Peoples Health Choices (PPO)
H4544-01
A Preferred Provider Organization plan with out-of-network coverage and Part D prescription drug coverage. Available in all Louisiana parishes.
$0
Primary Care
Physician visit
$50/quarter
Over-the-Counter
Health Related Items
$0
Dental Exams, Cleaning & X-rays
$0
Primary Care
Physician visit
$50/quarter
Over-the-Counter
Health Related Items
$0
Dental Exams, Cleaning & X-rays
Request a Free Medicare Information Kit
Get your FREE Medicare information kit, including these must-have guides: the 2022 Peoples Health Plan Overview and 8 Things You Need to Know About Medicare. Together, these booklets can help you better understand your coverage options under Medicare.
Plan Highlights
The costs for the health care services listed below are from network providers.Â
$0 Primary
Care Visits
$50 Over-the-Counter
Allowance per Quarter
$0
Hearing Aids
$0 Tier 1 & 2Â
Drug Coverage*
$0
Dental Exams,
Cleanings & X-rays
$0 Meals
after Inpatient
Hospital Stay
$0
Eyeglasses
or Contacts
$0
Fitness Center
Membership
*$0 Tier 2 drugs available by preferred mail-order on 90-day supplies.
Plan Benefits
| Peoples Health Choices (PPO) | Your Cost | Out-of-Network |
| Monthly Plan Premium | $0 | $0 |
| Doctor Visits & NurseLine | ||
| Primary Care Physician Visit | $0 | $20 |
| Specialist Visit | $35 | $55 |
| Virtual Medical Visit | $0 | $0 through contracted provider |
| 24-Hour NurseLine | $0 | $0 (provided by NurseLine) |
| Preventive Care+ | ||
| Pap Smears, Pelvic Exams and Mammograms | $0 | 30% coinsurance |
| Prostate and Colorectal Cancer Screenings | $0 | 30% coinsurance |
| Vaccinations (flu, pneumonia, hepatitis B, COVID-19) | $0 | $0 |
| Labs and Tests+ | ||
| Lab Services | $0 | $0 |
| Diagnostic Tests | $40 | 30% coinsurance |
| X-rays | $12 | $20 |
| Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.) | $175 | 30% coinsurance |
| Outpatient Surgery | ||
| Surgery (outpatient hospital or ambulatory surgical center) | $225 | 30% coinsurance |
| Inpatient Hospital Care per admission | ||
| Inpatient Deductible | $0 | $0 |
| Inpatient Stay | $225 per day for days 1-7; $0 for days 8 & beyond | 30% coinsurance per stay |
| Emergency Care, Urgent Care & Emergency Transportation^ | ||
| Emergency Care | $90 | $90 |
| Urgently Needed Care | $40 | $40 |
| Emergency Ambulance Services per one-way trip (ground or air) | $275 | $275 |
| Worldwide (out of USA) Emergency Care, Urgent Care and Emergency Transportation (to nearest facility) | N/A | $0 |
| Home Health & Skilled Nursing Facility Care | ||
| Home Health | $0 | 50% coinsurance |
| Skilled Nursing Facility Care per day (Semiprivate room and board) | $0 for days 1-20 $188 for days 21-56 $0 for days 57-100 | $225 for days 1-45 $0 for days 46-100 |
| Outpatient Services and Supplies | ||
| Occupational, Physical or Speech Therapy Visit | $20 | $40 |
| Durable Medical Equipment - DME (wheelchairs, oxygen, etc.) | 20% coinsurance | 50% coinsurance |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider) | $0 | 50% coinsurance |
| Mental Health and Substance Abuse Treatment | ||
| Inpatient Mental Health | $225 per day for days 1-7 $0 for days 8-90 | 30% coinsurance per stay |
| Outpatient Mental Health or Substance Abuse Group or Individual Visit | $15 group $25 individual | $30 group $40 individual |
| Virtual Mental Health or Virtual Substance Abuse Treatment Visit | $0 | $0 through contracted provider |
| +Office visit copay may apply. ^Emergency care copay waived if admitted to inpatient hospital care within 24 hours for the same condition. Authorization is required for certain services. See the Provider Directory for network lab and diagnostic providers. | ||
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 on tiers 1, 2, 3 and 4 are available at retail pharmacies and by mail order.
| Initial Coverage Stage | 30-Day Supply | 90-Day Supply |
| Tier 1 (with coverage through the gap) | $0 | $0 |
| Tier 2 (with coverage through the gap) | $10 | $0 (preferred mail order) |
| Tier 3 | $45 | $135 |
| Tier 4 | $100 | $300 |
| Tier 5 | 33% coinsurance | 30-day supply only |
| Peoples Health Choices (PPO) | Your Cost |
| Over-the-Counter Items | |
| $50 Allowance per quarter | $0 |
| Meals After Inpatient Hospital Stay | |
| 2 meals per day for up to 5 days | $0 |
| Hearing Services (provided through the TruHearing network) | |
| Hearing Aids (up to $500 per ear) | $0 |
| Vision Services | |
| Routine Eye Exam | $0 |
| Glasses or Contact Lenses (up to $200 in coverage) | $0 |
| Dental – $500 Coverage Maximum | |
| Dental - Preventive (1 set of X-rays and 2 exams and cleanings per year) | $0 |
| Dental - Comprehensive (fillings, etc.) | $0; no deductible |
| Fitness | |
| Fitness Center Membership | $0 |
Notes:
Authorization is required for certain services.
Doctor and Hospital Coverage
| Peoples Health Choices (PPO) | Your Cost | Out-of-Network |
| Monthly Plan Premium | $0 | $0 |
| Doctor Visits & NurseLine | ||
| Primary Care Physician Visit | $0 | $20 |
| Specialist Visit | $35 | $55 |
| Virtual Medical Visit | $0 | $0 through contracted provider |
| 24-Hour NurseLine | $0 | $0 (provided by NurseLine) |
| Preventive Care+ | ||
| Pap Smears, Pelvic Exams and Mammograms | $0 | 30% coinsurance |
| Prostate and Colorectal Cancer Screenings | $0 | 30% coinsurance |
| Vaccinations (flu, pneumonia, hepatitis B, COVID-19) | $0 | $0 |
| Labs and Tests+ | ||
| Lab Services | $0 | $0 |
| Diagnostic Tests | $40 | 30% coinsurance |
| X-rays | $12 | $20 |
| Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.) | $175 | 30% coinsurance |
| Outpatient Surgery | ||
| Surgery (outpatient hospital or ambulatory surgical center) | $225 | 30% coinsurance |
| Inpatient Hospital Care per admission | ||
| Inpatient Deductible | $0 | $0 |
| Inpatient Stay | $225 per day for days 1-7; $0 for days 8 & beyond | 30% coinsurance per stay |
| Emergency Care, Urgent Care & Emergency Transportation^ | ||
| Emergency Care | $90 | $90 |
| Urgently Needed Care | $40 | $40 |
| Emergency Ambulance Services per one-way trip (ground or air) | $275 | $275 |
| Worldwide (out of USA) Emergency Care, Urgent Care and Emergency Transportation (to nearest facility) | N/A | $0 |
| Home Health & Skilled Nursing Facility Care | ||
| Home Health | $0 | 50% coinsurance |
| Skilled Nursing Facility Care per day (Semiprivate room and board) | $0 for days 1-20 $188 for days 21-56 $0 for days 57-100 | $225 for days 1-45 $0 for days 46-100 |
| Outpatient Services and Supplies | ||
| Occupational, Physical or Speech Therapy Visit | $20 | $40 |
| Durable Medical Equipment - DME (wheelchairs, oxygen, etc.) | 20% coinsurance | 50% coinsurance |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider) | $0 | 50% coinsurance |
| Mental Health and Substance Abuse Treatment | ||
| Inpatient Mental Health | $225 per day for days 1-7 $0 for days 8-90 | 30% coinsurance per stay |
| Outpatient Mental Health or Substance Abuse Group or Individual Visit | $15 group $25 individual | $30 group $40 individual |
| Virtual Mental Health or Virtual Substance Abuse Treatment Visit | $0 | $0 through contracted provider |
| +Office visit copay may apply. ^Emergency care copay waived if admitted to inpatient hospital care within 24 hours for the same condition. Authorization is required for certain services. See the Provider Directory for network lab and diagnostic providers. | ||
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.
| Initial Coverage Stage | 30-Day Supply | 90-Day Supply |
| Tier 1 (with coverage through the gap) | $0 | $0 |
| Tier 2 (with coverage through the gap) | $10 | $0 (preferred mail order) |
| Tier 3 | $45 | $135 |
| Tier 4 | $100 | $300 |
| Tier 5 | 33% coinsurance | 30-day supply only |
Additional Benefits
| Peoples Health Choices (PPO) | Your Cost |
| Over-the-Counter Items | |
| $50 Allowance per quarter | $0 |
| Meals After Inpatient Hospital Stay | |
| 2 meals per day for up to 5 days | $0 |
| Hearing Services (provided through the TruHearing network) | |
| Hearing Aids (up to $500 per ear) | $0 |
| Vision Services | |
| Routine Eye Exam | $0 |
| Glasses or Contact Lenses (up to $200 in coverage) | $0 |
| Dental – $500 Coverage Maximum | |
| Dental - Preventive (1 set of X-rays and 2 exams and cleanings per year) | $0 |
| Dental - Comprehensive (fillings, etc.) | $0; no deductible |
| Fitness | |
| Fitness Center Membership | $0 |
Notes:
Authorization is required for certain services.
Find Doctors, Medications & More
Find Doctors, Medications & More
Important Documents
Plan Overview for Peoples Health Choices  – An overview of plan benefits
Annual Notice of Changes for Peoples Health Choices – A summary of plan benefit changes compared to the previous year and other important plan details
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
Online
Enrolling online only takes about 20 minutes. You’ll need your red, white and blue Medicare card to complete the online application.Â
By Phone
TTY users may call 711.
A plan representative will help you.
By Appointment
TTY users may call 711.
A sales representative will schedule an appointment with you.
By Mail
Write to us and request an enrollment packet. The address is:
Peoples Health ChoicesÂ
Three Lakeway Center
3838 N. Causeway Blvd.
Suite 2500
Metairie, LA 70002
Extra Help
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.
| YOUR LEVEL OF EXTRA HELP | MONTHLY PREMIUM FOR PEOPLES HEALTH CHOICES (PPO)* |
| 100% | $0 |
| 75% | $0 |
| 50% | $0 |
| 25% | $0 |
*This does not include any Medicare Part B premium you may have to pay.