Louisiana's Peoples Insurance: What You Need To Know

Peoples Health is a Medicare Advantage organisation with a Medicare contract. It was established in 1994 as a health services administrator for the Louisiana market and is part of UnitedHealthcare. Peoples Health offers Medicare Advantage plans with Part D coverage to Louisiana residents. These plans help cover the costs of services provided by hospitals, doctors, lab tests and some preventive screenings. They also often include an integrated Medicare Part D prescription drug benefit. Peoples Health's plans have received above-average star ratings from the Centers for Medicare & Medicaid Services (CMS), and member experience ratings are also above average when compared to major providers.

Peoples Health Medicare Advantage Plans with Part D

In Louisiana, Peoples Health Insurance Company offers Medicare Advantage Plans with Part D. These plans are an alternative way to get your Original Medicare coverage and are available to Louisiana residents. The plans help cover the costs of services provided by hospitals, doctors, lab tests, and some preventive screenings. Some of these plans have a prescription drug component that helps cover medications.

Even if a plan's monthly premium is $0, enrollees would still pay the Original Medicare Part B premium and Part A premium if applicable, to have medical coverage. Part B premiums can vary depending on income and are often automatically deducted from Social Security benefits. Not all plans are available in all areas, and enrollees must continue to live in the plan service area to maintain coverage.

Peoples Health offers Medicare Advantage Plans with Part D in the following categories:

• Peoples Health Choices 65 (HMO-POS)
• Peoples Health Choices Gold (HMO-POS)
• Peoples Health Medicare Advantage LA-0004 (HMO-POS)
• Peoples Health Choices (PPO)
• Peoples Health Patriot (PPO)

Health Maintenance Organization (HMO) plans have a defined network of contracted local physicians and hospitals to provide member care. Generally, members must use these care providers to receive benefits for covered services, except in emergencies. Point of Service (HMO-POS) plans include all the features of HMO plans, plus the ability to go outside the contracted network for certain health care services, typically at a higher cost. Peoples Health POS plans only cover out-of-network dental care.

Preferred Provider Organization (PPO) plans offer members access to a network of contracted physicians and hospitals but also allow them the flexibility to receive covered services from outside of the contracted network, usually at a higher cost.

Peoples Health also offers dual special needs plans in Louisiana.

Peoples Health Insurance Company Medicare Advantage with Part D coverage

The Peoples Health Insurance Company offers Medicare Advantage Plans with Part D coverage to Louisiana residents. These plans are an alternative way to access Original Medicare coverage and help cover the costs of services provided by hospitals, doctors, lab tests, and some preventive screenings.

Even if a plan's monthly premium is $0, enrollees are still required to pay the Original Medicare Part B premium and Part A premium (if applicable) to maintain their medical coverage. Part B premiums can vary depending on income, and for many people, the premium is automatically deducted from their Social Security benefits.

The Peoples Health Medicare Advantage Plans with Part D coverage include:

• Peoples Health Choices 65 (HMO-POS)
• Peoples Health Choices Gold (HMO-POS)
• Peoples Health Medicare Advantage LA-0004 (HMO-POS)
• Peoples Health Secure Complete (HMO-POS D-SNP)
• Peoples Health Secure Health (HMO-POS D-SNP)
• Peoples Health Choices (PPO)

These plans are available in specific parishes across Louisiana, including Assumption, Lafourche, St. Mary, Terrebonne, Ascension, East Baton Rouge, and more.

It is important to note that not all plans are available to everyone, and availability depends on location. To find out which plans are offered in your area, you can enter your ZIP Code on the Peoples Health website or contact Medicare directly.

Peoples Health Choices 65 (HMO-POS)

The plan offers a range of benefits, including:

• $0 primary care physician visits
• Over-the-counter health-related items allowance (ranging from $60 to $90 per quarter)
• Part B Premium Give Back (ranging from $30 to $35 per month)
• $0 dental exams, cleanings, and x-rays
• $0 eyeglasses or contacts
• Doctor and hospital coverage
• Part D prescription drug coverage
• Virtual medical visits
• Cancer screenings
• Vaccinations
• Advanced imaging
• Emergency care, urgent care, and emergency transportation
• Outpatient services and supplies
• Mental health and substance abuse treatment

The plan also includes additional benefits such as over-the-counter drug benefits, in-home support services, home and bathroom safety devices, meals for a short duration, and annual physical exams.

The monthly premium cost for Peoples Health Choices 65 (HMO-POS) is $0 per month, with an annual deductible of $0 and a maximum out-of-pocket cost-sharing of $4,500 in-network. The plan has received a 5-star government quality rating for 2024.

Peoples Health Medicare Advantage LA-0004 (HMO-POS)

Peoples Health is a UnitedHealthcare company based in southeast Louisiana that serves more than 60,000 members. They offer Medicare Advantage plans that cover more features and benefits than Original Medicare. The Peoples Health Medicare Advantage LA-0004 (HMO-POS) plan is one such option for Louisiana residents.

Costs

The Peoples Health Medicare Advantage LA-0004 (HMO-POS) plan has a $0 monthly premium. It also has a $0 Medicare Part B premium giveback, meaning UnitedHealthcare pays part of your Medicare Part B premium each month. The amount varies by plan. The annual medical deductible is also $0. The out-of-pocket maximum is $5,900.

Benefits

The Peoples Health Medicare Advantage LA-0004 (HMO-POS) plan includes a range of benefits. For prescription drugs, there is a $0 copay for Tier 1 medications with a preferred home delivery pharmacy from OptumRx. There is also a $1,000 dental allowance for covered preventive and comprehensive services, such as cleanings, fillings, and crowns. Additionally, there is a $40 credit every quarter for over-the-counter products like pain relievers, cold remedies, and vitamins. Routine vision benefits are also included, with a $0 copay for a routine eye exam and standard prescription lenses, plus a $150 allowance for frames or contacts.

The plan also covers chiropractic services, diabetes supplies and training, durable medical equipment, diagnostic tests, lab and radiology services, and X-rays. Mental health services are also covered, with a $15 copay for group sessions and a $25 copay for individual sessions. Ambulance services, inpatient hospital care, outpatient hospital services, and skilled nursing facility care are also included in the plan.

Extras

The Peoples Health Medicare Advantage LA-0004 (HMO-POS) plan also offers some extra benefits not provided under Original Medicare. These include a $0 copay for a personal emergency response system (PERS) monitoring device, a free gym membership with Renew Active®, and online fitness classes and brain health challenges. There is also coverage for at-home meals after an eligible hospital stay and a $0 copay for a routine hearing exam.

Limitations

While the Peoples Health Medicare Advantage LA-0004 (HMO-POS) plan offers comprehensive coverage, there are some limitations to consider. For example, the $0 copay for Tier 1 medications only applies to a preferred home delivery pharmacy, and there may be additional charges for out-of-network items and services. Additionally, the plan only covers out-of-network dental care for POS plans. It is important to review the plan's evidence of coverage and summary of benefits for a full understanding of the included benefits and limitations.

Peoples Health dual special needs plans

Peoples Health offers dual special needs plans in Louisiana. These plans are for people who are entitled to both Medicare and Medicaid. Dual special needs plans are a type of Special Needs Plan (SNP), which provides benefits and services to people with specific conditions, certain healthcare needs, or who also have Medicaid. SNPs include care coordination services and tailor their benefits, provider choices, and covered drugs to meet the specific needs of the groups they serve.

The specific benefits and services covered by Peoples Health dual special needs plans may vary depending on the plan and the individual's eligibility. However, some common features of dual special needs plans include:

• Care coordination services: You'll have a personal care coordinator who can help you understand your Medicare and Medicaid benefits, manage your doctors and specialists, and get the services you need to maintain your health.
• Integrated Medicare Part D prescription drug benefit: This covers the cost of medications.
• No referrals required: You can choose your own doctors and specialists without needing referrals.
• Additional benefits and features: Dual special needs plans typically offer more benefits and features than Original Medicare, such as coverage for hospital stays, doctor visits, lab tests, and preventive screenings.

Frequently asked questions