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Peoples Health Choices Gold (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Peoples Health Choices Gold (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 Gold (HMO-POS) in 2025, please refer to our full plan details page.
Peoples Health Choices Gold (HMO-POS) is a HMO-POS plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Southwest and North Louisiana. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Peoples Health Choices Gold (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 Gold (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 Gold (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 $6700.00 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 Gold (HMO-POS) plan has a $255 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you may pay a $10 copay for a preferred generic drug at a standard pharmacy. For preferred brand drugs, you will pay a $100 copay. For non-preferred drugs, you pay 30% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Peoples Health Choices Gold (HMO-POS) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays. Emergency, primary care, and preventive services often have no copay, while specialist visits and other services have copays. Dental, vision, and hearing services are also included, with specific copays for exams, aids, and other services. This plan covers ambulance, home health, and skilled nursing facility services, along with medical equipment and diagnostic services, with associated copays or coinsurance. Other benefits include partial hospitalization, home infusion, dialysis, and cardiac rehabilitation services. The plan also offers additional services like over-the-counter items and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $195 for days 1-10, and no copay for days 11-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric 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 $195, Observation Services have a $195 copay, and Ambulatory Surgical Center Services have no copay. Individual Sessions for Outpatient Substance Abuse have a copay between $0 and $25, while Group Sessions have a $15 copay. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Peoples Health Choices Gold (HMO-POS) plan, 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 Gold (HMO-POS) plan. Ground and Air Ambulance Services have a $290 copay, and there is no coinsurance. 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 Gold (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 Services have no copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Peoples Health Choices Gold (HMO-POS) plan offers primary care 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 physician specialist services with a copay between $0 and $30, mental health specialty services with a copay between $0 and $25 for individual sessions and a $15 copay for group sessions, and physical therapy and speech-language pathology services with a copay between $0 and $20. Additionally, the plan covers additional telehealth benefits with no copay, and opioid treatment program services with no copay. However, podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are covered with varying copays.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and OTC hearing aids. Hearing exams have a $20 copay, routine hearing exams have no copay, and fitting/evaluation for hearing aids are not covered. Prescription hearing aids have a copay between $199 and $1249 depending on the type, with inner ear, outer ear, and over-the-ear hearing aids not covered. OTC hearing aids have a copay between $99 and $829.
Vision Services See details
Vision services include eye exams, eyewear, and contact lenses. Eye exams and routine eye exams have no copay. Eyewear benefits include contact lenses, eyeglass lenses, and eyeglass frames, all with no copay. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Peoples Health Choices Gold (HMO-POS) plan covers dental services, including Medicare and other dental services. Medicare dental services have a $35 copay, and oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services have no copay. The plan also covers restorative services, adjunctive general services, endodontics, periodontics, maxillofacial prosthetics, and oral and maxillofacial surgery with no copay, and prosthodontics (removable and fixed) with 0%-50% coinsurance. However, implants and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Peoples Health Choices Gold (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, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay for diagnostic procedures/tests that is at most $50, and a copay for diagnostic radiological services that is at most $170. Lab services have no copay, and outpatient X-ray services have a $35 copay. Therapeutic radiological services have 20% coinsurance, while outpatient X-ray services have coinsurance.
Home Health Services See details
Home Health Services are covered by the Peoples Health Choices Gold (HMO-POS) plan 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, or Additional Cardiac Rehabilitation Services. Prior authorization is required, and the copay for covered services is listed separately.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Peoples Health Choices Gold (HMO-POS) plan with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and a Meal Benefit with no copay, while 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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