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Peoples Health Choices 65 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Peoples Health Choices 65 (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Peoples Health Choices 65 (HMO-POS) in 2026, please refer to our full plan details page.
Peoples Health Choices 65 (HMO-POS) is a HMO-POS plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in New Orleans Metro Area and Northshore. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Peoples Health Choices 65 (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Peoples Health Choices 65 (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Peoples Health Choices 65 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $30.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $355.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3900.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Peoples Health Choices 65 (HMO-POS) Medicare plan features an annual prescription drug deductible of $355. Tier 1 preferred generic drugs are highly affordable, offering no copay for 1-month and 3-month supplies at standard pharmacies and through mail order. Tier 2 generic drugs require a $5 copay for a 1-month standard pharmacy supply, but you can get a 3-month supply with no copay through preferred mail order. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs carry a 21% coinsurance, while Tier 4 non-preferred drugs require a 43% coinsurance. Specialty drugs in Tier 5 are covered with a 29% coinsurance for a 1-month supply across standard pharmacies and mail order services.
Additional Benefits
The Peoples Health Choices 65 (HMO-POS) plan offers comprehensive medical coverage with highly predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care, telehealth, and home health services. For inpatient hospital stays, members pay a $95 daily copay for the first 10 days and no copay for days 11 through 90, while outpatient services range from no copay to a $125 copay with no coinsurance. Emergency care is covered with a $150 copay, which is waived if admitted, and urgently needed services require a copay ranging from no copay to $65. This plan also includes robust supplemental benefits, such as preventive dental care with no copay and comprehensive dental services covered up to a $4,000 annual maximum with a 50% coinsurance. Vision and hearing benefits feature no copay for routine annual exams, alongside coverage for eyewear and prescription hearing aids. Additionally, members pay a 20% coinsurance and no copay for dialysis and durable medical equipment, while diabetic supplies are fully covered with no copay and no coinsurance.
Inpatient Hospital See details
Peoples Health Choices 65 (HMO-POS) covers inpatient hospital services with no coinsurance, requiring prior authorization and a $95 daily copay for days 1 to 10, followed by no copay for days 11 to 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, though unlimited additional acute days are covered with no copay.
Outpatient Services See details
Peoples Health Choices 65 (HMO-POS) covers outpatient services with no coinsurance, although prior authorization is required for most services. Covered ambulatory surgical center and blood services require no copay, while outpatient hospital, observation, and substance abuse services have copays ranging from $0 to $125.
Partial Hospitalization See details
Peoples Health Choices 65 (HMO-POS) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Peoples Health Choices 65 (HMO-POS) covers Medicare-covered ground and air ambulance services with a $275 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Peoples Health Choices 65 (HMO-POS) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a copay of $0 to $65 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
Peoples Health Choices 65 (HMO-POS) covers primary care and telehealth services with no copay and no coinsurance, while specialist, therapy, and mental health services have copays ranging up to $30 and no coinsurance. Podiatry services are not covered, and while some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
Peoples Health Choices 65 (HMO-POS) provides partially covered preventive services with no copay and no coinsurance for covered benefits, such as annual physical exams, kidney disease education, fitness benefits, and home safety devices. However, several additional preventive services, including health education, nutritional/dietary benefits, and personal emergency response systems, are not covered.
Hearing Services See details
Peoples Health Choices 65 (HMO-POS) offers partially covered hearing services, including one annual routine hearing exam with no copay and no coinsurance, though fitting and evaluation exams are not covered. Up to two prescription hearing aids (copays of $199 to $1,249) and two OTC hearing aids (copays of $199 to $829) are covered annually with no coinsurance, but inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Peoples Health Choices 65 (HMO-POS) provides partially covered vision services with no coinsurance, including one routine eye exam annually with no copay, while other eye exams are not covered. Eyewear is also partially covered up to a $300 combined limit every two years with no coinsurance, offering contacts and frames with no copay and lenses with a $0 to $153 copay, though upgrades and packaged eyeglasses are not covered.
Dental Services See details
Peoples Health Choices 65 (HMO-POS) covers dental services up to a $4,000 annual maximum, offering preventive care with no copay and no coinsurance, and Medicare-covered dental services for a $20 copay and no coinsurance. Comprehensive dental services are partially covered with no copay and 50% coinsurance, excluding implant services and orthodontics which are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under Peoples Health Choices 65 (HMO-POS) with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy and radiation, have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by the Peoples Health Choices 65 (HMO-POS) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Peoples Health Choices 65 (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes are covered with no copay and no coinsurance, though prior authorization is required for these services.
Diagnostic and Radiological Services See details
Peoples Health Choices 65 (HMO-POS) covers diagnostic and radiological services with prior authorization, offering lab services with no copay or coinsurance and diagnostic tests for a $50 copay and no coinsurance. Outpatient X-rays require a $30 copay, diagnostic radiology copays start with no copay, and therapeutic radiology services require a copay and a minimum 20% coinsurance.
Home Health Services See details
Peoples Health Choices 65 (HMO-POS) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under Peoples Health Choices 65 (HMO-POS) with no coinsurance and require prior authorization, though in practice, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Peoples Health Choices 65 (HMO-POS) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, no prior three-day hospital stay is needed, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Peoples Health Choices 65 (HMO-POS) partially covers other services, offering over-the-counter (OTC) items and meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan, and prior authorization is required for the meal benefit.
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