and "noted no such risk exists."
Horizon's filings say it owns 55 percent of the joint venture that holds Braven.
Its holding company reported net losses of $661.2 million in 2025 and $369.4 million in 2024, according to its statements to state regulators.
In February, when Horizon disclosed plans to cut 242 jobs, Wilson said the company faced "unprecedented financial challenges due largely to higher medical costs and utilization across all lines of business." Braven Health and Horizon did not respond to questions about the decision.
Neither hospital system's 2025 audited financial statements mentions Braven.
Some retirees moved into Braven only this year
The City of Elizabeth told retirees in November 2025 that it would leave the State Health Benefits Program on Jan. 1 and move those in an Aetna Medicare Advantage plan into Braven. The city's letter said the Braven plan's benefits were "equal to, or better than" their state coverage.
CMS's 2027 plan crosswalk lists every Braven plan, including its employer group plans, as terminated, with none moved into another plan.
Braven tells group members to call their former employer's benefits office. Its transition page does not name the employers that sponsor its group plans or say what their members will have in 2027.
Free advice comes from the State Health Insurance Assistance Program, or SHIP, which the New Jersey Department of Human Services runs. Its counselors do not sell or recommend plans, the program says, and its help line is 1-800-792-8820.
As of Oct. 9, the program's website listed only 2026 plan charts. The Department of Human Services did not respond to questions about the program.
For members who want to keep their doctors, the two hospital systems' insurance pages carry no date and do not say which Medicare Advantage plans their hospitals will accept in 2027. Hackensack Meridian Health referred questions to Horizon. RWJBarnabas Health did not respond to requests for comment.
Braven is one of at least 11 insurers dropping individual Medicare Advantage plans for 2027, according to a trade publication's review. Health systems own almost all of them.
Bills from Sens. Vin Gopal (D, 11th District) and Troy Singleton (D, 7th) and Assemblywoman Luanne Peterpaul (D, 11th) would require insurers to accept supplement applicants at any time of year. Neither has moved since its Jan. 13 introduction, legislative records show.
Open enrollment begins Oct. 15, and CMS says 1-800-MEDICARE answers around the clock. Braven members who let Dec. 7 pass can still switch through the end of February, though coverage chosen after Dec. 31 starts the first of the next month.
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Photo: Andrew nyr / Wikimedia Commons, CC BY-SA, cropped