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SALES: 1-800-978-9765 (TTY:711)
MEMBER SERVICES: 1-800-222-8600 (TTY:711)
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Peoples Health Choices (PPO)

$0

Monthly
Plan
Premium

Peoples Health Choices is a Preferred Provider Organization plan with out-of-network coverage and Part D prescription drug coverage.

Peoples Health Choices is a Preferred Provider Organization plan with out-of-network coverage and Part D prescription drug coverage.

Available in the following parishes

• Acadia
• Ascension
• Assumption
• Bossier
• Caddo
• Calcasieu
• Cameron

• East Baton Rouge
• East Feliciana
• Evangeline
• Iberia
• Iberville
• Jefferson
• Lafayette

• Lafourche
• Livingston
• Orleans
• Ouachita
• Plaquemines
• Pointe Coupee
• St. Bernard

• St. Charles
• St. Helena
• St. James
• St. John
• St. Landry
• St. Martin
• St. Mary

• St. Tammany
• Tangipahoa
• Terrebonne
• Vermilion
• Washington
• West Baton Rouge
• West Feliciana

Available in the Following Parishes

Acadia, Ascension, Assumption, Bossier, Caddo, Calcasieu, Cameron, East Baton Rouge, East Feliciana, Evangeline, Iberia, Iberville, Jefferson, Lafayette, Lafourche, Livingston, Orleans, Ouachita,  Plaquemines, Pointe Coupee, St. Bernard, St. Charles, St. Helena, St. James, St. John the Baptist, St. Landry, St. Martin, St. Mary, St. Tammany, Tangipahoa, Terrebonne, Vermilion, Washington, West Baton Rouge, West Feliciana

Plan Highlights

Plan Highlights

NEW FOR 2021: Preferred Provider Organization plan featuring out-of-network coverage.

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$5 PCP In-Network

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$50/Quarter Over-the-Counter Items

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$0 Tier 1 Drugs

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.

Peoples Health Choices (PPO) Your Cost
Monthly Plan Premium $0
In-network Out-of-network
Doctor Visits & NurseLine
Primary Care Physician Visit $5 $25
Specialist Visit $35 $55
Virtual Medical Visit $0 In-network provider must be used for the out-of-network benefit
24-Hour NurseLine $0 $0 (provided by NurseLine)
Preventive Care+
Pap Smears, Pelvic Exams, Mammograms $0 40% coinsurance
Prostate & Colorectal Cancer Screenings $0
Vaccinations (flu, pneumonia, hepatitis B) $0 $0
Labs & Tests*+
Lab Services $0 $0
Diagnostic Tests $20 40% coinsurance
X-Rays $15 $20
Advanced Imaging $110 40% coinsurance
Outpatient Surgery (Outpatient Hospital or Ambulatory Surgical Center)
Outpatient Surgery $110 40% coinsurance
Inpatient Hospital Care per admission
Inpatient Deductible $0 40% coinsurance
Inpatient Stay per day, for days 1 - 7 $225 40% coinsurance
Inpatient Stay for days 8 and beyond $0 40% coinsurance
Emergency Care, Urgent Care & Emergency Transportation♦
Emergency Care $90 $90
Urgent Care $30 $40
Emergency Ambulance $250 $250
Worldwide Coverage
Worldwide Emergency Care, Urgent Care and Emergency Transportation (to nearest facility) Does not apply $0
Home Health & Skilled Nursing Facility Care
Home Health $0 50% coinsurance
Skilled Nursing Facility Care $0 for days 1-20
$184 per day, for days 21-57
$0 for days 58-100
$225 per day, for days 1-45
$0 for days 46-100
Outpatient Services & Supplies
Occupational, Physical or Speech Therapy Visit $35 $55
Durable Medical Equipment - DME (wheelchairs, oxygen, etc.) 20% coinsurance 50% coinsurance
Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider) $0 40% coinsurance
Mental Health & Substance Abuse Treatment
Inpatient Mental Health $225 per day, for days 1-7
$0 for days 8-90
40% coinsurance
Outpatient Mental Health or Substance Abuse Group or Individual Visit $15 group
$25 individual
$30 group
$40 individual
Virtual Mental Health or Substance Abuse Treatment Visit $0 In-network provider must be used for the out-of-network benefit

 

Notes:

Authorization is required for certain services.

*See the Provider Directory for network lab and diagnostic providers.

+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-name drugs have partial coverage through the gap. 90-day supplies of maintenance medications for drugs on tiers 1-4 are available at retail pharmacies and by mail order.

*With coverage through the gap
**$100 deductible applies

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

Peoples Health Choices (PPO) Your Cost
Monthly Plan Premium $0
In-network Out-of-network
Doctor Visits & NurseLine
Primary Care Physician Visit $5 $25
Specialist Visit $35 $55
Virtual Medical Visit $0 In-network provider must be used for the out-of-network benefit
24-Hour NurseLine $0 $0 (provided by NurseLine)
Preventive Care+
Pap Smears, Pelvic Exams, Mammograms $0 40% coinsurance
Prostate & Colorectal Cancer Screenings $0
Vaccinations (flu, pneumonia, hepatitis B) $0 $0
Labs & Tests*+
Lab Services $0 $0
Diagnostic Tests $20 40% coinsurance
X-Rays $15 $20
Advanced Imaging $110 40% coinsurance
Outpatient Surgery (Outpatient Hospital or Ambulatory Surgical Center)
Outpatient Surgery $110 40% coinsurance
Inpatient Hospital Care per admission
Inpatient Deductible $0 40% coinsurance
Inpatient Stay per day, for days 1 - 7 $225 40% coinsurance
Inpatient Stay for days 8 and beyond $0 40% coinsurance
Emergency Care, Urgent Care & Emergency Transportation♦
Emergency Care $90 $90
Urgent Care $30 $40
Emergency Ambulance $250 $250
Worldwide Coverage
Worldwide Emergency Care, Urgent Care and Emergency Transportation (to nearest facility) Does not apply $0
Home Health & Skilled Nursing Facility Care
Home Health $0 50% coinsurance
Skilled Nursing Facility Care $0 for days 1-20
$184 per day, for days 21-57
$0 for days 58-100
$225 per day, for days 1-45
$0 for days 46-100
Outpatient Services & Supplies
Occupational, Physical or Speech Therapy Visit $35 $55
Durable Medical Equipment - DME (wheelchairs, oxygen, etc.) 20% coinsurance 50% coinsurance
Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider) $0 40% coinsurance
Mental Health & Substance Abuse Treatment
Inpatient Mental Health $225 per day, for days 1-7
$0 for days 8-90
40% coinsurance
Outpatient Mental Health or Substance Abuse Group or Individual Visit $15 group
$25 individual
$30 group
$40 individual
Virtual Mental Health or Substance Abuse Treatment Visit $0 In-network provider must be used for the out-of-network benefit

Notes:
Authorization is required for certain services.

*See the Provider Directory for network lab and diagnostic providers.

+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 for drugs on tiers 1-4 are available at retail pharmacies and by mail order.

*With coverage through the gap
**$100 deductible applies

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  – An overview of plan benefits

Evidence of Coverage for Peoples Health Choices – 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 – 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 1-800-978-9765, seven days a week, from 8 a.m. to 8 p.m.

TTY users may call 711.

A plan representative will help you.

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HOW DO I ENROLL BY APPOINTMENT?

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.

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HOW DO I ENROLL BY MAIL?

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

Peoples Health Choices Enrollment Packet Request

Three Lakeway Center
3838 N. Causeway Blvd.
Suite 2500
Metairie, LA 70002

Extra Help

Peoples Health Choices 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 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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