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crossed bandages iconOver-the-Counter Health & Wellness Items

$40 every quarter on health-related items and nonprescription medications

Peoples Health covers certain over-the-counter medications and health and wellness products

money1

Over-the-Counter Health & Wellness Items

$40 every quarter on health-related items and nonprescription medications

Peoples Health covers certain over-the-counter medications and health and wellness products

Peoples Health Choices Gold (HMO-POS) | 2020

A Medicare Advantage plan with a $0 monthly plan premium and +MORE benefits than Original Medicare.

Get these benefits +MORE!

$0 round icon

PRIMARY CARE
PHYSICIAN VISITS

$40 round icon

SPECIALIST
VISITS

$0 round icon

DENTAL EXAMS
& CLEANINGS

$0 round icon

TIER 1
GENERIC DRUGS

$0 round icon

FITNESS CLUB
MEMBERSHIP

$0 round icon

EYEGLASSES OR
CONTACTS

Peoples Health Choices Gold (HMO-POS) | 2020

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

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

Peoples Health Choices Gold 2020 Medicare Advantage plan parish map

Looking for 2019 plan information? Click here.

+MORE Plan Benefits

Over-the-Counter
Health and Wellness Items

clear crossed bandages icon

Health-related items and nonprescription medications: $0 

Peoples Health covers certain over-the-counter medications and health and wellness products – up to $40 every quarter from our network mail-order provider.

Meals After
Hospital Stays

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Two meals a day for five days after an inpatient hospital stay: $0

Good nutrition is important for your recovery and we want you to get well.

Respite
Care Services

hug (1)

4-hour session: $0

Short-term relief for caregivers of plan members with dementia, including Alzheimer’s disease. Coverage for up to 12 four-hour respite care sessions per year.

Hearing Aid
Coverage

ear-lobe-side-view-outline

Hearing Aid Exam for Evaluation and Fitting: $0 | Hearing Aids: $0

Up to two hearing aids (one per ear) each year, up to a maximum of $1,000 for both aids combined.

Virtual
Visits

virtual_visits3

The Doctor Will “See” You Now
Virtual Visits: $0

When you need care — anytime, day or night — virtual visits can be a great option. From treating colds and fevers to caring for migraines and allergies, you can connect with a doctor using your computer or mobile device.

Explore Plan Benefits

Doctor and Hospital Coverage

PEOPLES HEALTH CHOICES GOLDIN NETWORKOUT OF NETWORK
Monthly Plan Premium$0N/A
Doctor Visits
Primary Care Physician Visit$0Not covered
Virtual Visit$0Not covered
Specialist Visit$4030% 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 Ambulatory Surgical Center or Outpatient Hospital
Outpatient Surgery$25030% coinsurance
Inpatient Hospital Care per admission
Inpatient Deductible$0$0
Hospital Stay$195 per day for days 1-10
$0 per day for days 11 and beyond
30% coinsurance
Worldwide Emergency and Urgent Care♦
Emergency Care - Copay waived if admitted$90$90
Urgently Needed Care$40$40
Emergency Transportation per one-way trip
Emergency Ambulance Services (ground or air)$26030% 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
$16530% coinsurance
Outpatient Services and Supplies
Occupational, Physical or Speech Therapy Visit$2030% coinsurance
Durable Medical Equipment (DME)
(wheelchairs, oxygen, etc.)
20% coinsurance30% coinsurance
Diabetes Monitoring Supplies
(test strips, monitor, etc. from a preferred DME provider)
$030% coinsurance
Mental Health and Substance Abuse Treatment
Inpatient Mental Health Care$195 per day for days 1-9
$0 per day for days 10-90
30% coinsurance
Outpatient Mental Health or Substance Abuse Treatment Office Visit$4030% coinsurance

 

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 vary based on location of service.

+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 are available at retail pharmacies and by mail order.

 30-DAY SUPPLY AT A NETWORK PHARMACY90-DAY SUPPLY AT A NETWORK PHARMACY
Tier 1 $0$0
Tier 2$10$0
preferred mail order
Tier 3$45$135
Tier 4$100$300
Tier 533% coinsurance33% coinsurance

Additional Benefits –  Not Covered by Original Medicare

PEOPLES HEALTH CHOICES GOLDIN NETWORKOUT OF NETWORK
Over-the-Counter Health and Wellness Items
$40 Allowance (every quarter by mail order)$0Not covered
Meals
Meals After Hospital Stays (up to two meals per day for five days after an inpatient hospital stay)$0Not covered
Vision Services
Routine Eye Exam$35Not covered
Eyeglasses or Contact Lenses
(one pair per year)
$0Not covered
Hearing Aid Services*
Hearing Aid Exam for Evaluation and Fitting
Click here for more information
$0Not covered
Hearing Aids (up to one per ear, max of $1,000 for both)
Click here for more information
$0Not covered
Dental - up to $1,250 in coverage
Oral Exams and Cleanings (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 for members with Alzheimer’s or dementia
Up to 12 respite care sessions per year
(each session can be up to four hours)
$0Not covered
Fitness
Health Club Membership$0Not covered

Notes:

*Hearing aid services provided through the TruHearing network.

Costs listed are based on use of network providers.

Authorization is required for certain services.

Explore Plan Benefits

Doctor and Hospital Coverage

PEOPLES HEALTH CHOICES GOLDIN NETWORKOUT OF NETWORK
Monthly Plan Premium$0N/A
Doctor Visits
Primary Care Physician Visit$0Not covered
Virtual Visit$0Not covered
Specialist Visit$4030% 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 Ambulatory Surgical Center or Outpatient Hospital
Outpatient Surgery$25030% coinsurance
Inpatient Hospital Care per admission
Inpatient Deductible$0$0
Hospital Stay$195 per day for days 1-10
$0 per day for days 11 and beyond
30% coinsurance
Worldwide Emergency and Urgent Care♦
Emergency Care - Copay waived if admitted$90$90
Urgently Needed Care$40$40
Emergency Transportation per one-way trip
Emergency Ambulance Services (ground or air)$26030% 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
$16530% coinsurance
Outpatient Services and Supplies
Occupational, Physical or Speech Therapy Visit$2030% coinsurance
Durable Medical Equipment (DME)
(wheelchairs, oxygen, etc.)
20% coinsurance30% coinsurance
Diabetes Monitoring Supplies
(test strips, monitor, etc. from a preferred DME provider)
$030% coinsurance
Mental Health and Substance Abuse Treatment
Inpatient Mental Health Care$195 per day for days 1-9
$0 per day for days 10-90
30% coinsurance
Outpatient Mental Health or Substance Abuse Treatment Office Visit$4030% coinsurance

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 PHARMACY90-DAY SUPPLY AT A NETWORK PHARMACY
Tier 1 $0$0
Tier 2$10$0
preferred mail order
Tier 3$45$135
Tier 4$100$300
Tier 533% coinsurance33% coinsurance

Additional Benefits

PEOPLES HEALTH CHOICES GOLDIN NETWORKOUT OF NETWORK
Over-the-Counter Health and Wellness Items
$40 Allowance (every quarter by mail order)$0Not covered
Meals
Meals After Hospital Stays (up to two meals per day for five days after an inpatient hospital stay)$0Not covered
Vision Services
Routine Eye Exam$35Not covered
Eyeglasses or Contact Lenses
(one pair per year)
$0Not covered
Hearing Aid Services*
Hearing Aid Exam for Evaluation and Fitting
Click here for more information
$0Not covered
Hearing Aids (up to one per ear, max of $1,000 for both)
Click here for more information
$0Not covered
Dental - up to $1,250 in coverage
Oral Exams and Cleanings (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 for members with Alzheimer’s or dementia
Up to 12 respite care sessions per year
(each session can be up to four hours)
$0Not covered
Fitness
Health Club Membership$0Not covered
Notes:

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

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).

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

2020 Peoples Health choices gold plan 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:

Medicare PARTS A & B

N

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

END-STAGE RENAL DISEASE

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

PART B PREMIUM

N

Continue to pay your Medicare Part B premium

PLAN’S SERVICE AREA

N

Live in the plan’s service area, which includes the following Louisiana parishes: Acadia, Bossier, Caddo, Calcasieu, Cameron, Evangeline, Iberia, Lafayette, Ouachita, St. Landry, St. Martin, Vermilion

How to Enroll

ENROLL ONLINE

hands on laptop keyboard

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

patient consulting with physician

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 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 for 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.

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 (1-800-633-4227), 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 6 p.m. (TTY users call 1-800-220-5404), or
  • 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 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

l

ENROLL

We will send you written confirmation of your enrollment in the mail.

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.

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.

COMPREHENSIVE WELLNESS ASSESSMENT

We schedule a health evaluation at no cost through the Peoples Health Comprehensive Wellness Assessment Program. This assessment helps us understand your health needs and allows us to better work together to coordinate your care.

Why Medicare Advantage?

Peoples Health Choices Gold is a Medicare Advantage HMO 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). 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 the New Orleans and Baton Rouge areas. 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 up to $40 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. 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.

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