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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 $25.00. 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 $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) Medicare prescription drug plan features an annual drug deductible of $355. Under this plan, you will pay no copay for Tier 1 preferred generic drugs at standard pharmacies or through mail order. For Tier 2 generic drugs, costs are also low, featuring a $5 copay for a 1-month supply at standard pharmacies and no copay for a 3-month supply when using preferred mail order. Higher-tier medications transition to coinsurance, with Tier 3 preferred brand drugs requiring a 21% coinsurance for both 1-month and 3-month supplies. Tier 4 non-preferred drugs carry a 43% coinsurance, while Tier 5 specialty drugs require a 29% coinsurance for a 1-month supply. These cost-sharing details help you estimate your out-of-pocket prescription expenses under this plan.
Additional Benefits
The Peoples Health Choices 65 (HMO-POS) plan offers robust medical coverage with affordable out-of-pocket costs, featuring no copays or coinsurance for primary care visits, preventive care, and home health services. For more intensive care, specialist visits range from no copay up to a $40 copay, while inpatient hospital stays require a $225 daily copay for the first 10 days and no copay for remaining days. Outpatient hospital services feature copays up to $225, and emergency room visits carry a $130 copay which is waived upon hospital admission. This plan also includes valuable supplemental benefits for dental, vision, and hearing care with no deductibles. Routine hearing and eye exams, as well as preventive dental services, are available with no copays, and the plan provides a $2,000 annual allowance for comprehensive dental services. Additionally, diabetic supplies and therapeutic shoes are covered with no copay or coinsurance, though durable medical equipment and dialysis services require a 20% coinsurance.
Inpatient Hospital See details
Peoples Health Choices 65 (HMO-POS) covers inpatient hospital services with no coinsurance, requiring prior authorization and a $225 daily copay for days 1 to 10, with no copay for days 11 through 90. This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Peoples Health Choices 65 (HMO-POS) covers outpatient services with no coinsurance, featuring copays ranging from no copay up to $225 for outpatient hospital and observation services, and up to $25 for substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, though prior authorization is required for most services.
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 ground and air ambulance services with a $275 copay and no coinsurance, though prior authorization is required. For transportation benefits, some services are covered but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Peoples Health Choices 65 (HMO-POS) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have a copay ranging from $0 to $50 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copays and no coinsurance.
Primary Care See details
Peoples Health Choices 65 (HMO-POS) covers primary care physician and telehealth services with no copay and no coinsurance, while specialist visits range from a $0 to $40 copay with no coinsurance. Physical and occupational therapies require a $20 copay and no coinsurance, podiatry is not covered, and although some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Peoples Health Choices 65 (HMO-POS) covers preventive services with no copay and no coinsurance, including annual physicals, kidney disease education, fitness benefits, and various screenings. Additional preventive services are only partially covered, excluding health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary services, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, bathroom safety, and counseling.
Hearing Services See details
Peoples Health Choices 65 (HMO-POS) provides partially covered hearing services with no deductible and no coinsurance, offering routine hearing exams with no copay, OTC hearing aids with a $199 to $829 copay, and prescription hearing aids with a $199 to $1,249 copay. However, fitting and evaluation exams, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Peoples Health Choices 65 (HMO-POS) partially covers vision services with no deductibles or coinsurance, offering no copay for annual routine eye exams and contact lenses. Eyeglass frames have no copay and lenses have a $0 to $153 copay under a $250 combined limit every two years, while other eye exams, upgrades, and packaged eyeglasses are not covered.
Dental Services See details
Peoples Health Choices 65 (HMO-POS) offers partially covered dental services up to a $2,000 yearly maximum, excluding implant services and orthodontics. Medicare-covered dental services require a $20 copay and no coinsurance, preventive services are available with no copay and no coinsurance, and covered comprehensive services require no copay and a 50% coinsurance.
Home Infusion bundled Services See details
Peoples Health Choices 65 (HMO-POS) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Associated Medicare Part B chemotherapy, radiation, and other drugs require no copay and range from no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and ranges from no coinsurance to 20% coinsurance.
Dialysis Services See details
Peoples Health Choices 65 (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Peoples Health Choices 65 (HMO-POS) covers medical equipment with no copays, but a 20% coinsurance applies to durable medical equipment, prosthetic devices, and medical supplies. Diabetic supplies and therapeutic shoes are covered with no copay and no coinsurance, though prior authorization is required and manufacturer restrictions may apply.
Diagnostic and Radiological Services See details
Peoples Health Choices 65 (HMO-POS) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services and outpatient X-rays feature no copay, while diagnostic tests require a $50 copay, diagnostic radiological services start at a $0 copay, and therapeutic radiology services start at an $80 copay.
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
Peoples Health Choices 65 (HMO-POS) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization is required. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Peoples Health Choices 65 (HMO-POS) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and a $218 copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Peoples Health Choices 65 (HMO-POS) partially covers other services, providing a chronic illness meal benefit with no copay, no coinsurance, and prior authorization required. Acupuncture and over-the-counter (OTC) items are not covered under this benefit.
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