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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 $45.00. 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 $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 an enhanced alternative drug benefit. The plan has a $255 deductible for prescription drugs. In the initial coverage phase, after you meet your deductible, you will pay a copay for your prescriptions depending on the tier and pharmacy. For example, a standard pharmacy will have a $5 copay for preferred generic drugs, and $47 for standard generic drugs. Brand name drugs have a $100 copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for 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, while outpatient services, including primary care and many preventive services, often have no copay. Emergency and ambulance services have copays, and some services like home health and OTC items are covered with no copay. Additional benefits include coverage for hearing, vision, and dental services, with specific copays and coverage limits. The plan also covers medical equipment, diagnostic services, and skilled nursing, with associated costs like coinsurance or copays. Some services, such as cardiac rehabilitation and certain home health services, are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital coverage includes a $125 copay for days 1-10, and no copay for days 11-90, for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric stays. Additional Days for Inpatient Hospital-Acute has no copay for days 91-999, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Peoples Health Choices 65 (HMO-POS) plan, with a copay ranging from $0 to $125 for outpatient hospital services and a $125 copay for observation services. Additionally, Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a copay of $0 to $25 for individual sessions and $15 for group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Peoples Health Choices 65 (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $55.
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 $270 copay with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered by Peoples Health Choices 65 (HMO-POS). Emergency Services have a $120 copay, and Urgently Needed Services have a copay between $0 and $40, but both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
Primary Care See details
The Peoples Health Choices 65 (HMO-POS) plan offers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a copay between $0 and $20. The plan also covers specialist services with a copay between $0 and $30, mental health specialty services, and psychiatric services, both with a copay between $0 and $25 for individual sessions and $15 for group sessions. Physical therapy and speech-language pathology services have a copay between $0 and $20, while additional telehealth benefits have no copay, and Opioid Treatment Program Services have no copay. 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, and additional preventive services. Additional preventive services include no copay for Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Some services, such as Health Education, In-Home Safety Assessment, and others are not covered.
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, but the fitting/evaluation for hearing aids, and prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are covered with a copay between $99 and $829 for two hearing aids per year.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and routine eye exams are covered once per year. Eyewear is covered with no copay, but eyeglass lenses are covered with a copay between $0 and $153, and the plan offers a combined maximum of $200 for all eyewear every two years. Contact lenses are covered, but eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services are covered, with a $20 copay for Medicare Dental Services and no copay for Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Oral and Maxillofacial Surgery. Prosthodontics, removable and Prosthodontics, fixed have a coinsurance of 0% - 50%. Implant Services and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, are covered by the Peoples Health Choices 65 (HMO-POS) plan. For Medicare Part B Insulin Drugs, there is a $35 copay, and the coinsurance ranges from 0% to 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 coverage includes Durable Medical Equipment with 20% coinsurance and no copay, Prosthetic Devices with 20% coinsurance and no copay, 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, including diagnostic procedures and tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. Diagnostic Procedures/Tests have a copay of $25, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $250, and Therapeutic Radiological Services have a copay of at most $80. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Peoples Health Choices 65 (HMO-POS) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Peoples Health Choices 65 (HMO-POS) plan. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
The Peoples Health Choices 65 (HMO-POS) plan covers Skilled Nursing Facility (SNF) services, but prior authorization is required. For days 1-20, there is no copay, and for days 21-100, there is a $203 copay.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefit, both with no copay, but acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered. The Meal Benefit requires prior authorization.
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