Frequently Asked Questions
Your Questions Answered
We want to help you navigate the world of Medicare and understand the choices available to you.
How can Peoples Health plans offer so much coverage?
Medicare pays plans bonus money when they reach higher star ratings. From 2018 through 2021, we earned a rating of 4.5 stars out of 5. For 2022, Peoples Health earned 5 stars!* We use our bonus payments from Medicare to provide additional benefits to our members to help them be as healthy as possible.
Peoples Health saves money by keeping people healthy. Healthier people have lower health care costs, which is why we put so much emphasis on wellness programs, early detection, preventive medicine and coordination of care. We pass the savings back to our members through enhanced benefits.
*Every year, Medicare evaluates plans based on a 5-star rating system. Peoples Health HMO and HMO D-SNP plans under Medicare contract H1961 are rated 5 out of 5 stars for 2022. Our PPO plans (contract H4544) are too new to be rated.
When can I switch plans?
In general, people with Medicare can change the way they receive their Medicare benefits for next year during the annual enrollment period from October 15 through December 7. There are exceptions — for instance, if you are eligible for Medicaid, there are additional times of the year when you can switch.
There is also the open enrollment period from January 1 through March 31. During this period, you can make one change to how you receive your Medicare benefits (for example, by changing from one plan to another or by returning to Original Medicare).
Does Peoples Health replace my Medicare coverage?
No. When you enroll with Peoples Health, you are still enrolled in Medicare, but Peoples Health will administer your Medicare benefits. That’s why you must continue to pay your Medicare Part B premium.
Do I need a physical exam to enroll in Peoples Health?
No. You are not required to take a physical exam. You cannot be refused enrollment with Peoples Health for any pre-existing condition. That said, we encourage you to get a physical every year — even if you feel great.
Do Peoples Health plans that include Medicare Part D drug coverage provide drug coverage through the “doughnut hole”?
Yes. All Peoples Health plans that include Part D drug coverage provide continuous coverage through the Medicare Part D coverage gap (also called the doughnut hole) for many generic drugs.
Do I need to be 65 to enroll in a Peoples Health plan? Are there any special requirements to enroll?
You do not need to be 65 to enroll. Many of our members have Medicare due to a disability. The only requirements to enroll are:
- You must live in the plan service area.
- You must have both Medicare Part A and Part B.
What if I’m already enrolled in a prescription drug plan?
Most Medicare Advantage plans from Peoples Health include Medicare Part D prescription drug coverage. Medicare does not allow you to be enrolled in two Part D plans at once. If you enroll in a Peoples Health plan that includes Part D drug coverage, Medicare will transfer your Part D coverage from your previous plan to your Peoples Health plan. If you were paying a monthly premium for your previous Part D plan, you may now be able to save that money.
What happens after I disenroll from a Peoples Health plan?
Once you disenroll from a Peoples Health plan:
- You will no longer be covered by Peoples Health for medical care or prescription drugs (if your Peoples Health plan included Medicare Part D prescription drug coverage).
- You will be covered by Original Medicare unless you enroll in a different Medicare Advantage plan.
To have health care coverage other than Original Medicare, to have prescription drug coverage (if your Peoples Health plan included Part D coverage) or to have a Medigap policy, you need to take action immediately after you disenroll (for example, by enrolling in another plan or by buying a Medigap policy).
If your Peoples Health plan included Part D coverage: If you return to Original Medicare and want prescription drug coverage, you must join a Medicare prescription drug plan. If you do not enroll in another Medicare Advantage plan with prescription drug coverage or a Medicare prescription drug plan, you may have to pay a late enrollment penalty if you enroll in a Medicare plan with prescription drug coverage in the future. Note: If you have both Medicare and Medicaid, Medicare will automatically enroll you in a prescription drug plan unless you notify the plan that you do not want to enroll.
If you choose to return to Original Medicare, you may have a special temporary right to buy a Medigap policy, also called Medicare supplement insurance. If you have questions about Medigap or Medigap rights in Louisiana, contact Senior Health Insurance Information Program, also known as SHIIP, at 1-800-259-5300. You can also call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users should call 1-877-486-2048.
Still Have Questions?
If you have a question that’s not answered here, please call toll-free to speak with one of our plan representatives at 1-800-978-9765, seven days a week, from 8 a.m. to 8 p.m. TTY users may call 711.