Peoples Health Choices Gold (HMO-POS)
H1961-017
A Medicare Advantage plan with Part D prescription drug coverage. Available in the following parishes:
Acadia, Bossier, Caddo, Calcasieu, Cameron, Evangeline, Iberia, Lafayette, Ouachita, St. Landry, St. Martin, Vermilion
$0
Primary Care
Physician visit
$50/quarter
Over-the-Counter
Health Related Items
$0
Dental Exams, Cleanings & X-rays
$0
Primary Care
Physician visit
$50/quarter
Over-the-Counter
Health Related Items
$0
Dental Exams, Cleanings & X-rays
Request a Free Medicare Information Kit
Get your FREE Medicare information kit, including these must-have guides: the 2023 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.
You asked for more. We listened!
Now it’s easier than ever to picture yourself with Peoples Health. Every year, we look for ways to take care of our members better. The enhancements we’ve made for 2023 are designed to do just that. Look for:
More doctors
We've added more doctors to our Louisiana network.
More dentists & more dental coverage
We've added 95% more network dental locations^, and all plans now feature out-of-network dental coverage, a $0 deductible, $0 restorative services and an expanded list of covered services.*
More eye doctors
We've more than doubled our network of vision providers.
More savings
For many of our plans, there are lower copays and bigger allowances for select services, as well as lower maximum out-of-pocket costs.
More flexibility
Use our new retail card for over-the-counter health & wellness purchases. Also enjoy a retail option to get diabetes testing supplies at local network pharmacies.
^ Compared to 2022 Peoples Health network.
* Point-of-service (POS) option allows out-of-network dental services. Those out-of-network services may have a higher cost to members. Dental coverage maximums vary by plan.
Plan Highlights
$0 Primary
Care Visits
$50 Over-the-Counter
Allowance per Quarter
$0 Respite
Care Services
$0 Tier 1 & 2
Drug Coverage*
$0
Dental Exams,
Cleanings & X-rays
$0 Meals
After Inpatient
Hospital Stay
$0
Eyeglasses
or Contacts
One Pass™
Fitness†
*$0 Tier 2 drugs available by preferred mail-order as a 100-day supply.
†One Pass is a trademark of Optum, Inc. and/or its affiliates. © 2022 Optum, Inc.
Plan Benefits
The benefits below are available with this Medicare Advantage plan. For a full list of benefits, please see the Evidence of Coverage for this plan.
| Peoples Health Choices Gold (HMO-POS) | Your Cost |
| Monthly Plan Premium | $0 |
| Part B Premium Give Back | Does not apply |
| Doctor Visits & NurseLine | |
| Primary Care Physician Visit | $0 |
| Specialist Visit | $30 |
| 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 & X-rays | $0 |
| Diagnostic Tests | $10 |
| Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.) | $80 |
| Outpatient Surgery | |
| Surgery (outpatient hospital or ambulatory surgical center) | $250 |
| Inpatient Hospital Care perAdmission | |
| Inpatient Deductible | $0 |
| Inpatient Stay per Day, for Days 1-10 | $195 |
| Inpatient Stay for Days 11 and Beyond | $0 |
| Emergency Care, Urgent Care & Emergency Transportation^ | |
| Emergency Care | $90 |
| Urgently Needed Care | $40 |
| Emergency Ambulance Services per one-way trip (ground or air) | $250 |
| 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 $196 per day, for days 21-100 |
| Outpatient Services & Supplies | |
| Occupational, Physical or Speech Therapy Visit | $20 |
| Durable Medical Equipment - DME (wheelchairs, oxygen, etc.) | 20% coinsurance |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider or retail pharmacy) | $0 |
| Mental Health & Substance Abuse Treatment | |
| Inpatient Mental Health Care per Day | $195 for days 1-9 $0 for days 10-90 |
| Outpatient Mental Health Group or Individual Visit | $40 |
| Outpatient Substance Abuse Group or Individual Visit | $40 |
| Virtual Mental Health or 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. ++You will pay a $0 copay for all Part D covered vaccines, including Shingrix, from network providers. *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. 100-day supplies of maintenance medications on tiers 1, 2, 3 and 4 are available at retail pharmacies and by mail order.
You will pay a maximum of $35 for each 1-month supply of Part D select insulin drugs through all coverage stages
You will pay a $0 copay for all Part D covered vaccines, including Shingrix.
| Initial Coverage Stage | 30-Day Supply | 100-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 Gold (HMO-POS) | Your Cost |
| Over-the-Counter Items | |
| $50 allowance per Quarter | $0 |
| Meals After Inpatient Hospital Stay | |
| Up to 28 Meals over 14 Days | $0 |
| Vision Services | |
| Routine Eye Exam | $0 |
| Glasses or Contact Lenses (one pair per year - $200 Allowance) | $0 |
| Hearing Services | |
| Hearing Aids | Starting at $175 |
| Routine Hearing Exam | $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 - $1,250 Coverage Maximum | |
| Dental - Preventive (X-rays, cleanings, exams, fluoride - coverage frequency varies) | $0 |
| Dental - Comprehensive (fillings, crowns, bridges, dentures, etc.) | $0 |
| Fitness | |
| One Pass™ Fitness Membership (health clubs, online classes, brain health exercises and more) | $0 |
Notes:
Costs listed are based on use of network providers.
Authorization is required for certain services.
Doctor and Hospital Coverage
| Peoples Health Choices Gold (HMO-POS) | Your Cost |
| Monthly Plan Premium | $0 |
| Part B Premium Give Back | Does not apply |
| Doctor Visits & NurseLine | |
| Primary Care Physician Visit | $0 |
| Specialist Visit | $30 |
| 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 & X-rays | $0 |
| Diagnostic Tests | $10 |
| Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.) | $80 |
| Outpatient Surgery | |
| Surgery (outpatient hospital or ambulatory surgical center) | $250 |
| Inpatient Hospital Care perAdmission | |
| Inpatient Deductible | $0 |
| Inpatient Stay per Day, for Days 1-10 | $195 |
| Inpatient Stay for Days 11 and Beyond | $0 |
| Emergency Care, Urgent Care & Emergency Transportation^ | |
| Emergency Care | $90 |
| Urgently Needed Care | $40 |
| Emergency Ambulance Services per one-way trip (ground or air) | $250 |
| 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 $196 per day, for days 21-100 |
| Outpatient Services & Supplies | |
| Occupational, Physical or Speech Therapy Visit | $20 |
| Durable Medical Equipment - DME (wheelchairs, oxygen, etc.) | 20% coinsurance |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider or retail pharmacy) | $0 |
| Mental Health & Substance Abuse Treatment | |
| Inpatient Mental Health Care per Day | $195 for days 1-9 $0 for days 10-90 |
| Outpatient Mental Health Group or Individual Visit | $40 |
| Outpatient Substance Abuse Group or Individual Visit | $40 |
| Virtual Mental Health or 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. ++You will pay a $0 copay for all Part D covered vaccines, including Shingrix, from network providers. *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. 100-day supplies of maintenance medications on tiers 1, 2, 3 and 4 are available at retail pharmacies and by mail order.
You will pay a maximum of $35 for each 1-month supply of Part D select insulin drugs through all coverage stages
You will pay a $0 copay for all Part D covered vaccines, including Shingrix.
| Initial Coverage Stage | 30-Day Supply | 100-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 Gold (HMO-POS) | Your Cost |
| Over-the-Counter Items | |
| $50 allowance per Quarter | $0 |
| Meals After Inpatient Hospital Stay | |
| Up to 28 Meals over 14 Days | $0 |
| Vision Services | |
| Routine Eye Exam | $0 |
| Glasses or Contact Lenses (one pair per year - $200 Allowance) | $0 |
| Hearing Services | |
| Hearing Aids | Starting at $175 |
| Routine Hearing Exam | $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 - $1,250 Coverage Maximum | |
| Dental - Preventive (X-rays, cleanings, exams, fluoride - coverage frequency varies) | $0 |
| Dental - Comprehensive (fillings, crowns, bridges, dentures, etc.) | $0 |
| Fitness | |
| One Pass™ Fitness Membership (health clubs, online classes, brain health exercises and more) | $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 Gold – An overview of plan benefits
Annual Notice of Changes for Peoples Health Choices Gold – A summary of plan benefit changes compared to the previous year and other important plan details
Evidence of Coverage for Peoples Health Choices Gold – 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 Gold – A general summary of plan benefits
Vendor Information – A listing of providers offering benefit-related services
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
Call 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 plan representative will help you. You can also request an enrollment packet.
By Appointment
Call 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.
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 Gold (HMO-POS)’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 GOLD (HMO-POS)* |
| 100% | $0 |
| 75% | $0 |
| 50% | $0 |
| 25% | $0 |
*This does not include any Medicare Part B premium you may have to pay.