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Member services: 1-800-222-8600 (TTY:711)
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We have (9) plans available.
Peoples Health Choices 65 (HMO-POS) GNO & BR
Parishes  Ascension • East Baton Rouge • East Feliciana • Iberville • Jefferson • Livingston • Orleans • St. Charles • St. Helena • West Baton Rouge
To qualify for this plan, you must have Medicare through age or disability.
Monthly Premium:

$0*
YOUR COSTS:
Primary Care Physician $0
Specialist $20
Maximum Out of Pocket $3,600
Prescription Drugs $0 Tier 1
KEY BENEFITS INCLUDE:
1-month supply of select insulin prescriptions for or less
$0 copay for all Part D covered vaccines, including Shingrix
Respite Care
Peoples Health Choices 65 (HMO-POS) Northshore
Parishes  St. Tammany • Tangipahoa • Washington
To qualify for this plan, you must have Medicare through age or disability.
Monthly Premium:

$0*
YOUR COSTS:
Primary Care Physician $0
Specialist $40
Maximum Out of Pocket $4,500
Prescription Drugs $0 Tier 1
KEY BENEFITS INCLUDE:
1-month supply of select insulin prescriptions for or less
$0 copay for all Part D covered vaccines, including Shingrix
Respite Care
Peoples Health Choices 65 (HMO-POS) Southland
Parishes  Assumption • Lafourche • St. Mary • Terrebonne
To qualify for this plan, you must have Medicare through age or disability.
Monthly Premium:

$0*
YOUR COSTS:
Primary Care Physician $0
Specialist $30
Maximum Out of Pocket $5,900
Prescription Drugs $0 Tier 1
KEY BENEFITS INCLUDE:
1-month supply of select insulin prescriptions for or less
$0 copay for all Part D covered vaccines, including Shingrix
Respite Care
Peoples Health Choices 65 (HMO-POS) Rural Southeast
Parishes  Plaquemines • Pointe Coupee • St. Bernard • St. James • St. John the Baptist • West Feliciana
To qualify for this plan, you must have Medicare through age or disability.
Monthly Premium:

$0*
YOUR COSTS:
Primary Care Physician $0
Specialist $30
Maximum Out of Pocket $5,900
Prescription Drugs $0 Tier 1
KEY BENEFITS INCLUDE:
1-month supply of select insulin prescriptions for or less
$0 copay for all Part D covered vaccines, including Shingrix
Respite Care
Peoples Health Choices Gold (HMO-POS)
Parishes  Acadia • Bossier • Caddo • Calcasieu • Cameron • Evangeline • Iberia • Lafayette • Ouachita • St. Landry • St. Martin • Vermilion
To qualify for this plan, you must have Medicare through age or disability.
Monthly Premium:

$0*
YOUR COSTS:
Primary Care Physician $0
Specialist $30
Maximum Out of Pocket $5,900
Prescription Drugs $0 Tier 1
KEY BENEFITS INCLUDE:
1-month supply of select insulin prescriptions for or less
$0 copay for all Part D covered vaccines, including Shingrix
Respite Care
Peoples Health Choices (PPO)
Parishes  All Louisiana parishes
To qualify for this plan, you must have Medicare through age or disability.
Monthly Premium:

$0*
YOUR COSTS IN NETWORK:
Primary Care Physician $0
Specialist $35
Maximum Out of Pocket
In-network $5,900
Combined in-network and out-of-network $8,950
Prescription Drugs $0 Tier 1
KEY BENEFITS INCLUDE:
1-month supply of select insulin prescriptions for or less
$0 copay for all Part D covered vaccines, including Shingrix
Peoples Health Patriot (PPO)
Parishes  All Louisiana parishes
To qualify for this plan, you must have Medicare through age or disability.
Monthly Premium:

$0*
YOUR COSTS IN NETWORK:
Primary Care Physician $0
Specialist $30
Maximum Out of Pocket
In-network $5,900
Combined in-network and out-of-network $8,950
KEY BENEFITS INCLUDE:
Peoples Health Secure Health (HMO-POS D-SNP)
Parishes  All Louisiana parishes
To qualify for this plan, you must have both Medicare and Medicaid OR medical assistance from the state.
Monthly Premium:

$0**
YOUR COSTS:
Primary Care Physician $0
Specialist $0 or $10
Maximum Out of Pocket $3,500
Prescription Drugs $0
KEY BENEFITS INCLUDE:
Food and Utility Bill Allowance
1-month supply of covered insulin prescriptions for $0
$0 copay for all Part D covered vaccines, including Shingrix
Respite Care
Peoples Health Secure Complete (HMO-POS D-SNP)
Parishes  All Louisiana parishes
To qualify for this plan, you must have both Medicare and full Medicaid benefits.
Monthly Premium:

$0**
YOUR COSTS:
Primary Care Physician $0
Specialist $0
Maximum Out of Pocket N/A
Prescription Drugs $0
KEY BENEFITS INCLUDE:
Food and Utility Bill Allowance
1-month supply of covered insulin prescriptions for $0
$0 copay for all Part D covered vaccines, including Shingrix
Respite Care

*You must continue to pay your Medicare Part B premium.

**The plan’s monthly premium is paid by Medicare’s Extra Help program. The Medicare Part B premium is paid by the state of Louisiana. You must continue to pay your Medicare Part B premium if not paid by the state or another third party.

One Pass is a trademark of Optum, Inc. and/or its affiliates. © 2022 Optum, Inc.

††You will pay a maximum of $35 for each 1-month supply of Part D select insulin drugs through all coverage stages

†††You won’t pay more than $0 for a one-month supply of each insulin product covered by your plan through all coverage stages

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