Select Page

Peoples Health Choices Gold (HMO-POS) | 2019

Looking for 2020 plan information? Click here.

Blue circle with $0

$0 Monthly Plan Premium

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

new_circle_purple2

$10 Part B Premium Give Back

We’ll pay $10 of your Medicare Part B premium. It’s like getting a raise on your Social Security check!

new_circle_green2

Over-the-Counter Health Items

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

Peoples Health Choices Gold (HMO-POS) | 2019

A Medicare Advantage plan available to Medicare beneficiaries in the following parishes:

Acadia • Bossier • Caddo • Calcasieu • Cameron • Evangeline • Iberia • Lafayette • Ouachita • St. Bernard • St. Landry • St. Martin • Vermilion

Choices-Gold-2019-plan-map-300px

Blue circle with $0

$0 Monthly Plan Premium

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

Purple circle with NEW 2019

$10 Part B Premium Give Back

We’ll pay $10 of your Medicare Part B premium. It’s like getting a raise on your Social Security check!

Green Circle with NEW 2019Over-the-Counter Health Items

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

Part B Premium Give Back

$10 give back banner

Peoples Health will reduce your monthly Part B premium by $10 per month. It’s like getting a raise on your Social Security check. You can spend that money any way you want.

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 banner

$0

PRIMARY CARE PHYSICIAN VISIT

$0

DENTAL EXAMS & CLEANINGS

$0

TIER 1 GENERIC DRUGS

$35

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 (Sitter Sessions)

N

$0 Hearing Aids

N

Dentures included in dental coverage

Additional Benefits for 2019

$0

PRIMARY CARE PHYSICIAN VISIT

$35

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 GoldIn NetworkOUT OF NETWORK
Monthly Plan Premium$0N/A
Part B Premium Give Back (amount of your
Medicare Part B premium paid by Peoples Health)
You save
$10 per month
N/A
Doctor Visits
Primary Care Physician Visit$0Not covered
Specialist Visit$3530% coinsurance
Preventive Care+
Pap Smears, Pelvic Exams and Mammograms$0Not covered
Prostate and Colorectal Cancer Screenings$0Not covered
Bone Mass Measurement$0Not covered
Vaccinations (flu, pneumonia, hepatitis B)$0Not covered
Labs and Tests*+
Lab Services$030% coinsurance
Diagnostic Tests and X-rays$1030% coinsurance
Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.)$12030% coinsurance
Outpatient Surgery
Outpatient Hospital Facility or Ambulatory Surgical Center$250 for outpatient hospital facility surgery
$200 for ambulatory surgical center surgery
30% coinsurance
Inpatient Hospital Care
Inpatient Deductible$0$0
Hospital Stay$195 per day for days 1-7
$0 per day for days 8 and beyond
30% coinsurance
Worldwide Emergency and Urgent Care♦
Emergency Care - Copay waived if admitted$80$80
Urgently Needed Care$40$40
Emergency Transportation (per one-way trip)
Emergency Ambulance Services$23530% coinsurance
Home Health
Home Health Care$030% coinsurance
Skilled Nursing Facility Care
Semiprivate Room and Board
per day for days 1-20
$030% coinsurance
Semiprivate Room and Board
per day for days 21-100
$16030% coinsurance
Outpatient Services and Supplies
Occupational, Physical or Speech Therapy Visit
(Medicare limits apply)
$1530% coinsurance
Durable Medical Equipment (DME)
(wheelchairs, oxygen, etc.)
20% coinsurance30% coinsurance
Diabetes Monitoring Supplies
(test strips, monitor, etc. from a DME provider)
$0 from a preferred DME vendor30% coinsurance
Mental Health and Substance Abuse Treatment
Inpatient Mental Health Care$195 per day for days 1-7
$0 per day for days 8-90
30% coinsurance
Outpatient Mental Health or Substance Abuse Treatment Visit $40 for outpatient mental health visit

$40 for substance abuse visit with a specialist and $50 for substance abuse visit at an outpatient hospital
30% coinsurance

Notes:

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 GoldIn NetworkOUT OF NETWORK
Over-the-Counter Health-Related Items
$100 Allowance (every three months by mail order)$0Not covered
Meals
Meals After Hospital Stays (two meals per day for five days after an inpatient hospital stay)$0Not covered
Routine Vision Services
Routine Eye Exam$35Not covered
Eyeglasses or Contact Lenses
(one pair per year)
$0Not covered
Hearing Services
Routine Hearing Exam$40Not covered
Hearing Exam for Evaluation and Fitting of Hearing Aids
Click here for more information
$0Not covered
Hearing Aids (one per ear, max of $1,000 for both ears)
Click here for more information
$0Not covered
Dental – up to $2,000 in coverage
Oral Exams and Cleanings
(one every six months)
$0Not covered
X-rays (one set per year)$0Not covered
Comprehensive Dental Services
(such as fillings and dentures; $50 deductible applies)
Copays varyNot covered
Respite Care
Respite Care Services (for members with Alzheimer's or dementia; up to 12 sessions per year)$0Not covered
Fitness
Health Club Membership$0Not covered

Notes:

Authorization is required for certain services.

For a detailed list of all plan benefits, click here to download the 2019 Peoples Health Choices Gold Evidence of Coverage.

Explore Plan Benefits

Doctor and Hospital Coverage

Peoples Health Choices GoldIn NetworkOUT OF NETWORK
Monthly Plan Premium$0N/A
Part B Premium Give Back (amount of your
Medicare Part B premium paid by Peoples Health)
You save
$10 per month
N/A
Doctor Visits
Primary Care Physician Visit$0Not covered
Specialist Visit$3530% coinsurance
Preventive Care+
Pap Smears, Pelvic Exams and Mammograms$0Not covered
Prostate and Colorectal Cancer Screenings$0Not covered
Bone Mass Measurement$0Not covered
Vaccinations (flu, pneumonia, hepatitis B)$0Not covered
Labs and Tests*+
Lab Services$030% coinsurance
Diagnostic Tests and X-rays$1030% coinsurance
Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.)$12030% coinsurance
Outpatient Surgery
Outpatient Hospital Facility or Ambulatory Surgical Center$250 for outpatient hospital facility surgery
$200 for ambulatory surgical center surgery
30% coinsurance
Inpatient Hospital Care
Inpatient Deductible$0$0
Hospital Stay$195 per day for days 1-7
$0 per day for days 8 and beyond
30% coinsurance
Worldwide Emergency and Urgent Care♦
Emergency Care - Copay waived if admitted$80$80
Urgently Needed Care$40$40
Emergency Transportation (per one-way trip)
Emergency Ambulance Services$23530% coinsurance
Home Health
Home Health Care$030% coinsurance
Skilled Nursing Facility Care
Semiprivate Room and Board
per day for days 1-20
$030% coinsurance
Semiprivate Room and Board
per day for days 21-100
$16030% coinsurance
Outpatient Services and Supplies
Occupational, Physical or Speech Therapy Visit
(Medicare limits apply)
$1530% coinsurance
Durable Medical Equipment (DME)
(wheelchairs, oxygen, etc.)
20% coinsurance30% coinsurance
Diabetes Monitoring Supplies
(test strips, monitor, etc. from a DME provider)
$0 from a preferred DME vendor30% coinsurance
Mental Health and Substance Abuse Treatment
Inpatient Mental Health Care$195 per day for days 1-7
$0 per day for days 8-90
30% coinsurance
Outpatient Mental Health or Substance Abuse Treatment Visit $40 for outpatient mental health visit

$40 for substance abuse visit with a specialist and $50 for substance abuse visit at an outpatient hospital
30% coinsurance
Notes: 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 GoldIn NetworkOUT OF NETWORK
Over-the-Counter Health-Related Items
$100 Allowance (every three months by mail order)$0Not covered
Meals
Meals After Hospital Stays (two meals per day for five days after an inpatient hospital stay)$0Not covered
Routine Vision Services
Routine Eye Exam$35Not covered
Eyeglasses or Contact Lenses
(one pair per year)
$0Not covered
Hearing Services
Routine Hearing Exam$40Not covered
Hearing Exam for Evaluation and Fitting of Hearing Aids
Click here for more information
$0Not covered
Hearing Aids (one per ear, max of $1,000 for both ears)
Click here for more information
$0Not covered
Dental – up to $2,000 in coverage
Oral Exams and Cleanings
(one every six months)
$0Not covered
X-rays (one set per year)$0Not covered
Comprehensive Dental Services
(such as fillings and dentures; $50 deductible applies)
Copays varyNot covered
Respite Care
Respite Care Services (for members with Alzheimer's or dementia; up to 12 sessions per year)$0Not covered
Fitness
Health Club Membership$0Not covered
Notes:

 Authorization is required for certain services.

For a detailed list of all plan benefits, click here to download the 2019 Peoples Health Choices Gold 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 gold map
Determining if you’re eligible to enroll in Peoples Health Choices Gold 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: Acadia, Bossier, Caddo, Calcasieu, Cameron, Evangeline, Iberia, Lafayette, Ouachita, St. Bernard, St. Landry, St. Martin, Vermilion

How to Enroll

ENROLL ONLINE

man 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 delivering mail

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

Peoples Health Choices Gold Enrollment Packet Request

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

Extra Help

Peoples Health Choices Gold 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 Gold′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

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 GOLD*
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 Gold – An overview of plan benefits

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

Evidence of Coverage for Peoples Health Choices Gold  – 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 Gold  – A general summary of plan benefits

Why Medicare Advantage?

Peoples Health Choices Gold is a Medicare Advantage HMO plan with a $0 monthly plan premium. Plus, Peoples Health will pay $10 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.  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 Gold offers more benefits than ever before, like a $10 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 Gold 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 Gold: Acadia, Bossier, Caddo, Calcasieu, Cameron, Evangeline, Iberia, Lafayette, Ouachita, St. Bernard, St. Landry, St. Martin, Vermilion. 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.

×

You are about to leave peopleshealth.com.

Click OK to continue.