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Peoples Health Choices (PPO) | 2023

H4544-01

A Preferred Provider Organization plan with out-of-network coverage and Part D prescription drug coverage. Available in all Louisiana parishes.

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Doctor_Blue

$0
Primary Care
Physician visit

Pharmacist_Blue

$50/quarter
Over-the-Counter
Health Related Items

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$0
Dental Exams, Cleanings & X-rays

plan_premium_blue
Doctor_Blue

$0
Primary Care
Physician visit

Pharmacist_Blue

$50/quarter
Over-the-Counter
Health Related Items

Money-Stack_Blue

$0
Dental Exams, Cleanings & X-rays

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.
*Out-of-network dental services may have a higher cost to members.

Plan Highlights

The costs for the health care services listed below are from network providers. 

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$0 Primary
Care Visits

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$50 Over-the-Counter
Allowance per Quarter

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$0 Respite
Care Services

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$0 Tier 1 & 2 
Drug Coverage*

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$0
Dental Exams,
Cleanings & X-rays

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$0 Meals
After Inpatient
Hospital Stay

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$0
Eyeglasses
or Contacts

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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.

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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.

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Doctor and Hospital Coverage

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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.

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Additional Benefits

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Important Documents

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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 

2023  Medicare Star Ratings Summary

Extra Help

2022 Quick Guide C651-Choices-Patriot_male
2022 Quick Guide C651-Choices-Patriot_bfemale
2022 Quick Guide C651-Choices-Patriot_hmale
2022 Quick Guide C651-Choices-Patriot_afemale

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 (PPO)’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.

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*This does not include any Medicare Part B premium you may have to pay.

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