Peoples Health Secure Health (D-SNP HMO-POS), Washington Parish, LA
Peoples Health Secure Health (HMO-POS D-SNP), plan H1961-003-0, is a Medicare Advantage Special Needs Plan from Peoples Health. Delivery of healthcare services and costs are significantly different than in Original Medicare, and the plan offers additional benefits that are not included with Medicare Part A and Part B.
CMS rated this plan 5.0 (Excellent) out of 5 stars. See MedicareWire's review below. You must meet all qualification requirements to join this D-SNP plan.
GET NOTIFIED: 2024 Medicare Special Needs Plan Notification.
What You Need to Know
- Peoples Health Secure Health is a HMO-POS health plan for dual-eligible (Medicare and Medicaid) beneficiaries.
- This is not a zero-dollar D-SNP cost-sharing plan. Members have small copays on some Medicare-approved healthcare services.
- To qualify, you must have both Medicare Part A and Part B, you must live in the plan's service area (Washington Parish), and you must qualify for full Medicaid.
- It includes prescription drug coverage (Medicare Part D).
- The annual Part D deductible is $505.00. You pay this amount before cost-sharing begins.
- People who qualify for Medicare "Extra Help," can get additional assistance to help pay their Medicare Part D monthly premium, deductible, and copayments.
- The plan offers the same health insurance benefits as Original Medicare and some additional benefits that Original Medicare does not cover.
- If you don't qualify to join Peoples Health Secure Health, you might want to compare Medicare Advantage plans available in Washington Parish, Louisiana. Another popular option is to add one of the many Medicare supplements available in Louisiana and a stand-alone prescription drug plan.
- 2024 costs and benefits for Peoples Health Secure Health will be available in early October. Get Notification.
| H1961-003-0 Plan Basics | |
|---|---|
| Plan ID: | H1961-003-0 |
| Plan Type: | D-SNP |
| Network Type: | HMO-POS |
| Plan Year: | 2023 |
| Premium: | $38.40/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | $3,500 In-network |
| Drug Plan Benefit: | Basic $505.00 deductible |
| Rx Gap Coverage: | No |
| Supplemental Benefits: | Dental, Vision, Hearing |
| Availability: | Washington Parish, LA |
| Insured By: | Peoples Health |
Health Plan Costs & Benefits
Peoples Health Secure Health is an HMO-POS (point-of-sale) plan. HMO-POS plans offer the same features as a Health Maintenance Organization (HMO) plan, however, there is one major difference. HMO-POS plans allow members to access healthcare providers outside the plan's network to receive some or all of their services. In most cases, a member will need to get a referral from their physician to go out of the plan's network. Plus, there are separate deductibles for in-network and out-of-network services.
Premiums, deductibles, and copays vary widely from plan to plan. It is very important to compare costs and apply them to your personal financial and healthcare needs.
Monthly Premium
Peoples Health Secure Health's total monthly premium in Washington Parish is $38.40. This includes your prescription coverage, as well. Plus, you must continue to pay your monthly Medicare Part B premium.
Annual Deductible
Peoples Health Secure Health's annual health plan deductible is $0.00. This does not include the deductible for the prescription drug plan (if any), which is detailed below.
Maximum Out-of-Pocket Limit
The Maximum Out-of-Pocket (MOOP) with this Peoples Health plan is $3,500 in-network. Unlike Original Medicare, Medicare Advantage plans must set an annual Maximum Out-of-Pocket (MOOP) limit on inpatient and outpatient healthcare services. Once you reach this amount of spending on your copayments, all of your Medicare Part A and Part B services will be covered at no additional charge for the remainder of the year. MOOP does not include monthly premiums, prescriptions, or other extra benefits.
Health Plan Out-of-Pocket Costs
The following table is a summary of the most common out-of-pocket costs you will incur if you join this Peoples Health plan:
| Healthcare Service | Member Cost |
|---|---|
| Health plan deductible | $0 |
| Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) | $3,500 In-network |
| Doctor Visits | |
| Specialist (In-Network) | $0 or $10 copay per visit |
| Wellness programs (e.g., fitness, nursing hotline) | Covered |
| Preventive care | $0 copay |
| Mental Health Services | |
| Inpatient hospital - psychiatric (In-Network) | $0 or $75 per day for days 1 through 10 $0 per day for days 11 through 90 (authorization required) |
| Outpatient group therapy visit with a psychiatrist (In-Network) | $0 or $10 copay (authorization required) |
| Inpatient hospital - psychiatric (Out-of-Net) | Not Applicable (authorization required) |
| Outpatient individual therapy visit (In-Network) | $0 or $10 copay (authorization required) |
| Outpatient group therapy visit (In-Network) | $0 or $10 copay (authorization required) |
| Rehabilitation Services | |
| Physical therapy and speech and language therapy visit (In-Network) | $0 copay (authorization required) |
| Medical Equipment / Supplies | |
| Prosthetics (e.g., braces, artificial limbs) (In-Network) | $0 copay (authorization required) |
| Diabetes supplies (In-Network) | $0 copay (authorization required) |
| Diagnostic Procedures / Lab Services / Imaging | |
| Diagnostic radiology services (e.g., MRI) (In-Network) | $0 or $0-75 copay (authorization required) |
| Outpatient x-rays (In-Network) | $0 copay (authorization required) |
| Diagnostic tests and procedures (In-Network) | $0 copay (authorization required) |
| Medicare Part B Drugs | |
| Chemotherapy (In-Network) | 0% or 20% coinsurance (authorization required) |
| Foot Care (podiatry Services) | |
| Routine foot care | Not covered |
| Hearing | |
| Hearing aids (In-Network) | $0 copay (limits may apply) |
| Fitting/evaluation | Not covered |
| Preventive Dental | |
| Oral exam (In-Network) | $0 copay (limits may apply) |
| Fluoride treatment (Out-of-Net) | $0 copay (limits may apply) |
| Dental x-ray(s) (In-Network) | $0 copay (limits may apply) |
| Oral exam (Out-of-Net) | $0 copay (limits may apply) |
| Dental x-ray(s) (Out-of-Net) | $0 copay (limits may apply) |
| Fluoride treatment (In-Network) | $0 copay (limits may apply) |
| Cleaning (Out-of-Net) | $0 copay (limits may apply) |
| Comprehensive Dental | |
| Diagnostic services (In-Network) | $0 copay (limits may apply) |
| Restorative services (In-Network) | $0 copay (limits may apply) |
| Extractions (Out-of-Net) | $0 copay (limits may apply) |
| Prosthodontics, other oral/maxillofacial surgery, other services (Out-of-Net) | $0 copay (limits may apply) |
| Periodontics (Out-of-Net) | $0 copay (limits may apply) |
| Periodontics (In-Network) | $0 copay (limits may apply) |
| Non-routine services (Out-of-Net) | $0 copay (limits may apply) |
| Non-routine services (In-Network) | $0 copay (limits may apply) |
| Diagnostic services (Out-of-Net) | $0 copay (limits may apply) |
| Endodontics (In-Network) | $0 copay (limits may apply) |
| Restorative services (Out-of-Net) | $0 copay (limits may apply) |
| Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | $0 copay (limits may apply) |
| Endodontics (Out-of-Net) | $0 copay (limits may apply) |
| Vision | |
| Contact lenses (In-Network) | $0 copay (limits may apply) |
| Eyeglass lenses | Not covered |
| Eyeglass frames | Not covered |
| Upgrades | Not covered |
| Other | Not covered |
| Eyeglasses (frames and lenses) (In-Network) | $0 copay (limits may apply) |
| Emergency Care / Urgent Care | |
| Emergency | $0 or $50 copay per visit (always covered) |
| Ground ambulance | $0 or $75 copay |
| Inpatient hospital coverage | Not Applicable |
| Outpatient hospital coverage | $0 copay |
| Skilled Nursing Facility | $0 per day for days 1 through 20 $0 or $100 per day for days 21 through 100 |
| Optional supplemental benefits | No |
Feel free to download our Peoples Health Secure Health Summary of Benefits information.
Prescription Drug Plan Costs & Benefits
Peoples Health Secure Health includes an basic benefit Medicare Part D plan (PDP). This simply means that the plan covers the minimum amount required by the Centers for Medicare & Medicaid Services, whereas enhanced benefit plans cover more.
Basic plans typically have less cost-sharing by the plan than plans with an enhanced benefit. But, close to a third of all enhanced plans charge more than the average for preferred brand name drugs, and over 50% charge more for non-preferred brand drugs. For most people, a basic plan is their best bet, due to lower premiums and lower cost-sharing, even if the plan has a deductible.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.
| Basic Part D Premium: | $38.40 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $38.40 |
| Part D Premium with Full LIS Assistance: | $0.00 |
| Part D Premium with 75% LIS Assistance: | $9.60 |
| Part D Premium with 50% LIS Assistance: | $19.20 |
| Part D Premium with 25% LIS Assistance: | $28.80 |
For more information about the Low-Income Subsidy (aka, "Extra Help") program, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $505.00. This is the amount you must pay at the pharmacy before Peoples Health begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Peoples Health Secure Health has copayments (a fixed dollar amount) and/or coinsurances (a percentage amount) that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Tier | Preferred | Standard |
|---|---|---|
| $0 copay on all covered generic and brand-name prescriptions. | ||
CMS Rating Marks and Our Review
Each year Medicare rates D-SNP plans, like this one, in nine major categories. These ratings are designed to help you understand the quality of care and service you can expect if you qualify and choose to join Peoples Health Secure Health.
This is one of the rare 5-star Medicare Advantage D-SNP plans available in Louisiana. In MedicareWire's opinion, Peoples Health Secure Health does an excellent job keeping its plan members healthy through its preventive care program with proactive screenings, tests, and vaccines. This plan is good at managing its member's chronic (long-term) health conditions. Overall, members say their experience with this Peoples Health D-SNP plan is excellent. Complaints and changes in plan performance are one way we can measure quality, and this plan scores good at both. The plan shines at customer service with an overall excellent mark on this important metric.
| CMS Measure | Star Rating |
|---|---|
| 2023 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
How to Qualify to Enroll in
Peoples Health Secure Health
To qualify for enrollment in Peoples Health Secure Health in Washington Parish, you must be eligible for both Medicare and Medicaid. To be eligible for Medicare, you must be age 65 or older, or have Social Security Disability Insurance for 24 months. To be eligible for Medicaid, your income and assets must be at or below Louisiana's state thresholds.
Before enrolling in Peoples Health Secure Health, or any other dual-eligible SNP, be sure to ask the following questions:
- What costs should I expect to pay out-of-pocket (premiums, deductibles, copayments)?
- Will I be able to use my doctors? Are they in the plan's network?
- Are the plan's in-network providers and facilities in convenient locations?
- Does the plan provide coverage for services I receive from out-of-network providers?
- Do I need a referral to see a specialist?
- Are my medications on the Part D plan's formulary? What if I can't afford my medications?
- What special accommodations does the plan make for persons with disabilities?
- Does the plan offer free meal delivery after a stay in the hospital?
- What help is offered for caregivers? Is adult day care covered?
- Does the plan offer a prepaid card for over the counter medications and covered groceries?
Additional D-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
- Aetna Medicare Dual Select Plan
- Healthy Blue Dual Advantage
- Wellcare Dual Access Medicare
- Healthy Blue Enhanced Care
- Humana Gold Plus SNP-DE H1951-034
Contact Peoples Health
Call 1-855-728-0510 (TTY 711) to speak with a licensed insurance agent (Mon-Fri, 8am-9pm , Sat 8am-8pm EST) and learn more about this Special Needs Plan and other plans on this site. You may also Enroll Online using our safe and secure online enrollment website or take advantage of the following plan resources:
| Plan Website: | http://www.peopleshealth.com |
|---|---|
| Formulay Information: | http://www.peopleshealth.com/pharmacies |
| Pharmacy Information: | Peoples Health Pharmacy Page |
| Prospective Members: | (888)834-3721 |
| TTY Users: | (711)- |
If you qualify for Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Centene Corporation, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna-HealthSpring, Humana, Molina Healthcare, Mutual of Omaha, Oscar Health Insurance, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, and UnitedHealthcare.
Citations & References
- Peoples Health, http://www.peopleshealth.com, Last Accessed October 13, 2022
- Medicaid.gov, "Medicaid & CHIP in Louisiana", Last Accessed January 20, 2023
- CMS.gov, "Dual Eligible Special Needs Plans (D-SNPs)", Last Accessed January 20, 2023
- CMS.gov, Landscape Source Files, Last Accessed January 21, 2023
- CMS.gov, Medicare Part C & D Performance, Last Accessed January 21, 2023
- CMS.gov, Plan Benefits Package, Last Accessed January 21, 2023