Frequently Asked Questions
Q: How can Choices 65 (HMO) give me so much coverage without charging me a monthly plan premium?
A: We’re able to provide more coverage than Original Medicare alone because our physicians and hospitals are committed to working together to give you high-quality, affordable care. Choices 65 (HMO) is approved and funded by the Centers for Medicare & Medicaid Services (CMS), the agency that administers Medicare. When you join the plan, Medicare pays Choices 65 (HMO) to provide your health coverage. That’s why you continue paying your Medicare Part B premium – but no additional health plan premium is required.
Q: Am I giving up my Medicare coverage when I join Choices 65 (HMO)?
A: Absolutely not. Choices 65 (HMO) covers all of your Medicare benefits and additional benefits not covered by Original Medicare. You still pay your Medicare Part B premium, but in return you'll receive more benefits than Original Medicare without paying an additional health plan premium.
Q: Who is my primary care physician (PCP)?
A: When you join Choices 65 (HMO), you'll select a primary care physician (PCP) from our extensive network of physicians. Your current physician may already be affiliated with our network of doctors – but if not, there are many highly qualified physicians to choose from. You should have no trouble finding a new physician that you feel comfortable with.
Q: What is a physician team?
A physician team is a group of primary care and specialty care physicians who work together to coordinate your healthcare. Each physician team is also associated with specific hospitals. When you join Choices 65 (HMO), you select a primary care physician (PCP), who is associated with a physician team.
Q: Why is a physician team effective at managing my care?
A: Peoples Health has created physician teams for you to facilitate the coordination of your healthcare services, including your hospital inpatient and outpatient visits. Because the physicians in the physician team have established relationships with one another and open lines of communication, they are able to work closely together to coordinate your care.
Q: What is the difference between Choice 1 and Choice 2?
A: Each time you need to see a physician, you choose how you receive your care:
- Choice 1 (Within Physician Team) – Access care from any physician within your physician team, which is composed of primary care physicians and specialist physicians. You can benefit from the guidance and expertise of your primary care physician (PCP), who can help you coordinate care with the doctors and hospitals in your physician team. Office visits to your PCP cost just $5, and your visits to specialists within your physician team are only $15.
- Choice 2 (Within Choices 65 (HMO) Network) – You can see any physician in the Choices 65 (HMO) network of physicians for only $25 per visit.
Q: Are there any special requirements to enroll in Choices 65 (HMO)?
A: All we require is that you live in our service area: Orleans, Jefferson, Plaquemines or St. Tammany parish in Louisiana. In addition, you must be enrolled in Medicare Part B and Medicare Part A, and not have End-Stage Renal Disease (with limited exceptions, such as if you develop ESRD when you are already a member of a plan that we offer, or you were a member of a different plan that was terminated).
Q: Do I need to take a physical?
A: No physical is required. You only have to answer a few brief questions that Medicare requires on your enrollment request form to verify that you do not have End-Stage Renal Disease.
Q: What if I enroll in Choices 65 (HMO) and find that the plan is not right for me?
A: If you find that Choices 65 (HMO) is not best-suited for your needs and you would like to discontinue your membership, you have the option to enroll in another plan or return to Original Medicare only during certain times of the year. You may have additional rights depending on your previous coverage. For more information about your rights to change plans, call Member Services at (800) 631-8443, ext. 2, Monday through Friday, from 8 a.m. to 8 p.m. Telephone device for the hearing impaired users may call (888) 631-9979.
Q: How would I benefit from enrolling in Choices 65 (HMO)?
A: As a member of Choices 65 (HMO), you have the flexibility to choose your own primary care physician (PCP) and specialists from our extensive network of physicians. You also have the ability see specialists without a referral from your PCP. Choices 65 (HMO) also gives you all the benefits of Original Medicare plus much more, including:
- Physician office visits for only $5 (PCP) and $15 (specialists)
- Drug coverage through the gap for both generic and preferred brand-name drugs
- No additional monthly premiums
- Vision coverage (routine eye exam plus one pair of glasses or contacts per year)
- Preventive and comprehensive dental care
Q: What does Choices 65 (HMO) do to monitor my health and optimize my well-being?
A: Choices 65 (HMO) takes a proactive approach to maintaining and even improving your overall well-being. We offer many wellness features and programs to members including:
- New member wellness evaluation
- Smoking cessation programs
- Complimentary fitness center membership and classes
- Care Management programs to help manage chronic health conditions
Q: Is it true that there is virtually no claim paperwork?
A: Yes! Claims are forwarded to Choices 65 (HMO) directly and we take care of the paperwork.