Peoples Health Choices 65 (HMO) Greater New Orleans and Baton Rouge Area
H1961-014-001
A Medicare Advantage plan with Part D prescription drug coverage. Available in the following parishes: Ascension, East Baton Rouge, East Feliciana, Iberville, Jefferson, Livingston, Orleans, St. Charles, St. Helena, West Baton Rouge
Part B Premium
Give Back
$80/quarter
Over-the-Counter
Health Related Items
$0
Primary Care
Physician visit
$0
Primary Care
Physician visit
$30/month
Part B Premium
GiveBack
$80/quarter
Over-the-Counter
Health Related Items
Plan Highlights
$0 Primary
Care Visits
$80 Over-the-Counter
Allowance per quarter
$30/month Part B Premium Give Back
$0 Tier 1 & 2
Drug Coverage*
$0
Dental Exams,
Cleanings & X-rays
$0
Hearing
Aids
$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 65 (HMO) Greater New Orleans and Baton Rouge Area | Your Cost |
| Monthly Plan Premium | $0 |
| Part B Premium Give Back | $30 per month back to you |
| Doctor Visits & NurseLine | |
| Primary Care Physician Visit | $0 |
| Specialist Visit | $25 |
| 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, COVID-19) | $0 |
| Labs & Tests*+ | |
| Lab Services | $0 |
| Diagnostic Tests and X-rays (at contracted radiology facility) | $0 |
| Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.) | $90 |
| Outpatient Surgery | |
| Surgery (outpatient hospital or ambulatory surgical center) | $125 |
| Inpatient Hospital Care per admission | |
| Inpatient Deductible | $0 |
| Inpatient Stay per day for days 1 - 10 | $85 |
| Inpatient Stay for days 11 and beyond | $0 |
| Home Health & Skilled Nursing Facility Care | |
| Home Health | $0 |
| Skilled Nursing Facility Care per day (Semiprivate room and board) | $0 for days 1-20 $188 for days 21-100 |
| Emergency Care, Urgent Care & Emergency Transportation^ | |
| Emergency Care | $90 |
| Urgently Needed Care | $20 |
| Emergency Ambulance Services per one-way trip (ground or air) | $255 |
| Worldwide (out of USA) Emergency Care, Urgent Care and Emergency Transportation (to nearest facility) | $0 |
| Outpatient Services & Supplies | |
| Occupational, Physical or Speech Therapy Visit | $10 |
| Durable Medical Equipment - DME (wheelchairs, oxygen, etc.) | 20% coinsurance |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a preferred provider) | $0 |
| Mental Health & Substance Abuse Treatment | |
| Inpatient Mental Health per day | $85 for days 1-10 $0 for days 11-90 |
| Outpatient Mental Health Group or Individual Visit | $20 |
| Outpatient Substance Abuse Group or Individual Visit | $25 |
| Virtual Mental Health or Virtual Substance Abuse Treatment Visit | $0 |
| Costs listed are based on use of network providers Authorization is required for certain services. +Office visit copay may apply. *X-rays at network locations other than a radiology facility may have higher out-of-pocket costs. ^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 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 65 (HMO) Greater New Orleans and Baton Rouge Area | Your Cost |
| Over-the-Counter Items | |
| $80 allowance per quarter | $0 |
| Meals After Inpatient Hospital Stay | |
| 2 meals per day, for up to 5 days | $0 |
| Vision Services | |
| Routine Eye Exam | $20 |
| Glasses or Contact Lenses (one pair per year) | $0 |
| Hearing Services (provided through the TruHearing network) | |
| Hearing Aids (up to $500 per ear) | $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.) | Copays vary; $50 deductible applies |
| Respite Care | |
| Members diagnosed with dementia may be eligible for a maximum of 12 respite care sessions per year from the network respite care provider | $0 |
| Fitness | |
| Fitness Center Membership | $0 |
Notes:
Costs listed are based on use of network providers.
Authorization is required for certain services.
Doctor and Hospital Coverage
| Peoples Health Choices 65 (HMO) Greater New Orleans and Baton Rouge Area | Your Cost |
| Monthly Plan Premium | $0 |
| Part B Premium Give Back | $30 per month back to you |
| Doctor Visits & NurseLine | |
| Primary Care Physician Visit | $0 |
| Specialist Visit | $25 |
| 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, COVID-19) | $0 |
| Labs & Tests*+ | |
| Lab Services | $0 |
| Diagnostic Tests and X-rays (at contracted radiology facility) | $0 |
| Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.) | $90 |
| Outpatient Surgery | |
| Surgery (outpatient hospital or ambulatory surgical center) | $125 |
| Inpatient Hospital Care per admission | |
| Inpatient Deductible | $0 |
| Inpatient Stay per day for days 1 - 10 | $85 |
| Inpatient Stay for days 11 and beyond | $0 |
| Home Health & Skilled Nursing Facility Care | |
| Home Health | $0 |
| Skilled Nursing Facility Care per day (Semiprivate room and board) | $0 for days 1-20 $188 for days 21-100 |
| Emergency Care, Urgent Care & Emergency Transportation^ | |
| Emergency Care | $90 |
| Urgently Needed Care | $20 |
| Emergency Ambulance Services per one-way trip (ground or air) | $255 |
| Worldwide (out of USA) Emergency Care, Urgent Care and Emergency Transportation (to nearest facility) | $0 |
| Outpatient Services & Supplies | |
| Occupational, Physical or Speech Therapy Visit | $10 |
| Durable Medical Equipment - DME (wheelchairs, oxygen, etc.) | 20% coinsurance |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a preferred provider) | $0 |
| Mental Health & Substance Abuse Treatment | |
| Inpatient Mental Health per day | $85 for days 1-10 $0 for days 11-90 |
| Outpatient Mental Health Group or Individual Visit | $20 |
| Outpatient Substance Abuse Group or Individual Visit | $25 |
| Virtual Mental Health or Virtual Substance Abuse Treatment Visit | $0 |
| Costs listed are based on use of network providers Authorization is required for certain services. +Office visit copay may apply. *X-rays at network locations other than a radiology facility may have higher out-of-pocket costs. ^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.
| 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 65 (HMO) Greater New Orleans and Baton Rouge Area | Your Cost |
| Over-the-Counter Items | |
| $80 allowance per quarter | $0 |
| Meals After Inpatient Hospital Stay | |
| 2 meals per day, for up to 5 days | $0 |
| Vision Services | |
| Routine Eye Exam | $20 |
| Glasses or Contact Lenses (one pair per year) | $0 |
| Hearing Services (provided through the TruHearing network) | |
| Hearing Aids (up to $500 per ear) | $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.) | Copays vary; $50 deductible applies |
| Respite Care | |
| Members diagnosed with dementia may be eligible for a maximum of 12 respite care sessions per year from the network respite care provider | $0 |
| Fitness | |
| Fitness Center Membership | $0 |
Notes:
Costs listed are based on use of network providers.
Authorization is required for certain services.
Find Doctors, Medications & More
Find Doctors, Medications & More
Important Documents
Plan Overview for Peoples Health Choices 65 – An overview of plan benefits
For members with permanent residence in East Baton Rouge, Jefferson or Orleans parish:
Annual Notice of Changes for Peoples Health Choices 65 Greater New Orleans and Baton Rouge Area – A summary of plan benefit changes compared to the previous year and other important plan details
For members with permanent residence in Ascension, East Feliciana, Iberville, Livingston, St. Charles, St. Helena or West Baton Rouge parish:
Annual Notice of Changes for Peoples Health Choice 65 Rural Southeast to Greater New Orleans and Baton Rouge Area – A summary of plan benefit changes compared to the previous year and other important plan details
Evidence of Coverage for Peoples Health Choices 65 – 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 – A general summary of plan benefits
Vendor Information – A listing of providers offering benefit-related services for your plan
2022 Medicare Star Ratings Summary (Coming Soon)
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.
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 Choices 65
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 65 ‘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 Health Choices 65 (HMO) Greater New Orleans and Baton Rouge Area* |
| 100% | $0 |
| 75% | $0 |
| 50% | $0 |
| 25% | $0 |
*This does not include any Medicare Part B premium you may have to pay.