Peoples Health
Group Medicare
(HMO-POS) | 2027

The Peoples Health Group Medicare (HMO-POS) plan includes prescription drug coverage and a point-of-service (POS) option. This allows you to see providers who may not be part of the plan’s network for certain services.

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Looking for the 2026 Peoples Health Group Medicare (HMO-POS) plan? Click here.

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Member Website and App | 2027

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Plan Benefits for Peoples Health Group Medicare | 2027

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.

Page Title


Peoples Health Group Medicare (HMO-POS)	In-network	Out-of-network
Out-of-Pocket Maximum	$2,500	Does not apply
Out-of-Network Deductible	Does not apply	$2,000
Doctor Visits & NurseLine
Primary Care Provider Visit	$5	20% coinsurance
Specialist Visit*	$25	20% coinsurance
Virtual Medical Visit or 24-Hour NurseLine	$0	Available through contracted provider
Preventive Care+
Pap Smears, Pelvic Exams, Mammograms	$0	20% coinsurance
Prostate and Colorectal Cancer Screenings	$0	20% coinsurance
Bone Mass Measurement	$0	20% coinsurance
Vaccinations (COVID-19, flu, pneumonia)	$0	$0
Labs & Tests+
Lab Services, Diagnostic Tests, X-rays and Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.)	$0	20% coinsurance
Outpatient Surgery
Outpatient Surgery (outpatient hospital or ambulatory surgical center)	$0	20% coinsurance
Inpatient Hospital Care per Admission
Inpatient Deductible	$0	Plan-level deductible applies
Inpatient Stay per Day, for Days 1-10	$50	Same as Medicare
Inpatient Stay for Days 11 and Beyond	$0	Same as Medicare
Worldwide Emergency and Urgent Care^
Emergency Care (worldwide)	$50	$50
Urgent Care (inside the U.S.)	$10	$10
Urgent Care (outside the U.S.)	Does not apply	$50
Emergency Transportation (per one-way trip)
Emergency Ambulance Services (ground or air)	$50	$50
Home Health & Skilled Nursing Facility Care
Home Health	$0	20% coinsurance
Skilled Nursing Facility Care (semiprivate room and board, days 1-20)	$0	$0
Skilled Nursing Facility Care (semiprivate room and board, per each additional day)	$25 per day	$25 per day
Outpatient Services & Supplies
Occupational, Physical or Speech Therapy Visit	$0	20% coinsurance
Durable Medical Equipment (wheelchairs, oxygen, etc.)	5% coinsurance	20% coinsurance
Diabetes Monitoring Supplies (test strips, monitor, etc., from a retail pharmacy or a DME provider)	$0	20% coinsurance
Mental Health & Substance Abuse Treatment
Inpatient Mental Health (days 1-10)	$50 per day	Same as Medicare
Inpatient Mental Health (days 11-90)	$0	Same as Medicare
Outpatient Mental Health or Substance Abuse Group or Individual Visit	$10	20% coinsurance
Virtual Mental Health Visit	$0	Available through contracted provider
*Some network services, like visits to specialists, require a referral from the member's primary care provider (PCP) to be covered. The member's PCP choice can impact the specialists and hospitals they'll be able to see. +Office visit copay may apply. ^Emergency care copay waived if admitted to inpatient hospital care within 24 hours for the same condition.

$200 deductible for tiers 1-5

90-day supplies of maintenance medications 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, even if you haven’t paid your deductible, until you reach the Catastrophic Coverage stage where you pay $0.

You will pay a $0 copay for most Part D-covered vaccines.

Initial Coverage Period

30-Day Drug Supply

90-Day Drug Supply

Tier 1

Tier 2

$10

Tier 3

$25

$50

Tier 4

$50

$100

Tier 5

20% coinsurance

The Medicare Prescription Payment Plan: If you fill several high-cost covered Part D drugs early in the year, you may want to participate in the Medicare Prescription Payment Plan. This payment plan spreads your out-of-pocket prescription drug costs over the remainder of the calendar year. Learn more about the Medicare Prescription Payment Plan.


Peoples Health Group Medicare (HMO-POS)	Your Cost With Network Providers
Over-the-Counter Items
$40 allowance per quarter	$0
Meals After Inpatient Hospital Stay
Up to 28 meals over 14 days	$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
Fitness
Health Clubs	$0
Vision Services
Routine Eye Exam	$0
Glasses or Contact Lenses ($200 allowance)	$0
Hearing Services
Hearing Aids ($750 allowance)	$0
Routine Hearing Exam	$0
Preventive Dental
Dental - Preventive (X-rays, cleanings, exams - coverage frequency varies)	$0

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

Find Doctors, Medications and More | 2027

Doctors, Hospitals, Providers

Routine Vision Providers

Behavioral Health Providers

OTC Retail Locations

Fitness Center Locations

Dental Providers

Medications

Pharmacy Locations

Hearing

Important Documents | 2027

Plan Overview – An overview of plan benefits

Annual Notice of Changes – A summary of plan benefit changes compared to the previous year and other important plan details

Evidence of Coverage – Information about plan benefits, membership, covered and noncovered services, member rights and responsibilities, and other important plan details

Summary of Benefits – A general summary of plan benefits

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