A non-government entity
Peoples Health Choices (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Peoples Health Choices (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Peoples Health Choices (PPO) in 2025, please refer to our full plan details page.
Peoples Health Choices (PPO) is a PPO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in State of Louisiana. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Peoples Health Choices (PPO) 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 (PPO).
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 (PPO), 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 $420.00 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 combined Maximum Out-Of-Pocket cost of $10100.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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:
Sign up for Peoples Health Choices (PPO)
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Drug Coverage
The Peoples Health Choices (PPO) plan has a $420 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For standard generic drugs, you will pay a $10 copay. For preferred brand drugs, you will pay a $100 copay. For non-preferred drugs, you will pay 28% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Peoples Health Choices (PPO) plan offers a variety of benefits beyond basic Medicare coverage. This plan includes coverage for inpatient and outpatient hospital services, with copays varying by service type. It also provides coverage for ambulance services, emergency services, and primary care with no copay for many services. Additional benefits include preventive services such as annual physical exams with no copay, hearing and vision services, and dental services with varying cost-sharing. There are also benefits for home infusion, dialysis, medical equipment, diagnostic and radiological services, and home health services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but 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. For Inpatient Hospital-Acute, you pay a $225 copay for days 1-7 and no copay for days 8-90, and for Inpatient Hospital Psychiatric, you pay a $225 copay for days 1-4 and no copay for days 5-90.
Outpatient Services See details
Outpatient services, including all outpatient hospital services, are covered. Outpatient hospital services have a copay between $0 and $225, observation services have a $225 copay, and ambulatory surgical center services and outpatient blood services have no copay. Individual sessions for outpatient substance abuse have a copay between $0 and $25, while group sessions have a $15 copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Peoples Health Choices (PPO) plan, but requires prior authorization. You will pay a $55 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Peoples Health Choices (PPO) 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 Peoples Health Choices (PPO). Emergency Services has a $125 copay, while Urgently Needed Services has a copay of $0-$55; all other services have no copay and no coinsurance.
Primary Care See details
The Peoples Health Choices (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a copay between $0 and $30. The plan also covers physician specialist services with a copay between $0 and $35, and mental health and psychiatric services with varying copays depending on the session type. Podiatry services and other health care professional services have a copay of $35, while physical therapy and speech-language pathology services have a copay between $0 and $30. Finally, additional telehealth benefits and opioid treatment program services have no copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, as well as additional preventive services. Additional preventive services include 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 of which have no copay. Services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 (including Web/Phone-based technologies and Nursing Hotline), and Counseling Services are not covered.
Hearing Services See details
The Peoples Health Choices (PPO) plan covers hearing exams with no 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
The Peoples Health Choices (PPO) plan covers vision services, including eye exams and eyewear. Eye exams and routine eye exams have no copay, and eyewear has no copay. Contact lenses are covered with no copay, while eyeglass lenses have a copay between $0 and $153. Eyeglass frames have no copay. Eyeglasses (lenses and frames) and upgrades are not covered. There is a combined maximum plan benefit coverage of $300 for eyewear every two years.
Dental Services See details
Dental Services are covered under the Peoples Health Choices (PPO) plan, with a 20% coinsurance for Medicare Dental Services, and no copay for oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, and other preventive dental services. Orthodontic, restorative, adjunctive general, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, 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. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is 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 20% coinsurance, Prosthetics/Medical Supplies with no copay and a coinsurance for Medicare-covered supplies, and Diabetic Equipment. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Peoples Health Choices (PPO) plan. Diagnostic Procedures/Tests have a $50 copay, and Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $240, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $35 copay.
Home Health Services See details
Home Health Services are covered by Peoples Health Choices (PPO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Peoples Health Choices (PPO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Peoples Health Choices (PPO) plan, but require prior authorization. There is no copay for days 1-20, but there is a $203 copay for days 21-100; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and a Meal Benefit, both with no copay, but 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. The Meal Benefit requires prior authorization.
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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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