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Peoples Health Choices 65 (HMO) Northshore

St. Tammany, Tangipahoa, Washington

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Monthly
Plan
Premium

The Peoples Health Choices 65 (HMO) Northshore plan is a Medicare Advantage Prescription Drug plan with a Part B premium Give Back (we pay a portion of your monthly Medicare Part B premium for you) and a quarterly allowance for over-the-counter health & wellness items.

The Peoples Health Choices 65 (HMO) Northshore plan is a Medicare Advantage Prescription Drug plan with a Part B premium Give Back (we pay a portion of your monthly Medicare Part B premium for you) and a quarterly allowance for over-the-counter health & wellness items.

Plan Highlights

Plan Highlights

Coordinated care through our extensive network of providers. This plan features health and drug coverage, over-the-counter health & wellness items, plus a monthly Give Back – we pay part of your Medicare Part B premium for you.

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$0 PCP

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$40/Quarter Over-the-Counter Items

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$10 Give Back

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$0 Tier 1 Drugs

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$0 Dental Exams & Cleanings

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$0 Eyeglasses or contacts

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$0 Fitness Club Membership

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$0 Hearing Aids

Plan Benefits

The benefits below are available with this Medicare Advantage plan.  To see a full list of benefits, please see the Evidence of Coverage for this plan.

 

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. 

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.

*With coverage through the gap

Notes:

*Hearing aid services provided through the TruHearing network.

Costs listed are based on use of network providers.

Authorization is required for certain services.

Plan Benefits

Doctor and Hospital Coverage

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.

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.

*With coverage through the gap

Additional Benefits


Notes:

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

Important Documents

Shot of a african senior couple reading document with laptop at home

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

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

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

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

Vendor Information – A listing of providers offering benefit-related services for your plan

How to Enroll

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HOW DO I ENROLL ONLINE?

Enrolling only takes 20 minutes.

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HOW DO I ENROLL BY PHONE?

Call toll-free at 1-866-687-7335, seven days a week, from 8 a.m. to 8 p.m.

TTY users may call 711.

A plan representative will help you.

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HOW DO I ENROLL BY APPOINTMENT?

Call us toll-free at 1-866-687-7335, 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.

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HOW DO I ENROLL BY MAIL?

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

Peoples Health Choices 65 Northshore Enrollment Packet Request
Three Lakeway Center
3838 N. Causeway Blvd. Suite 2200
Metairie, LA 70002

Extra Help

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

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, (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.

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

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