PEOPLES HEALTH SECURE CHOICE #011 (HMO SNP) | 2019

Peoples Health Secure Choice #011

A Medicare Advantage special needs plan designed for people with both Medicare and medical assistance from the state or Medicaid.

Blue circle with $0With this plan, you pay a $0 monthly plan premium and enjoy a long list of benefits, including Part D prescription drug coverage, with coverage through the gap. Plus, you get a Peoples Health  member ID card that’s widely accepted and easy to use.

Blue circle with $0Peoples Health Secure Choice #011

A Medicare Advantage special needs plan designed for people with both Medicare and medical assistance from the state or Medicaid.

With this plan, you pay a $0 monthly plan premium and enjoy a long list of benefits, including Part D prescription drug coverage (with no coverage gap). Plus, you get a Peoples Health  member ID card that’s widely accepted and easy to use.

Plan Highlights for 2019

$0

PRIMARY CARE PHYSICIAN VISIT

$0

SPECIALIST VISIT

Part D

PRESCRIPTION DRUG COVERAGE

Explore Plan Benefits

Doctor and Hospital Coverage

Peoples Health Secure Choice #011Your Cost
Monthly Plan Premium$0
Inpatient Care
Inpatient Hospital CareThe amounts for each benefit period are $0* or:
– $1,364* deductible
– $0* per day for days 1-60
– $341* per day for days 61-90
– $682* per day for 60 lifetime reserve days
Inpatient Mental Health CareThe amounts for each benefit period are $0* or:
– $1,364* deductible
– $0* per day for days 1-60
– $341* per day for days 61-90
– $682* per day for 60 lifetime reserve days
Skilled Nursing Facility Care (Semiprivate Room and Board)For each benefit period you pay $0* or:
– $0* per day for days 1-20
– $170.50* per day for days 21-100
Labs and Tests
Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.)$0 or 20% coinsurance*
Outpatient Care
Primary Care Physician Office Visit$0
Specialist Visit $0
Outpatient Mental Health or Substance Abuse Treatment Visit$0 or $10* for outpatient mental health visit
$0 or $40* for substance abuse visit
Outpatient Surgery (Outpatient Hospital Facility or Ambulatory Surgical Center)$0 or 15%* coinsurance
Emergency Ambulance Services$0 or 20%* coinsurance for each one-way trip
Emergency Care (within the U.S. and its territories)$0 or 20%* coinsurance (up to $75); waived if admitted to inpatient hospital care within three days for the same condition
Urgently Needed Care (within the U.S. and its territories)$0 or 20%* coinsurance (up to $65); waived if admitted to inpatient hospital care within three days for the same condition
Occupational, Physical or Speech Therapy Visit (Medicare limits apply)$0
Outpatient Medical Services and Supplies
Durable Medical Equipment (DME) (wheelchairs, oxygen, etc.)$0 or 20%* coinsurance
Home Health Care$0
Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider)$0 or 20%* coinsurance
Lab Services
$0 at a lab provider or outpatient hospital contracted to provide lab services to Peoples Health plan members; $0 or 20%* coinsurance at other locations
Diagnostic Tests and X-rays$0 or 20%* coinsurance
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

Notes:

Authorization is required for certain services.

Costs listed are based on use of network providers.

*Cost-sharing varies based on your level of Louisiana Medicaid coverage.

Part D Prescription Drug Coverage

 FOR A 30-DAY SUPPLY or 90-DAY SUPPLY AT A NETWORK PHARMACY
Your plan has a $415 deductible for prescription drug coverage; however, because you receive extra help, Medicare pays this deductible on your behalf. Copays vary based on the level of extra help you receive. Please contact the plan for further details.
Generic drugs$0, $1.25 or $3.40
Brand drugs$0, $3.80 or $8.50

Additional Benefits – Not Covered by Original Medicare

Peoples Health Secure Choice #011Your Cost
Meals After Hospital Stays (three meals per day for seven days after an inpatient hospital stay)$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 Secure Choice #011 Evidence of Coverage.

Explore Plan Benefits

Doctor and Hospital Coverage
Peoples Health Secure Choice #011Your Cost
Monthly Plan Premium$0
Inpatient Care
Inpatient Hospital CareThe amounts for each benefit period are $0* or:
– $1,364* deductible
– $0* per day for days 1-60
– $341* per day for days 61-90
– $682* per day for 60 lifetime reserve days
Inpatient Mental Health CareThe amounts for each benefit period are $0* or:
– $1,364* deductible
– $0* per day for days 1-60
– $341* per day for days 61-90
– $682* per day for 60 lifetime reserve days
Skilled Nursing Facility Care (Semiprivate Room and Board)For each benefit period you pay $0* or:
– $0* per day for days 1-20
– $170.50* per day for days 21-100
Labs and Tests
Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.)$0 or 20% coinsurance*
Outpatient Care
Primary Care Physician Office Visit$0
Specialist Visit $0
Outpatient Mental Health or Substance Abuse Treatment Visit$0 or $10* for outpatient mental health visit
$0 or $40* for substance abuse visit
Outpatient Surgery (Outpatient Hospital Facility or Ambulatory Surgical Center)$0 or 15%* coinsurance
Emergency Ambulance Services$0 or 20%* coinsurance for each one-way trip
Emergency Care (within the U.S. and its territories)$0 or 20%* coinsurance (up to $75); waived if admitted to inpatient hospital care within three days for the same condition
Urgently Needed Care (within the U.S. and its territories)$0 or 20%* coinsurance (up to $65); waived if admitted to inpatient hospital care within three days for the same condition
Occupational, Physical or Speech Therapy Visit (Medicare limits apply)$0
Outpatient Medical Services and Supplies
Durable Medical Equipment (DME) (wheelchairs, oxygen, etc.)$0 or 20%* coinsurance
Home Health Care$0
Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider)$0 or 20%* coinsurance
Lab Services
$0 at a lab provider or outpatient hospital contracted to provide lab services to Peoples Health plan members; $0 or 20%* coinsurance at other locations
Diagnostic Tests and X-rays$0 or 20%* coinsurance
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
Notes:

Authorization is required for certain services.

Costs listed are based on use of network providers.

*Cost-sharing varies based on your level of Louisiana Medicaid coverage.

Part D Prescription Drug Coverage

 FOR A 30-DAY SUPPLY or 90-DAY SUPPLY AT A NETWORK PHARMACY
Your plan has a $415 deductible for prescription drug coverage; however, because you receive extra help, Medicare pays this deductible on your behalf. Copays vary based on the level of extra help you receive. Please contact the plan for further details.
Generic drugs$0, $1.25 or $3.40
Brand drugs$0, $3.80 or $8.50

Additional Benefits

Peoples Health Secure Choice #011Your Cost
Meals After Hospital Stays (three meals per day for seven days after an inpatient hospital stay)$0

For a detailed list of all plan benefits, click here to download the 2019 Peoples Health Secure Choice #011 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).

Medicaid Benefits

Peoples Health Secure Choice #011 members have coverage from both Medicare and Medicaid. These members receive their Medicare health care and prescription drug coverage through Peoples Health Secure Choice #011.

They are also eligible to receive additional health care services and coverage through Louisiana MedicaidClick here for more information on providers who participate in Louisiana Medicaid. For detailed information about Louisiana Medicaid benefits, please visit the Medicaid website and select the Learn about Medicaid Services link.

Eligibility Guidelines

State map of Louisiana with Secure Choice #011 parishes highlighted
Determining if you’re eligible to enroll in Peoples Health Secure Choice #011 is easy. If you meet the following Medicare enrollment requirements, you’re eligible to become a member of this plan:

N
Have medical assistance from the state or Louisiana Medicaid

N
Be enrolled in Medicare Part A and 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, unless otherwise paid for you by the state or another third party

N
Live in the plan’s service area, which includes the following Louisiana parishes: Allen, Avoyelles, Beauregard, Bienville, Caldwell, Catahoula, Claiborne, Concordia, DeSoto, East Carroll, Franklin, Grant, Jackson, Jefferson Davis, LaSalle, Lincoln, Madison, Morehouse, Natchitoches, Rapides, Red River, Richland, Sabine, Tensas, Union, Vernon, Webster, West Carroll, Winn

How to Enroll

ENROLL ONLINE

Hands on a laptop
Enrolling only takes about 20 minutes.

ENROLL BY PHONE

Senior woman on phone
Call toll-free at 1-800-978-9765, Monday through Friday, from 8 a.m. to 8 p.m. TTY users may call 711. A plan representative will help you.

ENROLL BY APPOINTMENT

senior couple meeting with 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 a mailbox
Write to us and request an enrollment packet. The address is:

Peoples Health Secure Choice #011 Enrollment Packet Request

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

Extra Help

Peoples Health Secure Choice #011 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 Secure Choice #011’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 SECURE CHOICE #011*
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.

 

Annual Notice of Changes for Peoples Health Secure Choice #011 – A summary of plan benefit changes compared to the previous year and other important plan details

Evidence of Coverage for Peoples Health Secure Choice #011 – 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 Secure Choice #011 – A general summary of plan benefits

Why Medicare Advantage?

Peoples Health Secure Choice #011 is a Medicare Advantage HMO SNP plan with a $0 monthly plan 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). 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. Peoples Health Secure Choice #011 includes Part D drug coverage at no additional cost per month!

If you live in one of the following Louisiana parishes, you may be eligible to enroll in Peoples Health Secure Choice #011: Allen, Avoyelles, Beauregard, Bienville, Caldwell, Catahoula, Claiborne, Concordia, DeSoto, East Carroll, Franklin, Grant, Jackson, Jefferson Davis, LaSalle, Lincoln, Madison, Morehouse, Natchitoches, Rapides, Red River, Richland, Sabine, Tensas, Union, Vernon, Webster, West Carroll, Winn. Do you live in a different Louisiana parish? Shop our other Medicare Advantage plans.

*The plan’s monthly premium of $33.10 is paid by Medicare’s Extra Help program. The Medicare Part B premium is paid by the state of Louisiana. You must continue to pay your Medicare Part B premium if not paid by the state or another third party.