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Peoples Health Medicare Advantage Patriot No Rx LA (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Peoples Health Medicare Advantage Patriot No Rx LA (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 Medicare Advantage Patriot No Rx LA (HMO-POS) in 2025, please refer to our full plan details page.
Peoples Health Medicare Advantage Patriot No Rx LA (HMO-POS) is a HMO-POS plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Greater New Orleans and Baton Rouge area. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Peoples Health Medicare Advantage Patriot No Rx LA (HMO-POS) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Peoples Health Medicare Advantage Patriot No Rx LA (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 Medicare Advantage Patriot No Rx LA (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 $173.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by Peoples Health Medicare Advantage Patriot No Rx LA (HMO-POS).
Additional Benefits
The Peoples Health Medicare Advantage Patriot No Rx LA (HMO-POS) plan offers a wide range of benefits, including coverage for inpatient and outpatient services, with varying copays. Emergency services have a $125 copay, and primary care visits have no copay. The plan also covers preventive services, hearing exams, and vision services with no copays for eye exams and eyewear. This plan provides coverage for dental services, with no copay for many preventive services, and a $5,000 maximum benefit per year. Additional benefits include ambulance services, home health services, and skilled nursing facility care, with specific copays and coinsurance amounts. The plan also covers diagnostic and radiological services.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $350 for days 1-8, and no copay for days 9-90. Additional days for Inpatient Hospital-Acute have no copay, and Inpatient Hospital Psychiatric services have a copay of $350 for days 1-6 and no copay for days 7-90; however, Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay of $0-$350, Observation Services with a copay of $350, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay of $0-$25 for individual sessions and $15 for group sessions, and Outpatient Blood Services with no copay. Prior authorization is required for all of these services.
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 Medicare Advantage Patriot No Rx LA (HMO-POS). Both ground and air ambulance services have a $275 copay, with no coinsurance, but transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services are covered by the Peoples Health Medicare Advantage Patriot No Rx LA (HMO-POS) plan. Emergency services have a $125 copay and no coinsurance, and urgently needed services have a copay between $0 and $55 and no coinsurance. Worldwide emergency services, including worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation, are covered with no copay and no coinsurance.
Primary Care See details
The Peoples Health Medicare Advantage Patriot No Rx LA (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy with a copay between $0 and $40, and physician specialist services with a copay between $0 and $40. Mental health specialty services have a copay between $0 and $25 for individual sessions and a $15 copay for group sessions, while other health care professionals and psychiatric services have a copay between $0 and $40 for individual sessions and a $15 copay for group sessions. Physical therapy and speech-language pathology services have a copay between $0 and $40, and additional telehealth benefits have no copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, an annual physical exam with no copay, and additional preventive services with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. The plan does not cover health education, in-home safety assessment, personal emergency response systems, 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 benefits, 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, or counseling services.
Hearing Services See details
Hearing exams are covered with no copay, while fitting/evaluation for hearing aids are not covered. Prescription hearing aids are partially covered, with a copay between $199 and $1249 for prescription hearing aids of all types, but not for inner ear, outer ear, or over the ear hearing aids. OTC hearing aids are covered with a copay between $99 and $829.
Vision Services See details
Vision services include eye exams and eyewear, with no copay for eye exams, routine eye exams, contact lenses, and eyeglass frames. Eyeglass lenses have a copay between $0 and $153, while eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with 20% coinsurance, and other dental services, with a $5,000 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered with no copay. Restorative services, adjunctive general services, endodontics, periodontics, maxillofacial prosthetics, and oral and maxillofacial surgery are covered with no copay. Prosthodontics, removable and prosthodontics, fixed have a coinsurance of 0% - 50%. Orthodontic services are covered under Diagnostic and Preventive Dental. Implant and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, you will pay a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetics/Medical Supplies (non-Medicare) with a 20% coinsurance, Prosthetic Devices with a 20% coinsurance, Medical Supplies with a 20% coinsurance, and Diabetic Equipment with a $0 copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, and 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 and radiological services, with prior authorization required. Diagnostic Procedures/Tests have a $50 copay, Lab Services have no copay, Diagnostic Radiological Services have a copay of at most $250, Therapeutic Radiological Services have at most 20% coinsurance, and Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the Peoples Health Medicare Advantage Patriot No Rx LA (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 by the Peoples Health Medicare Advantage Patriot No Rx LA (HMO-POS) plan, but the specific services are not covered. Prior authorization is required, and there is a copay for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Peoples Health Medicare Advantage Patriot No Rx LA (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, and a $203 copay for days 21-100, with no coinsurance. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits. 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. Over-the-Counter (OTC) Items have no copay, and Meal Benefits have no copay.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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