New Plan for 2025!
Peoples Health Dual Complete LA-S5 (HMO-POS D-SNP) | 2025
H1961-024
A plan with Part D drug coverage for people with Medicare and full Medicaid benefits (FBDE, QMB+ or SLMB+). This Medicare special needs plan offers additional benefits, such as an allowance for buying food and over-the-counter items and paying utility bills. Available in all Louisiana parishes.
$0
Primary Care
Provider Visit
$280/Month
Allowance for Food, Utility Bills and OTC Items
Nonemergency
Transportation
$0
Primary Care
Provider Visit
$280/Month
Allowance for Food, Utility Bills and OTC Items
Nonemergency
Transportation
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Plan Highlights | 2025
Primary
Care Visits
Hearing
Aids
$280/Month
Allowance for Food, Utility Bills, OTC Items
After Inpatient
Hospital Stay
Dental Exams,
Cleanings & X-rays
$0
Eyeglasses
or Contacts*
(Unlimited Trips)
Fitness
Benefit
*$0 Eyeglass Lenses; Allowance Amount for Eyeglass Frames or Contacts
Plan Benefits | 2025
| Peoples Health Dual Complete LA-S5 (HMO-POS D-SNP) | Your Cost |
| Monthly Plan Premium* | $0 |
| Doctor Visits | |
| Primary Care Provider Visit | $0 |
| Specialist Visit | $0 |
| Virtual Medical Visit | $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 |
| Outpatient Surgery | |
| Surgery (outpatient hospital) | $0 |
| Surgery (ambulatory surgical center) | $0 |
| Inpatient Hospital Care per Admission | |
| Inpatient Deductible | $0 |
| Inpatient Stay per Day | $0 |
| Emergency Care, Urgent Care & Emergency Transportation | |
| Emergency Care | $0 |
| Urgent Care | $0 |
| Emergency Ambulance Services (ground or air) | $0 |
| 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 1-100 |
| 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 for days 1-90 |
| Outpatient Mental Health Visit | $0 |
| Outpatient Substance Abuse Treatment Visit | $0 |
| Mental Health or Substance Abuse Treatment Telehealth Individual Visit | $0 |
| *This plan's premium is paid by Medicare's Extra Help program. ++You will pay a $0 copay for most Part D-covered vaccines, including Shingrix, from network providers. Costs listed are based on use of network providers. Authorization is required for certain services. | |
| 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. |
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 Dual Complete LA-S5 (HMO-POS D-SNP) | Your Cost |
| Over-the-Counter Items | |
| $280 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 - $350 allowance) | $0 |
| Hearing Services | |
| Routine Hearing Exam | $0 |
| Hearing Aids ($2,200 per year allowance) | $0 |
| Nonemergency Transportation (such as trips, within 75 miles of your home, to and from your doctor’s office) | |
| Unlimited 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 - $3,500 Coverage Maximum | |
| 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 Dual Complete LA-S5 (HMO-POS D-SNP) | Your Cost |
| Monthly Plan Premium* | $0 |
| Doctor Visits | |
| Primary Care Provider Visit | $0 |
| Specialist Visit | $0 |
| Virtual Medical Visit | $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 |
| Outpatient Surgery | |
| Surgery (outpatient hospital) | $0 |
| Surgery (ambulatory surgical center) | $0 |
| Inpatient Hospital Care per Admission | |
| Inpatient Deductible | $0 |
| Inpatient Stay per Day | $0 |
| Emergency Care, Urgent Care & Emergency Transportation | |
| Emergency Care | $0 |
| Urgent Care | $0 |
| Emergency Ambulance Services (ground or air) | $0 |
| 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 1-100 |
| 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 for days 1-90 |
| Outpatient Mental Health Visit | $0 |
| Outpatient Substance Abuse Treatment Visit | $0 |
| Mental Health or Substance Abuse Treatment Telehealth Individual Visit | $0 |
| *This plan's premium is paid by Medicare's Extra Help program. ++You will pay a $0 copay for most Part D-covered vaccines, including Shingrix, from network providers. Costs listed are based on use of network providers. Authorization is required for certain services. | |
Part D Prescription Drug Coverage
| 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. |
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 Dual Complete LA-S5 (HMO-POS D-SNP) | Your Cost |
| Over-the-Counter Items | |
| $280 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 - $350 allowance) | $0 |
| Hearing Services | |
| Routine Hearing Exam | $0 |
| Hearing Aids ($2,200 per year allowance) | $0 |
| Nonemergency Transportation (such as trips, within 75 miles of your home, to and from your doctor’s office) | |
| Unlimited 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 - $3,500 Coverage Maximum | |
| 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 | 2025
Important Documents | 2025
Plan Overview for Peoples Health Dual Complete LA-S5 – An overview of plan benefits
Evidence of Coveragefor Peoples Health Dual Complete LA-S5 – Information about plan benefits, membership, covered and noncovered services, member rights and responsibilities, and other important plan details
Summary of Benefits for Peoples Health Dual Complete LA-S5 – A general summary of plan benefits
Vendor Information – A listing of providers offering benefit-related services
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 appointment
with you.
Extra Help | 2025
Peoples Health Dual Complete LA-S5 (HMO-POS D-SNP)
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 Dual Complete LA-S5 (HMO-POS D-SNP)
Peoples Health Dual Complete LA-S5 (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, orÂ
- 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.