Peoples Health Secure Health (HMO D-SNP)
H1961-003
A 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
$42/month
Over-the-Counter
& Food Retail Card
$0
Up to 48
One-Way Trips
$0
Primary Care
Physician visit
$42/month
Over-the-Counter
& Food Retail Card
$0
Up to 48
One-Way Trips
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.
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.
• 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
Plan Highlights
$0 Primary
Care Visits
$42/month
Combined OTC &
Food Retail Card
$0
Hearing Aids
$0
Up to 48 one-way trips
$0
Dental Exams,
Cleanings & X-rays
$0 Meals
after Inpatient
Hospital Stay
$0
Eyeglasses
or Contacts
$0
Fitness Center
Membership
Plan Benefits
| Peoples Health Secure Health (HMO D-SNP) | Your Cost |
| Monthly Plan Premium* | $0 |
| Doctor Visits & NurseLine | |
| Primary Care Physician Visit | $0 |
| Specialist Visit | $0 or $10 |
| 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 | $0 |
| Advanced Imaging (MRI, MRA, CT, PET scans, etc.) | $0 or $75 |
| 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 or $75 |
| Inpatient Stay for days 11 and beyond | $0 |
| Emergency Care, Urgent Care & Emergency Transportation^ | |
| Emergency Care | $0 or $50 |
| Urgent Care | $0 |
| Emergency Ambulance Services (ground or air) | $0 or $75 |
| Worldwide (out of USA) Emergency Care, Urgent Care and Emergency Transportation (to nearest facility) | $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 $0 or $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 or $75 per day, days 1-10 $0 for days 11-90 |
| Outpatient Mental Health Visit | $0 or $10 |
| Outpatient Substance Abuse Visit | $0 or $10 |
| Virtual Mental Health or Substance Abuse Treatment Visit | $0 |
| *This plan's premium is paid by Medicare's Extra Help program. +Office visit copay may apply. ^Emergency care copay waived if admitted to inpatient hospital care within 24 hours for the same condition Costs listed are based on use of network providers. Authorization is required for certain services. | |
| 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 Health (HMO D-SNP) | Your Cost |
| Over-the-Counter Items | |
| $42 (every month) Combined OTC & Food Retail Card | $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 (provided through the TruHearing network) | |
| Hearing Aids (up to $500 per ear, per year) | $0 |
| Nonemergency Transportation (such as trips to and from your doctor's office) | |
| Up to 48 one-way trips | $0 |
| 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 |
| Dental - $2,000 Coverage Maximum ($0 deductible) | |
| Dental - Preventive (1 fluoride treatment, 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.
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 or $10 |
| 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 | $0 |
| Advanced Imaging (MRI, MRA, CT, PET scans, etc.) | $0 or $75 |
| 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 or $75 |
| Inpatient Stay for days 11 and beyond | $0 |
| Emergency Care, Urgent Care & Emergency Transportation^ | |
| Emergency Care | $0 or $50 |
| Urgent Care | $0 |
| Emergency Ambulance Services (ground or air) | $0 or $75 |
| Worldwide (out of USA) Emergency Care, Urgent Care and Emergency Transportation (to nearest facility) | $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 $0 or $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 or $75 per day, days 1-10 $0 for days 11-90 |
| Outpatient Mental Health Visit | $0 or $10 |
| Outpatient Substance Abuse Visit | $0 or $10 |
| Virtual Mental Health or Substance Abuse Treatment Visit | $0 |
| *This plan's premium is paid by Medicare's Extra Help program. +Office visit copay may apply. ^Emergency care copay waived if admitted to inpatient hospital care within 24 hours for the same condition Costs listed are based on use of network providers. Authorization is required for certain services. | |
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 Health (HMO D-SNP) | Your Cost |
| Over-the-Counter Items | |
| $42 (every month) Combined OTC & Food Retail Card | $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 (provided through the TruHearing network) | |
| Hearing Aids (up to $500 per ear, per year) | $0 |
| Nonemergency Transportation (such as trips to and from your doctor's office) | |
| Up to 48 one-way trips | $0 |
| 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 |
| Dental - $2,000 Coverage Maximum ($0 deductible) | |
| Dental - Preventive (1 fluoride treatment, 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.
Find Doctors, Medications & More
Find Doctors, Medications & More
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
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 Secure Health
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 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% | $9.10 |
| 50% | $18.20 |
| 25% | $27.30 |
*This does not include any Medicare Part B premium you may have to pay.