Peoples Health Secure Health (HMO D-SNP)
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Monthly
Plan
Premium
The Peoples Health Secure Health (HMO D-SNP) plan is a health plan with Part D drug coverage for people with Medicare and medical assistance from the state. This is a Medicare Special Needs Plan for people who also have Medicaid at levels ranging from the state paying your Part A or B premium to full Medicaid benefits.
The Peoples Health Secure Health (HMO D-SNP) plan is a health plan with Part D drug coverage for people with Medicare and medical assistance from the state. This is a Medicare Special Needs Plan for people who also have Medicaid at levels ranging from the state paying your Part A or B premium to full Medicaid benefits.
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
A Medicare health plan for people with medical assistance from the state (FBDE, QDWI, QI, QMB, QMB+, SLMB, SLMB+) and Medicare. This plan includes Part D drug coverage and a $160 per quarter allowance for over-the-counter health & wellness items.
$0 PCP
$160/Quarter Over-the-Counter Items
$0/Meals After Inpatient Hospital Stay
$0 Hearing Aids
$0 Eyeglasses or contacts
$0 Dental Exams & Cleanings
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 Secure Health (HMO D-SNP) | Your Cost |
| Monthly Plan Premium | $0 |
| Doctor Visits & NurseLine | |
| Primary Care Physician Visit | $0 |
| Specialist Visit | $0 - $20 |
| Virtual Medical Visit | $0 |
| 24-Hour NurseLine | $0 |
| Preventive Care+ | |
| Pap Smears, Pelvic Exams, Mammograms | $0 |
| Prostate & Colorectal Cancer Screenings | $0 |
| Vaccinations (flu, pneumonia, hepatitis B) | $0 |
| Labs & Tests*+ | |
| Lab Services | $0 |
| Diagnostic Tests and X-rays | $0 |
| Advanced Imaging (MRI, MRA, CT, PET scans, etc.) | $0 or $0 - $75, depending on the service |
| Outpatient Surgery | |
| Surgery (outpatient hospital or ambulatory surgical center) | $0 |
| Inpatient Hospital Care per admission | |
| Inpatient Deductible | $0 |
| Inpatient Stay per day, for days 1 - 10 | $0 - $75 |
| Inpatient Stay for days 11 and beyond | $0 |
| Emergency Care, Urgent Care & Emergency Transportation♦ | |
| Emergency Care | $0 - $50 |
| Urgent Care | $0 |
| Emergency Ambulance | $0 - $75 |
| Worldwide Emergency Care, Urgent Care and Emergency Transportation (to nearest facility) | $0 |
| Home Health & Skilled Nursing Facility Care | |
| Home Health | $0 |
| Skilled Nursing Facility Care | $0 for days 1-20 $0 - $100 per day, for days 21-100 |
| Outpatient Services & Supplies | |
| Occupational, Physical or Speech Therapy Visit | $0 |
| Durable Medical Equipment - DME (wheelchairs, oxygen, etc.) | $0 |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider) | $0 |
| Mental Health & Substance Abuse Treatment | |
| Inpatient Mental Health | $0 - $75 per day, days 1-10 $0 for days 11-90 |
| Outpatient Mental Health Visit | $0 - $10 |
| Outpatient Substance Abuse Visit | $0 - $10 |
| Virtual Mental Health or Substance Abuse Treatment Visit | $0 |
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.
+Office visit copay may apply.
♦Emergency care copay waived if admitted to inpatient hospital care within 24 hours for the same condition.
| Medicare Part D Prescription Drugs 30-DAY SUPPLY or 90-DAY SUPPLY AT A NETWORK PHARMACY | |
| Your deductible amount is either $0 or $92, depending on the level of “Extra Help” you receive. | |
| Generic Drugs (including brands treated as generics) | $0, $1.30, $3.70 copay, or 15% of the total cost. Some covered drugs limited to a 30-day supply. |
| All Other Drugs | $0, $4, $9.20 copay, or 15% of the total cost. Some covered drugs limited to a 30-day supply. |
| 90-day supplies of most maintenance drugs available at retail pharmacies and by mail order. Specialty drugs limited to a 30-day supply. |
| Peoples Health Secure Health (HMO D-SNP) | Your Cost |
| Over-the-Counter Health and Wellness Items | |
| $160 Allowance per quarter | $0 |
| Meals After Inpatient Hospital Stay | |
| 3 meals per day, for up to 7 days | $0 |
| Vision Services | |
| Routine Eye Exam | $0 |
| Eyeglasses or Contact Lenses (one pair per year) | $0 |
| Hearing Services* | |
| Hearing Aids (up to $500 per ear, per year) | $0 |
| Dental - $2,000 Coverage Maximum | |
| Dental - Preventive (1 set of X-rays and 2 exams and cleanings per year) | $0 |
| Dental - Comprehensive (fillings, dentures, etc.) | $0 |
| Fitness | |
| Fitness Center Membership | $0 |
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 Secure Health (HMO D-SNP) | Your Cost |
| Monthly Plan Premium | $0 |
| Doctor Visits & NurseLine | |
| Primary Care Physician Visit | $0 |
| Specialist Visit | $0 - $20 |
| Virtual Medical Visit | $0 |
| 24-Hour NurseLine | $0 |
| Preventive Care+ | |
| Pap Smears, Pelvic Exams, Mammograms | $0 |
| Prostate & Colorectal Cancer Screenings | $0 |
| Vaccinations (flu, pneumonia, hepatitis B) | $0 |
| Labs & Tests*+ | |
| Lab Services | $0 |
| Diagnostic Tests and X-rays | $0 |
| Advanced Imaging (MRI, MRA, CT, PET scans, etc.) | $0 or $0 - $75, depending on the service |
| Outpatient Surgery | |
| Surgery (outpatient hospital or ambulatory surgical center) | $0 |
| Inpatient Hospital Care per admission | |
| Inpatient Deductible | $0 |
| Inpatient Stay per day, for days 1 - 10 | $0 - $75 |
| Inpatient Stay for days 11 and beyond | $0 |
| Emergency Care, Urgent Care & Emergency Transportation♦ | |
| Emergency Care | $0 - $50 |
| Urgent Care | $0 |
| Emergency Ambulance | $0 - $75 |
| Worldwide Emergency Care, Urgent Care and Emergency Transportation (to nearest facility) | $0 |
| Home Health & Skilled Nursing Facility Care | |
| Home Health | $0 |
| Skilled Nursing Facility Care | $0 for days 1-20 $0 - $100 per day, for days 21-100 |
| Outpatient Services & Supplies | |
| Occupational, Physical or Speech Therapy Visit | $0 |
| Durable Medical Equipment - DME (wheelchairs, oxygen, etc.) | $0 |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider) | $0 |
| Mental Health & Substance Abuse Treatment | |
| Inpatient Mental Health | $0 - $75 per day, days 1-10 $0 for days 11-90 |
| Outpatient Mental Health Visit | $0 - $10 |
| Outpatient Substance Abuse Visit | $0 - $10 |
| Virtual Mental Health or Substance Abuse Treatment Visit | $0 |
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.
+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
| Medicare Part D Prescription Drugs 30-DAY SUPPLY or 90-DAY SUPPLY AT A NETWORK PHARMACY | |
| Your deductible amount is either $0 or $92, depending on the level of “Extra Help” you receive. | |
| Generic Drugs (including brands treated as generics) | $0, $1.30, $3.70 copay, or 15% of the total cost. Some covered drugs limited to a 30-day supply. |
| All Other Drugs | $0, $4, $9.20 copay, or 15% of the total cost. Some covered drugs limited to a 30-day supply. |
| 90-day supplies of most maintenance drugs available at retail pharmacies and by mail order. Specialty drugs limited to a 30-day supply. |
Additional Benefits
| Peoples Health Secure Health (HMO D-SNP) | Your Cost |
| Over-the-Counter Health and Wellness Items | |
| $160 Allowance per quarter | $0 |
| Meals After Inpatient Hospital Stay | |
| 3 meals per day, for up to 7 days | $0 |
| Vision Services | |
| Routine Eye Exam | $0 |
| Eyeglasses or Contact Lenses (one pair per year) | $0 |
| Hearing Services* | |
| Hearing Aids (up to $500 per ear, per year) | $0 |
| Dental - $2,000 Coverage Maximum | |
| Dental - Preventive (1 set of X-rays and 2 exams and cleanings per year) | $0 |
| Dental - Comprehensive (fillings, dentures, etc.) | $0 |
| Fitness | |
| Fitness Center Membership | $0 |
Notes:
Costs listed are based on use of network providers. Authorization is required for certain services.
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Important Documents
Plan Overview for Peoples Health Secure Health – An overview of plan benefits
Annual Notice of Changes for Peoples Health Secure Health– A summary of plan benefit changes compared to the previous year and other important plan details
Evidence of Coverage for Peoples Health Secure Health – Information about plan benefits, membership, covered and noncovered services, member rights and responsibilities, and other important plan details
Summary of Benefits for Peoples Health Secure Health– A general summary of plan benefits
Vendor Information – A listing of providers offering benefit-related services for your plan
How to Enroll
HOW DO I ENROLL ONLINE?
Enrolling only takes 20 minutes.
HOW DO I ENROLL BY PHONE?
TTY users may call 711.
A plan representative will help you.
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.
HOW DO I ENROLL BY MAIL?
Write to us and request an enrollment packet. The address is:
Peoples Health Secure Health Enrollment Packet Request
Three Lakeway Center
3838 N. Causeway Blvd. Suite 2200
Metairie, LA 70002
Extra Help
Peoples Health Secure Health 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 Secure Health’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.
| YOUR LEVEL OF EXTRA HELP | MONTHLY PREMIUM FOR PEOPLES SECURE HEALTH (HMO D-SNP) * |
| 100% | $0.00 |
| 75% | $8.60 |
| 50% | $17.20 |
| 25% | $25.70 |
*This does not include any Medicare Part B premium you may have to pay.