PEOPLES HEALTH CHOICES 65 #14 (HMO) for Northshore | 2019

Blue circle with $0Peoples Health Choices 65 #14 (HMO)
for Northshore

A Medicare Advantage HMO plan with a $0 monthly plan premium and a long list of benefits.

New for 2019 circlePart B Premium Give Back: $20!

We’ll pay $20 of your Medicare Part B premium. It’s like getting a raise on your Social Security check!

New for 2019 circleOver-the-Counter Items

Peoples Health covers certain over-the-counter health-related items and nonprescription medications.

Blue circle with $0Peoples Health Choices 65 #14 (HMO) for Northshore

A Medicare Advantage HMO plan with a $0 monthly plan premium and a long list of benefits.

Purple circle with NEW 2019

Part B Premium Give Back: $20!

We’ll pay $20 of your Medicare Part B premium. It’s like getting a raise on your Social Security check!

Green Circle with NEW 2019Over-the-Counter Items

Peoples Health covers certain over-the-counter health-related items and nonprescription medications.

Even Better Benefits for 2019!

new for 2019 banner

Part B Premium Give Back

$20 give back banner

Peoples Health will reduce your monthly Part B premium by $20 per month. It’s like getting a raise on your Social Security check. You can spend that money any way you want.

 

new for 2019 banner

Over-the-Counter Items

$100 over-the-counter banner

Peoples Health covers certain over-the-counter health-related items and nonprescription medications – up to $100 every three months from our network mail-order provider.

Plan Highlights for 2019

N

Over-the-Counter Items

N

$0 Meals After Inpatient Stay

N

$0 Respite Care Sessions

N

$0 Hearing Aids

N

Dentures Included in Dental Coverage

peoples health challenge promo banner

$0

PRIMARY CARE PHYSICIAN VISIT

$0

DENTAL EXAMS & CLEANINGS

$0

TIER 1 GENERIC DRUGS

$40

SPECIALIST VISIT

$0

FITNESS CLUB MEMBERSHIP

$0

EYEGLASSES OR CONTACTS

Plan Highlights for 2019

N

Over-the-Counter Items

N

$0 Meals After Inpatient Stay

N

$0 Respite Care Sessions

N

$0 Hearing Aids

N

Dentures Included in Dental Coverage

Additional Benefits for 2019

$0

PRIMARY CARE PHYSICIAN VISIT

$40

SPECIALIST VISIT

$0

DENTAL EXAMS & CLEANINGS

$0

FITNESS CLUB MEMBERSHIP

$0

TIER 1 GENERIC DRUGS

$0

EYEGLASSES OR CONTACTS

Explore Plan Benefits

Doctor and Hospital Coverage

Peoples Health Choices 65 #14 for NorthshoreYour Cost
Monthly Plan Premium$0
Part B Premium Give Back (amount of your
Medicare Part B premium paid by Peoples Health)
You save
$20 per month
Doctor Visits
Primary Care Physician Visit$0
Specialist Visit$40
Preventive Care+
Pap Smears, Pelvic Exams and Mammograms$0
Prostate and Colorectal Cancer Screenings$0
Bone Mass Measurement$0
Vaccinations (flu, pneumonia, hepatitis B)$0
Labs and Tests*+
Lab Services$0
Diagnostic Tests and X-rays$0
Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.)$175
Outpatient Surgery
Outpatient Hospital Facility or Ambulatory Surgical Center$195
Inpatient Hospital Care
Inpatient Deductible$0
Hospital Stay$180 per day for days 1-10
$0 per day for days 11 and beyond
Worldwide Emergency and Urgent Care♦
Emergency Care –Copay waived if admitted$80
Urgently Needed Care$45
Emergency Transportation (per one-way trip)
Emergency Ambulance Services$235
Home Health
Home Health Care$0
Skilled Nursing Facility Care
Semiprivate Room and Board
per day for days 1-20
$0
Semiprivate Room and Board
per day for days 21-100
$165
Outpatient Services and Supplies
Occupational, Physical or Speech Therapy Visit
(Medicare limits apply)
$20
Durable Medical Equipment (DME)
(wheelchairs, oxygen, etc.)
20% coinsurance
Diabetes Monitoring Supplies
(test strips, monitor, etc.,
from a preferred DME provider)
$0
Mental Health and Substance Abuse Treatment
Inpatient Mental Health Care$152 per day for days 1-10
$0 per day for days 11-90
Outpatient Mental Health or Substance Abuse Treatment Visit$40 for outpatient mental health visit
$45 for substance abuse visit

Notes:

Costs listed are based on use of network providers.

Authorization is required for certain services.

*See the Provider Directory for network lab and diagnostic providers. Lab services, diagnostic tests and X-rays at a doctor’s office or outpatient hospital may have higher out-of-pocket costs.

+Office visit copay may apply.

♦Emergency care copay waived if admitted to inpatient hospital care within 24 hours for the same condition. Up to $5,000 of coverage for emergency and urgently needed care (combined) outside the U.S. and its territories.

Part D Prescription Drug Coverage

All tier 1 and 2 generics are COVERED through the Part D coverage gap. Brand-name drugs have partial coverage through the gap. 90-day supplies of maintenance medications on tiers 1, 2, 3 and 4 are available at retail pharmacies and by mail order.

 30-DAY SUPPLY AT A NETWORK PHARMACY
Tier 1 $0
Tier 2$10
Tier 3$30
Tier 4$80
Tier 533% coinsurance

Additional Benefits –  Not Covered by Original Medicare

Peoples Health Choices 65 #14 for NorthshoreYour Cost
Over-the-Counter Health-Related Items
$100 Allowance (every three months by mail order)$0
Meals
Meals After Hospital Stays (two meals per day for five days after an inpatient hospital stay)$0
Routine Vision Services
Routine Eye Exam$40
Eyeglasses or Contact Lenses
(one pair per year)
$0
Hearing Services
Routine Hearing Exam$45
Hearing Exam for Evaluation and Fitting of Hearing Aids
Click here for more information
$0
Hearing Aids (one per ear, max of $1,000 for both ears)
Click here for more information
$0
Dental – up to $2,000 in coverage
Oral Exams and Cleanings
(one every six months)
$0
X-rays (one set per year)$0
Comprehensive Dental Services
(such as fillings and dentures; $50 deductible applies)
Copays vary
Respite Care
Respite Care Services (for members with Alzheimer's or dementia; up to 12 sessions per year)$0
Fitness
Health Club Membership$0

Notes:

Costs listed are based on use of network providers.

Authorization is required for certain services.

For a detailed list of all plan benefits, click here to download the 2019 Peoples Health Choices 65 #14 for Northshore Evidence of Coverage.

 

Explore Plan Benefits

Doctor and Hospital Coverage

Peoples Health Choices 65 #14 for NorthshoreYour Cost
Monthly Plan Premium$0
Part B Premium Give Back (amount of your
Medicare Part B premium paid by Peoples Health)
You save
$20 per month
Doctor Visits
Primary Care Physician Visit$0
Specialist Visit$40
Preventive Care+
Pap Smears, Pelvic Exams and Mammograms$0
Prostate and Colorectal Cancer Screenings$0
Bone Mass Measurement$0
Vaccinations (flu, pneumonia, hepatitis B)$0
Labs and Tests*+
Lab Services$0
Diagnostic Tests and X-rays$0
Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.)$175
Outpatient Surgery
Outpatient Hospital Facility or Ambulatory Surgical Center$195
Inpatient Hospital Care
Inpatient Deductible$0
Hospital Stay$180 per day for days 1-10
$0 per day for days 11 and beyond
Worldwide Emergency and Urgent Care♦
Emergency Care –Copay waived if admitted$80
Urgently Needed Care$45
Emergency Transportation (per one-way trip)
Emergency Ambulance Services$235
Home Health
Home Health Care$0
Skilled Nursing Facility Care
Semiprivate Room and Board
per day for days 1-20
$0
Semiprivate Room and Board
per day for days 21-100
$165
Outpatient Services and Supplies
Occupational, Physical or Speech Therapy Visit
(Medicare limits apply)
$20
Durable Medical Equipment (DME)
(wheelchairs, oxygen, etc.)
20% coinsurance
Diabetes Monitoring Supplies
(test strips, monitor, etc.,
from a preferred DME provider)
$0
Mental Health and Substance Abuse Treatment
Inpatient Mental Health Care$152 per day for days 1-10
$0 per day for days 11-90
Outpatient Mental Health or Substance Abuse Treatment Visit$40 for outpatient mental health visit
$45 for substance abuse visit

Notes:

Costs listed are based on use of network providers.

Authorization is required for certain services.

*See the Provider Directory for network lab and diagnostic providers. Lab services, diagnostic tests and X-rays at a doctor’s office or outpatient hospital may have higher out-of-pocket costs.

+Office visit copay may apply.

♦Emergency care copay waived if admitted to inpatient hospital care within 24 hours for the same condition. Up to $5,000 of coverage for emergency and urgently needed care (combined) outside the U.S. and its territories.

Part D Prescription Drug Coverage

All tier 1 and 2 generics are COVERED through the Part D coverage gap. Brand drugs have partial coverage through the gap. 90-day supplies of maintenance medications on tiers 1, 2, 3 and 4 are available at retail pharmacies and by mail order.

 30-DAY SUPPLY AT A NETWORK PHARMACY
Tier 1 $0
Tier 2$10
Tier 3$30
Tier 4$80
Tier 533% coinsurance

Additional Benefits

Peoples Health Choices 65 #14 for NorthshoreYour Cost
Over-the-Counter Health-Related Items
$100 Allowance (every three months by mail order)$0
Meals
Meals After Hospital Stays (two meals per day for five days after an inpatient hospital stay)$0
Routine Vision Services
Routine Eye Exam$40
Eyeglasses or Contact Lenses
(one pair per year)
$0
Hearing Services
Routine Hearing Exam$45
Hearing Exam for Evaluation and Fitting of Hearing Aids
Click here for more information
$0
Hearing Aids (one per ear, max of $1,000 for both ears)
Click here for more information
$0
Dental – up to $2,000 in coverage
Oral Exams and Cleanings
(one every six months)
$0
X-rays (one set per year)$0
Comprehensive Dental Services
(such as fillings and dentures; $50 deductible applies)
Copays vary
Respite Care
Respite Care Services (for members with Alzheimer's or dementia; up to 12 sessions per year)$0
Fitness
Health Club Membership$0
Notes:

Costs listed are based on use of network providers. Authorization is required for certain services.

For a detailed list of all plan benefits, click here to download the 2019 Peoples Health Choices 65 #14 for Northshore Evidence of Coverage.

Find Doctors, Search Medications and More

Use our search tools to find out if your doctors and favorite pharmacy are in our network or if we cover your prescription drug. If you need help, call us at 1-800-978-9765 (TTY: 711).

Eligibility Guidelines

choices 65 northshore map

Determining if you’re eligible to enroll in Peoples Health Choices 65 #14 for Northshore is easy. If you meet the following Medicare enrollment requirements, you’re eligible to become a member of this plan:

N

Be entitled to Medicare Part A and enrolled in Medicare Part B

N

Not have end-stage renal disease (ESRD), with limited exceptions, such as if you develop ESRD when you are already a member of a plan that we offer, or you were a member of a different plan that is no longer available

N

Continue to pay your Medicare Part B premium

N

Live in the plan’s service area, which includes the following Louisiana parishes:

St. Tammany, Tangipahoa and Washington

How to Enroll

ENROLL ONLINE

man's hands typing on laptop

Enrolling only takes about 20 minutes.

ENROLL BY PHONE

senior woman on phone

Call toll-free at 1-800-978-9765, seven days a week, from 8 a.m. to 8 p.m. TTY users may call 711. A plan representative will help you.

ENROLL BY APPOINTMENT

man talking to doctor

Call us toll-free at 1-800-978-9765, seven days a week, from 8 a.m. to 8 p.m. TTY users may call 711.

A sales representative will schedule an appointment with you at your home or meet you at one of our offices.

Peoples Health – Baton Rouge
7434 Perkins Road, Suite 200
Baton Rouge, LA 70808 
View Map: Peoples Health – Baton Rouge

Peoples Health – Metairie
Three Lakeway Center
3838 N. Causeway Blvd., Suite 2200
Metairie, LA 70002 
View Map: Peoples Health – Metairie

ENROLL BY MAIL

hand putting mail in mailbox

Write to us and request an enrollment packet. The address is:

Peoples Health Choices 65 #14 for Northshore Enrollment Packet Request

Three Lakeway Center
3838 N. Causeway Blvd.
Suite 2200
Metairie, LA 70002

Extra Help

Peoples Health Choices 65 #14 for Northshore Monthly Plan Premium for People Who Get Extra Help From Medicare to Help Pay Their Prescription Drug Costs

If you get extra help from Medicare to help pay your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our plan.

Peoples Health Choices 65 #14 for Northshore’s premium includes coverage for both medical services and prescription drugs.

Download the Extra Help Plan Premium Summary and Table.

See if You Qualify for Extra Help

If you aren’t getting extra help, you can see if you qualify by calling:

  • Medicare at 1-800-MEDICARE, 24 hours a day, seven days a week (TTY users call 1-877-486-2048)
  • Louisiana Medicaid at 1-888-342-6207, Monday through Friday, from 7 a.m. to 4:30 p.m. (TTY users call 1-800-220-5404)
  • Social Security Administration at 1-800-772-1213, Monday through Friday, from 7 a.m. to 7 p.m. (TTY users call 1-800-325-0778)

Extra Help Monthly Plan Premium Table

This table shows you what your monthly plan premium will be if you get extra help.

YOUR LEVEL OF EXTRA HELPMONTHLY PREMIUM FOR PEOPLES HEALTH CHOICES 65 #14 for Northshore*
100%$0
75%$0
50%$0
25%$0

*This does not include any Medicare Part B premium you may have to pay.

What to Expect Next

1

ENROLL

We will mail a confirmation of your enrollment to you.

2

NEW MEMBER PACKET

We will mail a packet to you with important information about your coverage through your Peoples Health plan. Be sure to read everything in the packet and call us with any questions.  We will also send you a member ID card.

3

TRANSITION CALL

As a new member, you will receive a call from a Peoples Health representative to coordinate continuation of any special services you may need. This helps us make sure there are no interruptions in your health care.

Important Documents

i

View important 2019 plan documents here.

Plan Overview for Peoples Health Choices 65 #14 for Northshore – An overview of plan benefits

Annual Notice of Changes for Peoples Health Choices 65 #14 for Northshore– A summary of plan benefit changes compared to the previous year and other important plan details

Annual Notice of Changes for Peoples Health Choices Select (HMO) – A summary of plan benefit changes compared to the previous year and other important plan details

Evidence of Coverage for Peoples Health Choices 65 #14 for Northshore – Information about plan benefits, membership, covered and noncovered services, member rights and responsibilities, and other important plan details

Prior Authorization Criteria – Detailed criteria for select covered drugs

Step Therapy Criteria – Detailed criteria for select covered drugs

Summary of Benefits for Peoples Health Choices 65 #14 for Northshore – A general summary of plan benefits

Why Medicare Advantage?

Peoples Health Choices 65 #14 for Northshore is a Medicare Advantage HMO plan with a $0 monthly plan premium. Plus, Peoples Health will pay $20 per month of your Part B premium!

As good as Medicare is, it doesn’t cover everything. To protect yourself from high health care costs, consider a Medicare Advantage plan, like the ones offered by Peoples Health.

Also known as Medicare Part C, Medicare Advantage combines your Part A (hospital insurance) and Part B (medical coverage), such as doctor’s visits and outpatient services, into one plan. Medicare Advantage plans usually include prescription drug coverage (Part D). Additionally, Medicare Advantage plans may include extra benefits, like worldwide urgent and emergency care, routine dental and vision coverage, and gym memberships. A Medicare Advantage plan from Peoples Health is an all-inclusive package, making your health insurance easy and convenient. Our rich health care benefits make Peoples Health one of the most popular Medicare Advantage plans in Louisiana. It’s no wonder Peoples Health has been covering people with Medicare in Louisiana for over 20 years.

During select parts of the year, like Medicare’s Annual Enrollment Period, you have the option to compare Medicare health insurance plans and decide what fit is best for you. Let us help make that decision easy. Peoples Health Choices 65 #14 for Northshore offers more benefits than ever before, like a $20 monthly reduction on your Part B premium, up to $100 per quarter for over-the-counter items, $0 meals after an inpatient stay, $0 respite care sessions, and much, much more. Enroll in this plan to enjoy these benefits.

Unlike supplemental insurance, which typically costs more for fewer services, a Medicare Advantage plan from Peoples Health offers you more benefits and saves you money. Peoples Health Choices 65 #14 for Northshore includes Part D drug coverage at no additional cost per month! Lower your out-of-pocket-costs and get more health coverage with this affordable Medicare plan.

If you live in one of the following Louisiana parishes, you may be eligible to enroll in Peoples Health Choices 65 #14 for Northshore: St. Tammany, Tangipahoa and Washington. Do you live in a different Louisiana parish? Shop our other Medicare Advantage plans. If you have Medicare and Medicaid, also known as state assistance, ask about a Peoples Health special needs plan. You may be entitled to more coverage and bigger savings.