New Plan for 2025!
Peoples Health Complete Care LA-7 (HMO-POS C-SNP) | 2025
H1961-025
A Medicare Advantage plan with Part D prescription drug coverage. Peoples Health chronic condition special needs plans are designed for people with diabetes, cardiovascular disease or chronic heart failure and include benefits and services tailored to support these conditions. Available in the following parishes: Assumption, Lafourche, Plaquemines, Pointe Coupee, St. Bernard, St. James, St. John the Baptist, St. Mary, Terrebonne and West Feliciana.
$0
Primary Care
Provider Visit
$77/Month
Allowance for Food
and OTC Items
$0
Dental Exams, Cleanings
& X-rays
$0
Primary Care
Provider Visit
Dental Exams,
Cleanings & X-rays
$77/Month
Over-the-Counter
Items Allowance
Request a Free Medicare Information Kit
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
Dental Exams,
Cleanings & X-rays
$77/Month
Allowance for Food
and OTC Items
Respite Care
Services
$0 Eyeglasses
or Contacts**
After Inpatient
Hospital Stay
Drug Coverage*
Fitness
Benefit
*$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
| Peoples HealthComplete Care LA-7 (HMO-POS C-SNP) | Your Cost |
| Monthly Plan Premium | $0 |
| Doctor Visits | |
| Primary Care Provider Visit | $0 |
| Specialist Visit | $20 |
| 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 | $40 |
| X-rays | $20 |
| Advanced Imaging (MRI, MRA, CT, PET scans, etc.) | $250 |
| Outpatient Surgery | |
| Surgery (outpatient hospital) | $155 |
| Surgery (ambulatory surgical center) | $155 |
| Inpatient Hospital Care per Admission | |
| Inpatient Deductible | $0 |
| Inpatient Stay per Day | $155 for days 1-10 $0 for days 11 and beyond |
| Emergency Care, Urgent Care & Emergency Transportation^ | |
| Emergency Care | $125 |
| Urgent Care | $55 |
| Emergency Ambulance Services (ground or air) | $120 |
| 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 $203 for days 21-100 |
| Outpatient Services & Supplies | |
| Occupational, Physical or Speech Therapy Visit | $20 |
| Durable Medical Equipment - DME (wheelchairs, oxygen, etc.) | 20% coinsurance |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider or retail pharmacy) | $0 |
| Mental Health & Substance Abuse Treatment | |
| Inpatient Mental Health Care | $155 per day, for days 1-10 $0 per day for days 11-90 |
| Outpatient Mental Health Visit | $25 individual $15 group |
| Outpatient Substance Abuse Treatment Visit | $25 individual $15 group |
| Mental Health or Substance Abuse Treatment Telehealth Individual Visit | $0 |
| +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 Costs listed are based on use of network providers. Authorization is required for certain services. | |
100-day supplies of maintenance medications on tiers 1, 2 and 3Â 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 | $255 deductible for tiers 3-5 | |
| Initial Coverage Stage | 30-Day Supply | 100-Day Supply |
| Tier 1 | $0 | $0 |
| Tier 2 | $5 | $0 (preferred mail order) |
| Tier 3 | $47 | $141 |
| Tier 4 | $100 | 30-day supply only |
| Tier 5 | 30% 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 Complete Care LA-7 (HMO-POS C-SNP) | Your Cost |
| Over-the-Counter Items | |
| $77 Monthly Allowance Combined Food and OTC Debit Card The healthy food benefit is a special supplemental benefit only available to chronically ill enrollees with a qualifying condition, such as diabetes, chronic heart failure and/or cardiovascular disorders, and who also meet all applicable plan coverage criteria. Contact us for details. | $0 |
| Meals After Inpatient Hospital Stay | |
| Up to 28 Meals Over 14 Days | $0 |
| Vision Services | |
| Routine Eye Exam | $0 |
| Eyeglass Lenses (every two years) | $0 to $153 |
| Frames or Contact Lenses (every two years) | $200 allowance |
| 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 |
| Dental - $1,500 Coverage Maximum With Platinum Dental Rider | |
| Dental - Preventive (X-rays, cleanings, exams, fluoride - coverage frequency varies) | $0 |
| Platinum Dental Rider for Comprehensive Services - $54/month rider | |
| Dental - Comprehensive/Restorative | $0 |
| Dental – Bridges or Dentures | 50% coinsurance |
| 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 |
| 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 HealthComplete Care LA-7 (HMO-POS C-SNP) | Your Cost |
| Monthly Plan Premium | $0 |
| Doctor Visits | |
| Primary Care Provider Visit | $0 |
| Specialist Visit | $20 |
| 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 | $40 |
| X-rays | $20 |
| Advanced Imaging (MRI, MRA, CT, PET scans, etc.) | $250 |
| Outpatient Surgery | |
| Surgery (outpatient hospital) | $155 |
| Surgery (ambulatory surgical center) | $155 |
| Inpatient Hospital Care per Admission | |
| Inpatient Deductible | $0 |
| Inpatient Stay per Day | $155 for days 1-10 $0 for days 11 and beyond |
| Emergency Care, Urgent Care & Emergency Transportation^ | |
| Emergency Care | $125 |
| Urgent Care | $55 |
| Emergency Ambulance Services (ground or air) | $120 |
| 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 $203 for days 21-100 |
| Outpatient Services & Supplies | |
| Occupational, Physical or Speech Therapy Visit | $20 |
| Durable Medical Equipment - DME (wheelchairs, oxygen, etc.) | 20% coinsurance |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider or retail pharmacy) | $0 |
| Mental Health & Substance Abuse Treatment | |
| Inpatient Mental Health Care | $155 per day, for days 1-10 $0 per day for days 11-90 |
| Outpatient Mental Health Visit | $25 individual $15 group |
| Outpatient Substance Abuse Treatment Visit | $25 individual $15 group |
| Mental Health or Substance Abuse Treatment Telehealth Individual Visit | $0 |
| +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 Costs listed are based on use of network providers. Authorization is required for certain services. | |
Part D Prescription Drug Coverage
100-day supplies of maintenance medications on tiers 1, 2 and 3Â 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 | $255 deductible for tiers 3-5 | |
| Initial Coverage Stage | 30-Day Supply | 100-Day Supply |
| Tier 1 | $0 | $0 |
| Tier 2 | $5 | $0 (preferred mail order) |
| Tier 3 | $47 | $141 |
| Tier 4 | $100 | 30-day supply only |
| Tier 5 | 30% 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 Complete Care LA-7 (HMO-POS C-SNP) | Your Cost |
| Over-the-Counter Items | |
| $77 Monthly Allowance Combined Food and OTC Debit Card The healthy food benefit is a special supplemental benefit only available to chronically ill enrollees with a qualifying condition, such as diabetes, chronic heart failure and/or cardiovascular disorders, and who also meet all applicable plan coverage criteria. Contact us for details. | $0 |
| Meals After Inpatient Hospital Stay | |
| Up to 28 Meals Over 14 Days | $0 |
| Vision Services | |
| Routine Eye Exam | $0 |
| Eyeglass Lenses (every two years) | $0 to $153 |
| Frames or Contact Lenses (every two years) | $200 allowance |
| 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 |
| Dental - $1,500 Coverage Maximum With Platinum Dental Rider | |
| Dental - Preventive (X-rays, cleanings, exams, fluoride - coverage frequency varies) | $0 |
| Platinum Dental Rider for Comprehensive Services - $54/month rider | |
| Dental - Comprehensive/Restorative | $0 |
| Dental – Bridges or Dentures | 50% coinsurance |
| 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 |
| 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 Complete Care LA-7 – An overview of plan benefits
Evidence of Coverage for Peoples Health Complete Care LA-7 – Information about plan benefits, membership, covered and noncovered services, member rights and responsibilities, and other important plan details
Summary of Benefits for Peoples Health Complete Care LA-7 – A general summary of plan benefits
Vendor Information – A listing of providers offering benefit-related services
How to Enroll | 2025
Enroll Online
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.