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Peoples Health Patriot (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Peoples Health Patriot (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Peoples Health Patriot (PPO) in 2025, please refer to our full plan details page.
Peoples Health Patriot (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 Patriot (PPO) 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 Patriot (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 Patriot (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. Additionally, this plan comes with a Part B Premium reduction of $110.00. 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 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:
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Drug Coverage
Prescription drugs are not covered by Peoples Health Patriot (PPO).
Additional Benefits
The Peoples Health Patriot (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays that vary by service. Emergency services have a $125 copay, and primary care visits have no copay, along with coverage for hearing and vision services. Additional benefits include dental coverage, dialysis services, and medical equipment, often with coinsurance or copays. Home health services and skilled nursing facilities are covered with no or low copays for a limited time. The plan also offers over-the-counter items and meal benefits with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For days 1-6, the copay is $295, and for days 7-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades are not covered for Inpatient Hospital-Acute or Psychiatric services.
Outpatient Services See details
Outpatient services are covered under the Peoples Health Patriot (PPO) plan, with the following cost-sharing: Outpatient Hospital Services have a copay between $0 and $295, Observation Services have a $295 copay, Ambulatory Surgical Center (ASC) Services have no copay, Individual Sessions for Outpatient Substance Abuse have a copay between $0 and $25, Group Sessions for Outpatient Substance Abuse have a $15 copay, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Peoples Health Patriot (PPO) plan, requiring prior authorization, and has a copay of $55.
Ambulance and Transportation Services See details
For the Peoples Health Patriot (PPO) plan, ambulance services are covered with a $275 copay for both ground and air ambulance services, and no coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services are covered by the Peoples Health Patriot (PPO) plan, with a $125 copay, and no coinsurance. Urgently Needed Services have a copay between $0 and $55, and no coinsurance. Worldwide Emergency Services are covered, with Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each having no copay, and no coinsurance.
Primary Care See details
The Peoples Health Patriot (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a copay between $0 and $45, and physician specialist services with a copay between $0 and $55. Mental health specialty services, including individual and group sessions, are covered with copays ranging from $0 to $25, and $15, respectively. Podiatry services and other health care professional services are covered with copays between $45 and $55. Psychiatric services, including individual and group sessions, are covered with copays ranging from $0 to $25, and $15, respectively. Physical therapy and speech-language pathology services are covered with copays between $0 and $50, and additional telehealth benefits and opioid treatment program services are covered with no copay.
Preventive Services See details
Preventive Services include coverage for Annual Physical Exams with no copay. This plan does not cover 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, and Remote Access Technologies. The plan also covers Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following Welcome Visits, all with no copay.
Hearing Services See details
Hearing Services includes coverage for hearing exams with no copay, but fitting/evaluation for hearing aids is not covered. Prescription hearing aids (all types) are covered with a copay between $199 and $1249, and OTC hearing aids have a copay between $99 and $829.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, including routine eye exams. Eyewear has no copay, with a combined maximum benefit of $250 every two years, but eyeglass lenses and eyeglass frames are covered, and contact lenses are covered with no copay, with no copay. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Peoples Health Patriot (PPO) plan covers dental services, including Medicare dental services with 20% coinsurance. Other dental services, oral exams, dental x-rays, other diagnostic, preventive, and restorative services are covered with a $0 copay, while orthodontics, and implant services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Peoples Health Patriot (PPO) plan, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay, and coinsurance can range from 0% to 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 and a $0 copay, Prosthetics/Medical Supplies with no copay, and 20% coinsurance for Medicare-covered Prosthetic Devices and Medical Supplies. Diabetic Equipment benefits are covered, including Diabetic Supplies with no copay and 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with a $50 copay, lab services with no copay, diagnostic radiological services with a maximum copay of $250, therapeutic radiological services with a minimum 20% coinsurance, and outpatient X-ray services with a $25 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the Peoples Health Patriot (PPO) 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 not covered by the Peoples Health Patriot (PPO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Peoples Health Patriot (PPO) plan, with a $0 copay for days 1-20 and 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 includes coverage for Over-the-Counter (OTC) Items and Meal Benefits, but not 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. Over-the-Counter (OTC) Items have no copay, and Meal Benefits also have no copay, and require prior authorization.
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