Peoples Health Secure Choice (HMO D-SNP)
H1961-011
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.
$0
Primary Care
Physician visit
$0
Specialist
Visit
$0
Meals After
Inpatient Hospital Stay
$0
Primary Care
Physician visit
$0
Specialist
Visit
$0
Meals After
Inpatient Hospital Stay
Available in the Following Parishes
Allen, Avoyelles, Beauregard, Bienville, Caldwell, Catahoula, Claiborne, Concordia, DeSoto, East Carroll, Franklin, Grant, Jackson, Jefferson Davis, LaSalle, Lincoln, Madison, Morehouse, Natchitoches, Rapides, Red River, Richland, Sabine, Tensas, Union, Vernon, Webster, West Carroll, Winn.
• Allen
• Avoyelles
• Beauregard
• Bienville
• Caldwell
• Catahoula
• Claiborne
• Concordia
• DeSoto
• East Carroll
• Franklin
• Grant
• Jackson
• Jefferson Davis
• LaSalle
• Lincoln
• Madison
• Morehouse
• Natchitoches
• Rapides
• Red River
• Richland
• Sabine
• Tensas
• Union
• Vernon
• Webster
• West Carroll
• Winn
Plan Benefits
| Peoples Health Secure Choice (HMO D-SNP) | Your Cost |
| Monthly Plan Premium* | $0 |
| Doctor Visits & NurseLine | |
| Primary Care Physician Visit | $0 |
| Specialist Visit | $0 |
| 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 | |
| Diagnostic radiology services (e.g. MRI) | $0 or $0 - 20% coinsurance, depending on the service |
| Lab services | $0 |
| Diagnostic tests and procedures | $0 - 20% coinsurance |
| Therapeutic Radiology | $0 - 20% coinsurance |
| Outpatient X-rays | $0 - 20% coinsurance |
| Outpatient Surgery | |
| Surgery (outpatient hospital or ambulatory surgical center) | $0 or $0 - 15% coinsurance, depending on the service |
| Inpatient Hospital Care per admission | |
| Inpatient Hospital Stay | $0 - $1,480 per stay (or the 2022 Original Medicare Part A deductible amount, whichever is less). Our plan covers an unlimited number of days for an inpatient hospital stay. |
| Emergency Care, Urgent Care & Emergency Transportation^ | |
| Emergency Care | $0 - $90 ($0 for worldwide coverage) |
| Urgent Care | $0 - $65 ($0 for worldwide coverage) |
| Emergency Ambulance | $0 - 20% coinsurance |
| Home Health & Skilled Nursing Facility Care | |
| Home Health | $0 |
| Skilled Nursing Facility Care | $0 for days 1-20 Up to $185.50** per day, for days 21-100 |
| Outpatient Services & Supplies | |
| Occupational, Physical or Speech Therapy Visit | $0 |
| Durable Medical Equipment - DME (wheelchairs, oxygen, etc.) | $0 - 20% coinsurance |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider) | $0 - 20% coinsurance |
| Mental Health & Substance Abuse Treatment | |
| Inpatient Mental Health | $0 - $1,480 per stay (or the 2022 Original Medicare Part A deductible amount, whichever is less). Our plan covers 90 days for an inpatient hospital stay. |
| Outpatient Mental Health Visit | $0 - $10 |
| Outpatient Substance Abuse Visit | $0 - $40 |
| Virtual Mental Health or Substance Abuse Treatment Visit | $0 |
+Office visit copay may apply.
^Emergency care copay waived if admitted to inpatient hospital care within 24 hours for the same condition
*This plan’s premium is paid by Medicare’s Extra Help program.
**These are the 2021 cost sharing amounts and may change for 2022. We will provide updated rates as soon as they are released.
^Emergency care copay waived if admitted to inpatient hospital care within 24 hours for
| Medicare Part D Prescription Drugs 30-day or 90-day supply from a retail network pharmacy |
| All Covered Drugs: $0 |
| 90-day supplies of maintenance drugs available at retail pharmacies and by mail order. Specialty drugs limited to a 30-day supply. |
| Peoples Health Secure Choice (HMO D-SNP) | Your Cost |
| Meals After Inpatient Hospital Stay | |
| 3 meals per day, for up to 7 days | $0 |
Notes:
Costs listed are based on use of network providers.
Authorization is required for certain services.
Doctor and Hospital Coverage
| Peoples Health Secure Choice (HMO D-SNP) | Your Cost |
| Monthly Plan Premium* | $0 |
| Doctor Visits & NurseLine | |
| Primary Care Physician Visit | $0 |
| Specialist Visit | $0 |
| 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 | |
| Diagnostic radiology services (e.g. MRI) | $0 or $0 - 20% coinsurance, depending on the service |
| Lab services | $0 |
| Diagnostic tests and procedures | $0 - 20% coinsurance |
| Therapeutic Radiology | $0 - 20% coinsurance |
| Outpatient X-rays | $0 - 20% coinsurance |
| Outpatient Surgery | |
| Surgery (outpatient hospital or ambulatory surgical center) | $0 or $0 - 15% coinsurance, depending on the service |
| Inpatient Hospital Care per admission | |
| Inpatient Hospital Stay | $0 - $1,480 per stay (or the 2022 Original Medicare Part A deductible amount, whichever is less). Our plan covers an unlimited number of days for an inpatient hospital stay. |
| Emergency Care, Urgent Care & Emergency Transportation^ | |
| Emergency Care | $0 - $90 ($0 for worldwide coverage) |
| Urgent Care | $0 - $65 ($0 for worldwide coverage) |
| Emergency Ambulance | $0 - 20% coinsurance |
| Home Health & Skilled Nursing Facility Care | |
| Home Health | $0 |
| Skilled Nursing Facility Care | $0 for days 1-20 Up to $185.50** per day, for days 21-100 |
| Outpatient Services & Supplies | |
| Occupational, Physical or Speech Therapy Visit | $0 |
| Durable Medical Equipment - DME (wheelchairs, oxygen, etc.) | $0 - 20% coinsurance |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider) | $0 - 20% coinsurance |
| Mental Health & Substance Abuse Treatment | |
| Inpatient Mental Health | $0 - $1,480 per stay (or the 2022 Original Medicare Part A deductible amount, whichever is less). Our plan covers 90 days for an inpatient hospital stay. |
| Outpatient Mental Health Visit | $0 - $10 |
| Outpatient Substance Abuse Visit | $0 - $40 |
| Virtual Mental Health or Substance Abuse Treatment Visit | $0 |
+Office visit copay may apply.
^Emergency care copay waived if admitted to inpatient hospital care within 24 hours for the same condition
*This plan’s premium is paid by Medicare’s Extra Help program.
**These are the 2021 cost sharing amounts and may change for 2022. We will provide updated rates as soon as they are released.
^Emergency care copay waived if admitted to inpatient hospital care within 24 hours for
Part D Prescription Drug Coverage
| Medicare Part D Prescription Drugs 30-day or 90-day supply from a retail network pharmacy |
| All Covered Drugs: $0 |
| 90-day supplies of maintenance drugs available at retail pharmacies and by mail order. Specialty drugs limited to a 30-day supply. |
Additional Benefits
| Peoples Health Secure Choice (HMO D-SNP) | Your Cost |
| Meals After Inpatient Hospital Stay | |
| 3 meals per day, for up to 7 days | $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
Annual Notice of Changes for Peoples Health Secure Choice – A summary of plan benefit changes compared to the previous year and other important plan details
Evidence of Coverage for Peoples Health Secure Choice – 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 Choice – A general summary of plan benefits
Vendor Information – A listing of providers offering benefit-related services for your plan
2022 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 Secure Choice
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 Secure Choice’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 CHOICE (HMO D-SNP) * |
| 100% | $0 |
| 75% | $8.50 |
| 50% | $17.00 |
| 25% | $25.50 |
*This does not include any Medicare Part B premium you may have to pay.