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Peoples Health Group Medicare (HMO-POS) | 2019

Looking for 2020 plan information? Click here.

Peoples Health Group Medicare

A Medicare Advantage HMO plan with a POS option, which lets you see providers who are not in the plan’s provider network. Not all services received from out-of-network providers are covered.

You get more benefits than Original Medicare, plus additional benefits like coverage for Part D prescription drugs with coverage through the gap (sometimes called the doughnut hole), routine vision and dental benefits, a $0 fitness center membership, worldwide urgent and emergency care, and much more.

Peoples Health Group Medicare

A Medicare Advantage HMO plan with a POS option, which lets you see providers who are not in the plan’s provider network. Not all services received from an out-of-network providers are covered.

You get more benefits than Original Medicare, plus additional benefits like coverage for Part D prescription drugs with coverage through the gap (sometimes called the doughnut hole), routine vision and dental benefits, a $0 fitness center membership, worldwide urgent and emergency care, and much more.

Plan Highlights for 2019

$5

PRIMARY CARE PHYSICIAN VISIT

$0

TIER 1 AND TIER 2 GENERIC DRUGS*

*90-day supply at a retail pharmacy with preferred cost-sharing or a mail-order pharmacy

$10

SPECIALIST VISIT

$0

FITNESS CLUB MEMBERSHIP

$0

EYEGLASSES OR CONTACTS

$0

DENTAL EXAMS & CLEANINGS

Plan Highlights for 2019

$5

PRIMARY CARE PHYSICIAN VISIT

$10

SPECIALIST VISIT

$0

DENTAL EXAMS & CLEANINGS

$0

FITNESS CLUB MEMBERSHIP

$0

90-DAY SUPPLY TIER 1 AND TIER 2 GENERIC DRUGS*

$0

EYEGLASSES OR CONTACTS

*90-day supply at a pharmacy with preferred cost-sharing or a mail-order pharmacy

Explore Plan Benefits

Doctor and Hospital Coverage

Peoples Health Group MedicareIn NetworkOut Of Network
Out-of-Pocket Maximum$2,500Does not apply out of network
Doctor Visits
Primary Care Physician Visit$520% coinsurance
Specialist Visit$1020% coinsurance
Preventive Care+
Pap Smears, Pelvic Exams and Mammograms$020% coinsurance
Prostate and Colorectal Cancer Screenings$020% coinsurance
Bone Mass Measurement$020% coinsurance
Vaccinations (flu, pneumonia)$0$0
Labs and Tests+
Lab Services, Diagnostic Tests, X-rays and Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.)$020% coinsurance
Outpatient Surgery
Outpatient Hospital Facility or Ambulatory Surgical Center$020% coinsurance
Inpatient Hospital Care
Inpatient Deductible$0Same as Medicare
Hospital Stay per day for days 1-10$50Same as Medicare
Hospital Stay per day for days 11 and beyond $0Same as Medicare
Worldwide Emergency and Urgent Care♦
Emergency Care – Copay waived if admitted.$50$50
Urgently Needed Care$10 in the U.S. and its territories$10 in the U.S. and its territories; $50 outside the U.S. and its territories
Emergency Transportation (per one-way trip)
Emergency Ambulance Services$50$50
Home Health
Home Health Care$020% coinsurance
Skilled Nursing Facility Care
Semiprivate Room and Board per day for days 1-20$0$0
Semiprivate Room and Board per day for each additional day$25$25
Outpatient Services and Supplies
Occupational, Physical or Speech Therapy Visit (Medicare limits apply)$020% coinsurance
Durable Medical Equipment (DME) (wheelchairs, oxygen, etc.)5% coinsurance20% coinsurance
Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider)$020% coinsurance
Mental Health and Substance Abuse Treatment
Inpatient Mental Health Care per day for days 1-10$50Same as Medicare
Inpatient Mental Health Care per day for days 11-90$0Same as Medicare
Outpatient Mental Health or Substance Abuse Treatment Visit$1020% coinsurance
Hearing Services
Diagnostic Exam$1020% coinsurance

Notes:

Authorization is required for certain services.

+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 drug tiers are COVERED through the Part D coverage gap.

90-day supplies of maintenance medications are available at retail pharmacies and by mail order.

 30-DAY SUPPLY AT A NETWORK PHARMACY 90-DAY SUPPLY AT A NETWORK PHARMACY*
Tier 1 $3$0
Tier 2$10$0
Tier 3$25$50
Tier 4$50$100
Tier 520% coinsurance20% coinsurance

*90-day supply costs listed are at pharmacies with preferred cost-sharing

Additional Benefits – Not Covered by Original Medicare

Peoples Health Group MedicareIN NETWORKOUT OF NETWORK
Fitness
Fitness Center Membership$0Not covered
Routine Vision Services
Routine Eye Exam$15Not covered
Eyeglasses or Contact Lenses (one pair per year)$0Not covered
Dental – up to $2,000 in coverage
Oral Exams and Cleanings (one every six months)$0Out-of-pocket costs are higher. Member is responsible for any charges over and above the agreed amount the plan would normally pay as its share of the cost to a network provider.
X-rays (one set per year)$0Out-of-pocket costs are higher. Member is responsible for any charges over and above the agreed amount the plan would normally pay as its share of the cost to a network provider.
Comprehensive Dental Services (such as fillings and dentures; $50 deductible applies)Copays varyOut-of-pocket costs are higher. Member is responsible for any charges over and above the agreed amount the plan would normally pay as its share of the cost to a network provider.

Notes:

Authorization is required for certain services.

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

Explore Plan Benefits

Doctor and Hospital Coverage

Peoples Health Group MedicareIn NetworkOut Of Network
Out-of-Pocket Maximum$2,500Does not apply out of network
Doctor Visits
Primary Care Physician Visit$520% coinsurance
Specialist Visit$1020% coinsurance
Preventive Care+
Pap Smears, Pelvic Exams and Mammograms$020% coinsurance
Prostate and Colorectal Cancer Screenings$020% coinsurance
Bone Mass Measurement$020% coinsurance
Vaccinations (flu, pneumonia)$0$0
Labs and Tests+
Lab Services, Diagnostic Tests, X-rays and Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.)$020% coinsurance
Outpatient Surgery
Outpatient Hospital Facility or Ambulatory Surgical Center$020% coinsurance
Inpatient Hospital Care
Inpatient Deductible$0Same as Medicare
Hospital Stay per day for days 1-10$50Same as Medicare
Hospital Stay per day for days 11 and beyond $0Same as Medicare
Worldwide Emergency and Urgent Care♦
Emergency Care – Copay waived if admitted.$50$50
Urgently Needed Care$10 in the U.S. and its territories$10 in the U.S. and its territories; $50 outside the U.S. and its territories
Emergency Transportation (per one-way trip)
Emergency Ambulance Services$50$50
Home Health
Home Health Care$020% coinsurance
Skilled Nursing Facility Care
Semiprivate Room and Board per day for days 1-20$0$0
Semiprivate Room and Board per day for each additional day$25$25
Outpatient Services and Supplies
Occupational, Physical or Speech Therapy Visit (Medicare limits apply)$020% coinsurance
Durable Medical Equipment (DME) (wheelchairs, oxygen, etc.)5% coinsurance20% coinsurance
Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider)$020% coinsurance
Mental Health and Substance Abuse Treatment
Inpatient Mental Health Care per day for days 1-10$50Same as Medicare
Inpatient Mental Health Care per day for days 11-90$0Same as Medicare
Outpatient Mental Health or Substance Abuse Treatment Visit$1020% coinsurance
Hearing Services
Diagnostic Exam$1020% coinsurance

Notes:

Costs listed are based on use of network providers. Authorization is required for certain services. +Office visit copay may apply. *See your 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. ♦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 90-DAY SUPPLY AT A NETWORK PHARMACY*
Tier 1 $3$0
Tier 2$10$0
Tier 3$25$50
Tier 4$50$100
Tier 520% coinsurance20% coinsurance
*90-day supply costs listed are at pharmacies with preferred cost-sharing

Additional Benefits

Peoples Health Group MedicareIN NETWORKOUT OF NETWORK
Fitness
Fitness Center Membership$0Not covered
Routine Vision Services
Routine Eye Exam$15Not covered
Eyeglasses or Contact Lenses (one pair per year)$0Not covered
Dental – up to $2,000 in coverage
Oral Exams and Cleanings (one every six months)$0Out-of-pocket costs are higher. Member is responsible for any charges over and above the agreed amount the plan would normally pay as its share of the cost to a network provider.
X-rays (one set per year)$0Out-of-pocket costs are higher. Member is responsible for any charges over and above the agreed amount the plan would normally pay as its share of the cost to a network provider.
Comprehensive Dental Services (such as fillings and dentures; $50 deductible applies)Copays varyOut-of-pocket costs are higher. Member is responsible for any charges over and above the agreed amount the plan would normally pay as its share of the cost to a network provider.

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 Group Medicare 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

Louisiana state map with all parishes highlighted for Group plans

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

N

Be a member of a participating employer or retiree group and meet any additional requirements determined by the group

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

Be enrolled in Medicare Part A and Medicare Part B

N

Live in the plan’s service area determined individually by each group

How to Enroll

ENROLL BY APPOINTMENT

Senior couple meeting with young sales agent

Call us toll-free at 1-800-978-9765, Monday through Friday, 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 into the mailbox

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

Peoples Health Group Medicare
Enrollment Packet Request

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

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 Group Medicare  An overview of plan benefits

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

Evidence of Coverage for Peoples Health Group Medicare – 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

Why Medicare Advantage?

Peoples Health Group Medicare is a Medicare Advantage HMO plan with a POS option, which lets you see providers who are not in our provider network. Not all services received from out-of-network providers are covered.

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’s 2019 Medicare Advantage plans offer more benefits than ever before. 

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. The Peoples Health Group Medicare plan includes Part D drug coverage.

If you’re a member of a participating employer or retiree group and live in the plan’s service area determined individually by each group,  you may be eligible to enroll in Peoples Health Group Medicare. Not part of an employer or retiree group? 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.

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