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Peoples Health Secure Health (HMO-POS D-SNP) | 2024
H1961-003
A plan with Part D drug coverage for people with Medicare and medical assistance from the state. This is a Medicare Special Needs Plan for people who also have Medicaid at levels ranging from the state paying your Part A or B premium to full Medicaid benefits. Available in all Louisiana parishes.
$0
Primary Care
Physician Visit
$112/month
Allowance for Food, Utility Bills and OTC Items
$0
Up to 36
One-Way Trips
$0
Primary Care
Physician Visit
$112/month
Allowance for Food, Utility Bills and OTC Items
$0
Up to 36
One-Way Trips
 Plan Highlights | 2024
$0 Primary
Care
Visits
$0
Hearing Aids
$112/Month
Allowance for Food, Utility Bills and OTC Items
$0 Meals
After Inpatient
Hospital Stay
$0
Dental Exams,
Cleanings & X-rays
$0
Eyeglasses
or Contacts
$0Â
Up to 36
One-Way Trips
$0
Fitness
Benefit
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.
| Peoples Health Secure Health (HMO-PPO D-SNP) | Your Cost |
| Monthly Plan Premium* | $0 |
| Doctor Visits & NurseLine | |
| Primary Care Physician Visit | $0 |
| Specialist Visit | $0 |
| Virtual Medical Visit | $0 |
| 24-Hour NurseLine | $0 |
| Preventive Care+ | |
| Pap Smears, Pelvic Exams, Mammograms | $0 |
| Prostate & Colorectal Cancer Screenings | $0 |
| Vaccinations (flu, pneumonia, hepatitis B, COVID-19)++ | $0 |
| Labs & Tests+ | |
| Lab Services | $0 |
| Diagnostic Tests and X-rays | $0 |
| Advanced Imaging (MRI, MRA, CT, PET scans, etc.) | $0 or $225 |
| Outpatient Surgery | |
| Surgery (outpatient hospital) | $0 or $50 |
| Surgery (ambulatory surgical center) | $0 |
| Inpatient Hospital Care per Admission | |
| Inpatient Deductible | $0 |
| Inpatient Stay per Day | $0 or $75 for days 1-10 for days 11 and beyond |
| Emergency Care, Urgent Care & Emergency Transportation^ | |
| Emergency Care | $0 or $135 |
| Urgent Care | $0 |
| Emergency Ambulance Services (ground or air) | $0 or $275 |
| Worldwide (out of U.S.) Emergency Care, Urgent Care and Emergency Transportation (to nearest facility) | $0 |
| Home Health & Skilled Nursing Facility Care | |
| Home Health | $0 |
| Skilled Nursing Facility Care per Day (semiprivate room and board) | $0 for days 1-20 $0 or $100 for days 21-100 |
| Outpatient Services & Supplies | |
| Occupational, Physical or Speech Therapy Visit | $0 |
| Durable Medical Equipment - DME (wheelchairs, oxygen, etc.) | $0 |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider or retail pharmacy) | $0 |
| Mental Health & Substance Abuse Treatment | |
| Inpatient Mental Health Care | $0 or $75 per day, for days 1-10 $0 per day for days 11-90 |
| Outpatient Mental Health Visit | $0 or $10 |
| Outpatient Substance Abuse Treatment Visit | $0 or $10 |
| Virtual Mental Health or Substance Abuse Treatment Visit | $0 |
| *This plan's premium is paid by Medicare's Extra Help program. +Office visit copay may apply. ++You will pay a $0 copay for all 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 Costs listed are based on use of network providers. Authorization is required for certain services. | |
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.
| Medicare Part D Prescription Drugs 30-day or 100-day supply from a retail network pharmacy |
| All Covered Drugs: $0 |
| 100-day supplies of maintenance drugs available at retail pharmacies and by mail order. Specialty drugs limited to a 30-day supply. |
| Peoples Health Secure Health (HMO D-SNP) | Your Cost |
| Over-the-Counter Items | |
| $112 Monthly Allowance Combined Food, OTC and Utilities Debit Card | $0 |
| Meals After Inpatient Hospital Stay | |
| Up to 28 Meals over 14 Days | $0 |
| Vision Services | |
| Routine Eye Exam | $0 |
| Eyeglasses or Contact Lenses (one pair per year - $300 allowance) | $0 |
| Hearing Services | |
| Hearing Aids ($1,100 per year allowance) | $0 |
| Routine Hearing Exam | $0 |
| Nonemergency Transportation (such as trips, within 40 miles of your home, to and from your doctor’s office) | |
| Up to 36 one-way trips | $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 |
| Dental - $2,500 Coverage Maximum ($0 deductible) | |
| Dental - Preventive (X-rays, cleanings, exams, fluoride - coverage frequency varies) | $0 |
| Dental - Comprehensive/Restorative | $0 |
| 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 Secure Health (HMO-PPO D-SNP) | Your Cost |
| Monthly Plan Premium* | $0 |
| Doctor Visits & NurseLine | |
| Primary Care Physician Visit | $0 |
| Specialist Visit | $0 |
| Virtual Medical Visit | $0 |
| 24-Hour NurseLine | $0 |
| Preventive Care+ | |
| Pap Smears, Pelvic Exams, Mammograms | $0 |
| Prostate & Colorectal Cancer Screenings | $0 |
| Vaccinations (flu, pneumonia, hepatitis B, COVID-19)++ | $0 |
| Labs & Tests+ | |
| Lab Services | $0 |
| Diagnostic Tests and X-rays | $0 |
| Advanced Imaging (MRI, MRA, CT, PET scans, etc.) | $0 or $225 |
| Outpatient Surgery | |
| Surgery (outpatient hospital) | $0 or $50 |
| Surgery (ambulatory surgical center) | $0 |
| Inpatient Hospital Care per Admission | |
| Inpatient Deductible | $0 |
| Inpatient Stay per Day | $0 or $75 for days 1-10 for days 11 and beyond |
| Emergency Care, Urgent Care & Emergency Transportation^ | |
| Emergency Care | $0 or $135 |
| Urgent Care | $0 |
| Emergency Ambulance Services (ground or air) | $0 or $275 |
| Worldwide (out of U.S.) Emergency Care, Urgent Care and Emergency Transportation (to nearest facility) | $0 |
| Home Health & Skilled Nursing Facility Care | |
| Home Health | $0 |
| Skilled Nursing Facility Care per Day (semiprivate room and board) | $0 for days 1-20 $0 or $100 for days 21-100 |
| Outpatient Services & Supplies | |
| Occupational, Physical or Speech Therapy Visit | $0 |
| Durable Medical Equipment - DME (wheelchairs, oxygen, etc.) | $0 |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider or retail pharmacy) | $0 |
| Mental Health & Substance Abuse Treatment | |
| Inpatient Mental Health Care | $0 or $75 per day, for days 1-10 $0 per day for days 11-90 |
| Outpatient Mental Health Visit | $0 or $10 |
| Outpatient Substance Abuse Treatment Visit | $0 or $10 |
| Virtual Mental Health or Substance Abuse Treatment Visit | $0 |
| *This plan's premium is paid by Medicare's Extra Help program. +Office visit copay may apply. ++You will pay a $0 copay for all 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 Costs listed are based on use of network providers. Authorization is required for certain services. | |
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.
| Medicare Part D Prescription Drugs 30-day or 100-day supply from a retail network pharmacy |
| All Covered Drugs: $0 |
| 100-day supplies of maintenance drugs available at retail pharmacies and by mail order. Specialty drugs limited to a 30-day supply. |
Additional Benefits
| Peoples Health Secure Health (HMO D-SNP) | Your Cost |
| Over-the-Counter Items | |
| $112 Monthly Allowance Combined Food, OTC and Utilities Debit Card | $0 |
| Meals After Inpatient Hospital Stay | |
| Up to 28 Meals over 14 Days | $0 |
| Vision Services | |
| Routine Eye Exam | $0 |
| Eyeglasses or Contact Lenses (one pair per year - $300 allowance) | $0 |
| Hearing Services | |
| Hearing Aids ($1,100 per year allowance) | $0 |
| Routine Hearing Exam | $0 |
| Nonemergency Transportation (such as trips, within 40 miles of your home, to and from your doctor’s office) | |
| Up to 36 one-way trips | $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 |
| Dental - $2,500 Coverage Maximum ($0 deductible) | |
| Dental - Preventive (X-rays, cleanings, exams, fluoride - coverage frequency varies) | $0 |
| Dental - Comprehensive/Restorative | $0 |
| 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 | 2024
Important Documents | 2024
Plan Overview for Peoples Health Secure Health – An overview of plan benefits
Annual Notice of Changes for Peoples Health Secure Health – A summary of plan benefit changes compared to the previous year and other important plan details
Evidence of Coverage for Peoples Health Secure Health – Information about plan benefits, membership, covered and noncovered services, member rights and responsibilities, and other important plan details
Summary of Benefits for Peoples Health Secure Health – A general summary of plan benefits
Vendor Information – A listing of providers offering benefit-related services
How to Enroll | 2024
Enroll 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 appointment
with you.
Extra Help | 2024
Peoples Health Secure Health (HMO-POS D-SNP)Â
Monthly Plan premium for people who get Extra Help from Medicare to help pay for their prescription drug costs
If you get Extra Help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get Extra Help from Medicare.
If you get extra help, your monthly plan premium will be $0 for any of the plan(s) below. (This does not include any Medicare Part B premium you may have to pay.)
- Peoples Health Secure Health (HMO-POS D-SNP)
Peoples Health Secure Health (HMO-POS D-SNP) premium includes coverage for both medical services and prescription drug coverage.
If you aren’t getting Extra Help, you can see if you qualify by calling:
- 1-800-Medicare or TTY users call 1-877-486-2048 (24 hours a day/7 days a week),
- Your State Medicaid Office, or
- Â The Social Security Administration at 1-800-772-1213. TTY users should call 1-800-325-0778 between 7 a.m. and 7 p.m., Monday through Friday.
If you have any questions, please call Customer Service at 1-855-269-0778, TTY 711, from 8 a.m.-8 p.m. local time, 7 days a week.