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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 2025, 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 2025.
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 $41.00. 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 $255.00 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) plan has a $255 deductible for prescription drugs. In the initial coverage phase, you will pay the following copays and coinsurance amounts depending on the drug tier and pharmacy type. For preferred generic drugs at a standard pharmacy, the copay is $5.00. For standard generic drugs at a standard pharmacy, the copay is $47.00. For preferred brand drugs, the copay is $100.00 at standard and mail order pharmacies. Non-preferred drugs have a 30% coinsurance. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for covered drugs.
Additional Benefits
The Peoples Health Choices 65 (HMO-POS) plan offers comprehensive coverage with a variety of benefits. Inpatient hospital stays have a copay, and outpatient services vary in cost depending on the service. Emergency, primary care, preventive, and vision services are covered, with many services having no copay. The plan also includes coverage for hearing, dental, home infusion, dialysis, medical equipment, and diagnostic services, with varying copays and coinsurance amounts. Additional benefits include home health, skilled nursing, and other services like OTC items and meal benefits.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered. For inpatient hospital-acute stays, you'll pay a $95 copay for days 1-10 and no copay for days 11-90, with additional days 91-999 having no copay; non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a copay between $0 and $125, Observation Services have a $125 copay, Ambulatory Surgical Center Services have no copay, Individual Sessions for Outpatient Substance Abuse have a copay between $0 and $25, Group Sessions for Outpatient Substance Abuse have a $15 copay, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Peoples Health Choices 65 (HMO-POS) plan. Ground and Air Ambulance Services have a $260 copay, but there is no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Peoples Health Choices 65 (HMO-POS) plan. Emergency Services have a $125 copay and no coinsurance, while Urgently Needed Services have a copay between $0-$40 and no coinsurance, and Worldwide Emergency Services have a $0 copay and no coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Peoples Health Choices 65 (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a copay between $0 and $10, and physician specialist services with a copay between $0 and $20. The plan also covers mental health specialty services, other health care professionals, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams with no copay, additional preventive services, and other preventive services. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, and counseling services are not covered.
Hearing Services See details
The Peoples Health Choices 65 (HMO-POS) plan covers hearing exams with a $20 copay, routine hearing exams with no copay, and OTC hearing aids with a copay between $99 and $829, but fitting/evaluation for hearing aids, and prescription hearing aids - inner ear, outer ear, and over the ear are not covered. The plan covers prescription hearing aids (all types) with a copay between $199 and $1249.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and eyewear has a combined maximum plan benefit coverage amount of $250 every two years.
Dental Services See details
Peoples Health Choices 65 (HMO-POS) covers dental services including oral exams, dental x-rays, other diagnostic services, cleanings, fluoride treatments, other preventive services, restorative services, and general services. Oral exams, dental x-rays, other diagnostic services, cleanings, fluoride treatments, other preventive services, and oral and maxillofacial surgery have no copay, while prosthodontics (removable and fixed) may have a coinsurance of up to 50%. The plan does not cover implant services or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Peoples Health Choices 65 (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetics and Medical Supplies with 20% coinsurance and no copay, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a $40 copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $250.00. Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by Peoples Health Choices 65 (HMO-POS) with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the following services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Peoples Health Choices 65 (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, but for days 21-100, there is a $203 copay.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and Meal Benefits. OTC items have no copay, and Meal Benefits also have no copay, but require prior authorization. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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