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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 $5900.00 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 the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, in the initial coverage phase, you will pay a $5.00 copay for preferred generic drugs at a standard pharmacy. For non-preferred drugs, you will pay 30% coinsurance. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs.
Additional Benefits
The Peoples Health Choices 65 (HMO-POS) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a copay, but many outpatient services, including primary care visits, have no copay. The plan also covers emergency services, ambulance services, and offers additional benefits like hearing and vision services with copays, along with dental coverage. This plan includes coverage for preventive services with no copay, along with home health services, and durable medical equipment. The plan also covers services such as diagnostic and radiological services, skilled nursing facilities and cardiac rehabilitation services, but may require prior authorization or have copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a $125 copay for days 1-10 and no copay for days 11-90. Additional Days for Inpatient Hospital-Acute has no copay for days 91-999. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, covered by Peoples Health Choices 65 (HMO-POS), include Outpatient Hospital Services with a copay between $0 and $125, Observation Services with a $125 copay, Ambulatory Surgical Center (ASC) Services with no copay, Individual Sessions for Outpatient Substance Abuse with a copay between $0 and $25, Group Sessions for Outpatient Substance Abuse with a $15 copay, and Outpatient Blood Services with no copay. All of these services require prior authorization.
Partial Hospitalization See details
Partial Hospitalization is covered under the Peoples Health Choices 65 (HMO-POS) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
For Peoples Health Choices 65 (HMO-POS), Ambulance Services are covered with no coinsurance and a $280 copay for both Ground and Air Ambulance Services, but Transportation Services 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 and $55 with no coinsurance. Worldwide Emergency, Urgent, and Transportation services each have no copay and no coinsurance.
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 from $0 to $30, physician specialist services with a copay from $0 to $30, mental health specialty services with a copay from $0 to $25 for individual sessions and $15 for group sessions, other health care professional services with a copay from $0 to $30, psychiatric services with a copay from $0 to $25 for individual sessions and $15 for group sessions, physical therapy and speech-language pathology services with a copay from $0 to $30, additional telehealth benefits with no copay, and opioid treatment program services with no copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams with no copay, and additional preventive services including Fitness Benefit, Home and Bathroom Safety Devices and Modifications, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. This plan does not cover Health Education, In-Home Safety Assessment, Personal Emergency Response System, 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 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, and Counseling Services.
Hearing Services See details
The Peoples Health Choices 65 (HMO-POS) plan covers hearing exams with a $20 copay, and routine hearing exams with no copay for one visit per year. Prescription hearing aids are covered with a copay between $199 and $1249 for two hearing aids per year, while OTC hearing aids have a copay between $99 and $829 for two hearing aids per year. Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision services include eye exams, eyewear, contact lenses, eyeglass lenses, and eyeglass frames. Eye exams and eyewear have no copay, with routine eye exams covered once per year and contact lenses covered without limit. Eyeglass lenses have a copay of $0-$153, and eyeglass frames are covered once every two years. Eyeglass frames and upgrades are not covered.
Dental Services See details
The Peoples Health Choices 65 (HMO-POS) plan covers dental services, including Medicare Dental Services with a $20 copay. Other covered services include oral exams, dental x-rays, other diagnostic services, cleaning, fluoride treatment, other preventive services, restorative services, and oral surgery, all with no copay, along with orthodontics and prosthodontics which have coinsurance. However, implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0% and 20%, while the other drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Peoples Health Choices 65 (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment with no copay and 20% coinsurance, prosthetics/medical supplies with no copay and 20% coinsurance, and diabetic equipment with no copay and 20% coinsurance for some services. 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 $20 copay, Lab Services have no copay, Diagnostic Radiological Services have a copay of up to $170, Therapeutic Radiological Services have a copay of at least $80, and Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered by Peoples Health Choices 65 (HMO-POS) with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, 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, and Additional Cardiac Rehabilitation Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Peoples Health Choices 65 (HMO-POS) plan covers 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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