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Looking for 2025 Peoples Health Choices 65 (HMO-POS) Rural Southeast? Click here.

Peoples Health Choices 65 (HMO-POS) Rural Southeast | 2024

H1961-014-004

A Medicare Advantage plan with Part D prescription drug coverage. Available in the following parishes: Plaquemines, Pointe Coupee, St. Bernard, St. James, St. John the Baptist, West Feliciana

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$35/month
Part B Premium
Give Back

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$65/quarter
Over-the-Counter
Items Allowance

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$0
Primary Care
Physician Visit

plan_premium_blue
Stethoscope icon

$0
Primary Care
Physician Visit

Piggy bank icon with dollar sign over the top

$35/month
Part B Premium
GiveBack

Icon of a bandage

$65/quarter
Over-the-Counter
Items Allowance

Plan Highlights | 2024

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$0 Primary
Care Visits

Tooth icon

$0
Dental Exams,
Cleanings & X-rays

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$65 Over-the-Counter
Allowance per Quarter

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$0
Respite Care
Services

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$35/Month Part B Premium Give Back

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$0
Eyeglasses
or Contacts

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$0 Tier 1 & 2 
Drug Coverage*

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$0
Fitness
Benefit

*$0 Tier 2 drugs available by preferred mail-order as a 100-day supply.

Plan Benefits | 2024

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-covered insulin drugs through all drug payment stages, except the Catastrophic drug payment stage, where you pay $0.

You will pay a $0 copay for all Part D-covered vaccines, including Shingrix.

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Notes:

Costs listed are based on use of network providers.

Authorization is required for certain services.

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-covered insulin drugs through all drug payment stages, except the Catastrophic drug payment stage, where you pay $0.

You will pay a $0 copay for all Part D covered vaccines, including Shingrix.

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Additional Benefits

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Notes:

Costs listed are based on use of network providers.
Authorization is required for certain services.

Important Documents | 2024

Plan Overview for Peoples Health Choices 65 Rural Southeast – An overview of plan benefits

Annual Notice of Changes for Peoples Health Choices 65 Rural Southeast – A summary of plan benefit changes compared to the previous year and other important plan details

Evidence of Coverage for Peoples Health Choices 65 Rural Southeast – 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 65 Rural Southeast – A general summary of plan benefits

Vendor Information – A listing of providers offering benefit-related services

Medicare Star Ratings Summary

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How to Enroll | 2024

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