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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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $4900.00 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 $255.00 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you'll pay a $5 copay for preferred generic drugs at a standard pharmacy. For preferred brand drugs, you'll pay a $100 copay at both standard and mail-order pharmacies. After your total yearly drug costs reach $2000.00, you will enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs.
Additional Benefits
The Peoples Health Choices 65 (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, and emergency services have a $125 copay, while many outpatient services have copays between $0 and $205. The plan also includes coverage for hearing, vision, and dental services, with no copays for eye exams, contact lenses, and many dental services. Additional benefits include coverage for ambulance services, with a $235 copay, and home health services with no copay. Diagnostic and radiological services have a $30 copay, and skilled nursing facilities have a copay depending on the length of stay. The plan also offers coverage for OTC items and meal benefits.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Peoples Health Choices 65 (HMO-POS) plan. For Inpatient Hospital-Acute, you'll pay a $205 copay for days 1-10, and no copay for days 11-90. For Additional Days, there is no copay for days 91-999. Inpatient Hospital Psychiatric has a $205 copay for days 1-10 and no copay for days 11-90, but additional days are not covered.
Outpatient Services See details
Outpatient services are covered by the Peoples Health Choices 65 (HMO-POS) plan, including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $205, observation services have a $205 copay, ASC services have no copay, individual outpatient substance abuse sessions have a copay between $0 and $25, group outpatient substance abuse sessions 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 Peoples Health Choices 65 (HMO-POS). This includes both ground and air ambulance services, each with a $235 copay and no coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the Peoples Health Choices 65 (HMO-POS) plan. For Emergency Services, there is a $125 copay and no coinsurance, and the copay is waived if admitted to the hospital within 24 hours. Urgently Needed Services have a copay between $0 and $55 with no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
Primary Care See details
Primary Care Physician Services are covered with no copay, while Chiropractic Services have a $20 copay and require prior authorization. Occupational Therapy Services have a copay between $0 and $25, and Physician Specialist Services have a copay between $0 and $40, and both require prior authorization. Mental Health and Psychiatric individual sessions have a copay between $0 and $25 and group sessions have a $15 copay, and all require prior authorization. Physical Therapy and Speech-Language Pathology Services have a copay between $0 and $25 and require prior authorization. Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have no copay and require prior authorization. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay and an annual physical exam with no copay. Additional preventive services are covered, and services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, 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 (including Web/Phone-based technologies and Nursing Hotline), and Counseling Services are not covered.
Hearing Services See details
Peoples Health Choices 65 (HMO-POS) covers hearing exams with a $20 copay, routine hearing exams with no copay for one visit per year, and OTC hearing aids with a copay between $99 and $829 for two hearing aids per year. Prescription hearing aids are covered with a copay between $199 and $1249 for two hearing aids per year, but fitting/evaluation for hearing aids, and prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Peoples Health Choices 65 (HMO-POS) plan covers vision services, including eye exams and eyewear. Eye exams have no copay. Contact lenses and eyeglass frames have no copay, and eyeglass lenses have a copay of $0-$153. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $40 copay for Medicare Dental Services. Other Dental Services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, and oral and maxillofacial surgery, all with no copay. Prosthodontics (removable and fixed) and prosthodontics (fixed) have a coinsurance between 0% and 50%. The plan does not cover implant services or orthodontics, but does cover orthodontic services, which are covered under Diagnostic and Preventive Dental.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. 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 for this benefit.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment. DME has a 20% coinsurance with no copay, and durable medical equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance with no copay, and diabetic supplies and diabetic therapeutic shoes/inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a $30 copay, lab services with no copay, all radiological services, diagnostic radiological services with a copay up to $240, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $20 copay. Prior authorization is required for all diagnostic and radiological services.
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 by Peoples Health Choices 65 (HMO-POS), but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization is required, and there is a copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Peoples Health Choices 65 (HMO-POS) plan, with prior authorization required. You will have no copay for days 1-20, but will have a $203 copay for days 21-100.
Other Services See details
Other Services includes 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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