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Peoples Health Choices (PPO) | 2025
H4544-001
A Preferred Provider Organization plan with out-of-network coverage and Part D prescription drug coverage. Available in all Louisiana parishes.
$0
Primary Care
Provider Visit
$40/Quarter
Over-the-Counter
Items Allowance
$0
Dental Exams, Cleanings
& X-rays
$0
Primary Care
Physician Visit
$0
Dental Exams,
Cleanings & X-rays
$40/quarter
Over-the-Counter
Items Allowance
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Get your FREE Medicare information kit, including these must-have guides: 2025 Peoples Health Plan Overview and Get Ready for Medicare. Together, these booklets can help you better understand your Medicare coverage options.
Plan Highlights | 2025
$0 Primary
Care Visits
$0
Dental Exams,
Cleanings & X-rays
$40 Over-the-Counter
Allowance per Quarter
$0 Annual
Routine Hearing
Exam
$0 Fitness
Benefit
$0
Eyeglasses
or Contacts**
$0 Tier 1 & 2Â
Drug Coverage*
$0 Meals
After Inpatient
Hospital Stay
*$0 tier 2 drugs available by preferred mail-order as a 100-day supply.
**$0 Standard Eyeglass Lenses; Allowance Amount for Eyeglass Frames or Contacts
Plan Benefits | 2025
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.
| Peoples Health Choices (PPO) | Your Cost | Out-of-Network |
| Monthly Plan Premium | $0 | $0 |
| Doctor Visits | ||
| Primary Care Provider Visit | $0 | $20 |
| Specialist Visit | $35 | $60 |
| Virtual Medical Visit | $0 | Costs vary* |
| Preventive Care+ | ||
| Pap Smears, Pelvic Exams and Mammograms | $0 | 30% coinsurance |
| Prostate and Colorectal Cancer Screenings | $0 | 30% coinsurance |
| Vaccinations (flu, pneumonia, hepatitis B, COVID-19)++ | $0 | $0 |
| Labs and Tests+ | ||
| Lab Services | $0 | $0 |
| Diagnostic Procedures/Tests | $50 | 30% coinsurance |
| X-rays | $35 | $40 |
| Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.) | $240 | 30% coinsurance |
| Outpatient Surgery | ||
| Surgery (outpatient hospital or ambulatory surgical center) | $225 | 30% coinsurance |
| Inpatient Hospital Care per Admission | ||
| Inpatient Deductible | $0 | $0 |
| Inpatient Stay | $225 per day for days 1-7 $0 for days 8 & beyond | 30% coinsurance per admission |
| Emergency Care, Urgent Care & Emergency Transportation^ | ||
| Emergency Care | $125 | $125 |
| Urgently Needed Care | $55 | $55 |
| Emergency Ambulance Services per One-Way Trip (ground or air) | $290 | $290 |
| Worldwide (out of U.S.) Emergency Care, Urgent Care and Emergency Transportation (to nearest facility) | N/A | $0 |
| Home Health & Skilled Nursing Facility Care | ||
| Home Health | $0 | 50% coinsurance |
| Skilled Nursing Facility Care per Day (semiprivate room and board) | $0 for days 1-20 $203 for days 21-100 | $225 for days 1-100 |
| Outpatient Services and Supplies | ||
| Occupational, Physical or Speech Therapy Visit | $30 | $60 |
| Durable Medical Equipment - DME (wheelchairs, oxygen, etc.) | 20% coinsurance | 50% coinsurance |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider or retail pharmacy) | $0 | 50% coinsurance |
| Mental Health and Substance Abuse Treatment | ||
| Inpatient Mental Health Care | $225 per day for days 1-4 $0 per day for days 5-90 | 30% coinsurance per admission |
| Outpatient Mental Health or Substance Abuse Visit | $25 individual $15 group | $40 individual $30 group |
| Mental Health or Substance Abuse Treatment Telehealth Individual Visit | $0 | $40 |
| *For primary care provider and specialist telehealth visits, in-office visit costs apply. +Office visit copay may apply. ++You will pay a $0 copay for most Part D-covered vaccines, including Shingrix, from network providers. ^Emergency care copay waived if admitted to inpatient hospital care within 24 hours for the same condition. Authorization is required for certain services. See the Provider Directory for network lab and diagnostic providers. | ||
100-day supplies of maintenance medications on tiers 1, 2 and 3 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 coverage stage, where you pay $0.
You will pay a $0 copay for most Part D-covered vaccines, including Shingrix.
| Deductible Stage | $420 deductible for tiers 3-5 | |
| Initial Coverage Stage | 30-Day Supply | 100-Day Supply |
| Tier 1 | $0 | $0 |
| Tier 2 | $10 | $0 (preferred mail order) |
| Tier 3 | $47 | $141 |
| Tier 4 | $100 | 30-day supply only |
| Tier 5 | 28% coinsurance | 30-day supply only |
The Medicare Prescription Payment Plan: Starting Jan. 1, 2025, if you spend more than $2,000 for covered Part D prescription drugs each 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 Choices (PPO) | Your Cost |
| Over-the-Counter Items | |
| $40 Allowance per Quarter | $0 |
| Meals After Inpatient Hospital Stay | |
| Up to 28 Meals Over 14 Days | $0 |
| Hearing Services | |
| Routine Hearing Exam | $0 |
| Hearing Aids | $199 - $1,249 for each prescription hearing aid device $99 - $829 for each OTC hearing aid device |
| Vision Services | |
| Routine Eye Exam | $0 |
| Eyeglass Lenses (every two years) | $0 to $153 |
| Frames or Contact Lenses (every two years) | $300 allowance |
| Dental - $1,500 Coverage Maximum With Platinum Dental Rider | |
| Dental - Preventive (X-rays, cleanings, exams, fluoride - coverage frequency varies) | $0 |
| Comprehensive/Restorative - $54 per month rider | |
| Dental - Comprehensive/Restorative | $0 |
| Dental – Bridges or Dentures | 50% coinsurance |
| Fitness | |
| Health Clubs, Online Classes, Brain Health Exercises and More | $0 |
Notes:
Costs listed are based on use of network providers.
Authorization is required for certain services.
Doctor and Hospital Coverage
| Peoples Health Choices (PPO) | Your Cost | Out-of-Network |
| Monthly Plan Premium | $0 | $0 |
| Doctor Visits | ||
| Primary Care Provider Visit | $0 | $20 |
| Specialist Visit | $35 | $60 |
| Virtual Medical Visit | $0 | Costs vary* |
| Preventive Care+ | ||
| Pap Smears, Pelvic Exams and Mammograms | $0 | 30% coinsurance |
| Prostate and Colorectal Cancer Screenings | $0 | 30% coinsurance |
| Vaccinations (flu, pneumonia, hepatitis B, COVID-19)++ | $0 | $0 |
| Labs and Tests+ | ||
| Lab Services | $0 | $0 |
| Diagnostic Procedures/Tests | $50 | 30% coinsurance |
| X-rays | $35 | $40 |
| Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.) | $240 | 30% coinsurance |
| Outpatient Surgery | ||
| Surgery (outpatient hospital or ambulatory surgical center) | $225 | 30% coinsurance |
| Inpatient Hospital Care per Admission | ||
| Inpatient Deductible | $0 | $0 |
| Inpatient Stay | $225 per day for days 1-7 $0 for days 8 & beyond | 30% coinsurance per admission |
| Emergency Care, Urgent Care & Emergency Transportation^ | ||
| Emergency Care | $125 | $125 |
| Urgently Needed Care | $55 | $55 |
| Emergency Ambulance Services per One-Way Trip (ground or air) | $290 | $290 |
| Worldwide (out of U.S.) Emergency Care, Urgent Care and Emergency Transportation (to nearest facility) | N/A | $0 |
| Home Health & Skilled Nursing Facility Care | ||
| Home Health | $0 | 50% coinsurance |
| Skilled Nursing Facility Care per Day (semiprivate room and board) | $0 for days 1-20 $203 for days 21-100 | $225 for days 1-100 |
| Outpatient Services and Supplies | ||
| Occupational, Physical or Speech Therapy Visit | $30 | $60 |
| Durable Medical Equipment - DME (wheelchairs, oxygen, etc.) | 20% coinsurance | 50% coinsurance |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider or retail pharmacy) | $0 | 50% coinsurance |
| Mental Health and Substance Abuse Treatment | ||
| Inpatient Mental Health Care | $225 per day for days 1-4 $0 per day for days 5-90 | 30% coinsurance per admission |
| Outpatient Mental Health or Substance Abuse Visit | $25 individual $15 group | $40 individual $30 group |
| Mental Health or Substance Abuse Treatment Telehealth Individual Visit | $0 | $40 |
| *For primary care provider and specialist telehealth visits, in-office visit costs apply. +Office visit copay may apply. ++You will pay a $0 copay for most Part D-covered vaccines, including Shingrix, from network providers. ^Emergency care copay waived if admitted to inpatient hospital care within 24 hours for the same condition. Authorization is required for certain services. See the Provider Directory for network lab and diagnostic providers. | ||
Part D Prescription Drug Coverage
100-day supplies of maintenance medications on tiers 1, 2 and 3 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 coverage stage, where you pay $0.
You will pay a $0 copay for most Part D-covered vaccines, including Shingrix.
| Deductible Stage | $420 deductible for tiers 3-5 | |
| Initial Coverage Stage | 30-Day Supply | 100-Day Supply |
| Tier 1 | $0 | $0 |
| Tier 2 | $10 | $0 (preferred mail order) |
| Tier 3 | $47 | $141 |
| Tier 4 | $100 | 30-day supply only |
| Tier 5 | 28% coinsurance | 30-day supply only |
The Medicare Prescription Payment Plan: Starting Jan. 1, 2025, if you spend more than $2,000 for covered Part D prescription drugs each 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.
Additional Benefits
| Peoples Health Choices (PPO) | Your Cost |
| Over-the-Counter Items | |
| $40 Allowance per Quarter | $0 |
| Meals After Inpatient Hospital Stay | |
| Up to 28 Meals Over 14 Days | $0 |
| Hearing Services | |
| Routine Hearing Exam | $0 |
| Hearing Aids | $199 - $1,249 for each prescription hearing aid device $99 - $829 for each OTC hearing aid device |
| Vision Services | |
| Routine Eye Exam | $0 |
| Eyeglass Lenses (every two years) | $0 to $153 |
| Frames or Contact Lenses (every two years) | $300 allowance |
| Dental - $1,500 Coverage Maximum With Platinum Dental Rider | |
| Dental - Preventive (X-rays, cleanings, exams, fluoride - coverage frequency varies) | $0 |
| Comprehensive/Restorative - $54 per month rider | |
| Dental - Comprehensive/Restorative | $0 |
| Dental – Bridges or Dentures | 50% coinsurance |
| Fitness | |
| Health Clubs, Online Classes, Brain Health Exercises and More | $0 |
Notes:
Costs listed are based on use of network providers.
Authorization is required for certain services.
Find Doctors, Medications & More | 2025
Important Documents | 2025
Plan Overview for Peoples Health Choices – An overview of plan benefits
Annual Notice of Changes for Peoples Health Choices – A summary of plan benefit changes compared to the previous year and other important plan details
Evidence of Coverage for Peoples Health Choices – 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 – A general summary of plan benefits
Vendor Information – A listing of providers offering benefit-related servicesÂ
Medicare Star Ratings Summary
How to Enroll | 2025
Online
Enrolling online only takes about 20 minutes. You’ll need your red, white and blue Medicare card to complete the online application.
By Phone
Call toll-free at
1-800-978-9765, seven days a week, from 8 a.m. to 8 p.m.
TTY users may call 711.
A plan representative will help you. You can also request an enrollment packet.
By Appointment
Call toll-free at
1-800-978-9765, seven days a week, from 8 a.m. to 8 p.m.
TTY users may call 711.
A sales representative will schedule an appointmentÂ
with you.