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Align ChoiceElite (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Align ChoiceElite (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Align ChoiceElite (PPO) in 2026, please refer to our full plan details page.
Align ChoiceElite (PPO) is a PPO plan offered by Sanford Health available for enrollment in 2025 to people living in Minnesota. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Align ChoiceElite (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 Align ChoiceElite (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 Align ChoiceElite (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $94.00. 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 $300.00 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 $3000.00 (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 $3000.00 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
The Align ChoiceElite (PPO) Medicare plan features a $300 annual drug deductible and offers competitive pricing on prescription medications. Under this plan, you will pay no copay for Tier 1 preferred generic drugs at preferred pharmacies or through preferred mail order, and Tier 6 select care drugs also feature no copay at all pharmacy types. Tier 2 generic drugs are available for a low $4 copay for a one-month supply at preferred pharmacies, compared to $10 at standard pharmacies. For brand-name and specialty medications, Tier 3 preferred brand drugs cost a $42 copay for a one-month supply at preferred locations, while standard locations cost $47. Tier 4 non-preferred drugs require a 50% coinsurance, and Tier 5 specialty drugs require a 29% coinsurance across all pharmacies. Utilizing preferred pharmacies and preferred mail-order services consistently provides the lowest out-of-pocket costs on this plan.
Additional Benefits
The Align ChoiceElite (PPO) plan offers comprehensive medical coverage with no copay for primary care visits, telehealth, and preventive services. Specialist visits feature a copay ranging from no copay to $25, while inpatient hospital stays require a $250 daily copay for days one through five and no copay for days six through ninety. Emergency room visits have a $110 copay, which is waived if you are admitted, while outpatient hospital services require a $30 to $150 copay with a 20% coinsurance. Additional benefits include dental, vision, and hearing coverage with no copays for routine care and no plan deductibles. Preventive and comprehensive dental services are covered with no copay up to a $1,000 annual limit, and routine hearing exams include up to $800 annually for hearing aids. Furthermore, members receive home health services and an over-the-counter allowance of up to $85 every three months with no copay.
Inpatient Hospital See details
Align ChoiceElite (PPO) offers partial coverage for inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. For Medicare-covered stays, there is a $250 daily copay for days 1 through 5 and no copay for days 6 through 90, but additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Align ChoiceElite (PPO) covers outpatient hospital services with a $30 to $150 copay and 20% coinsurance, and ambulatory surgical center services with a $100 copay and no coinsurance. Additionally, outpatient substance abuse services carry a $15 copay per session with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Align ChoiceElite (PPO) with a $55.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Align ChoiceElite (PPO) plan, which requires a $200 copay and no coinsurance for both ground and air ambulance services. While some transportation services are covered, trips to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Align ChoiceElite (PPO) covers emergency services with a $110 copay and no coinsurance, and urgently needed services with a $30 copay and no coinsurance, with both copays waived if you are admitted to the hospital within three days. Worldwide emergency, urgent, and transportation services are also covered with no copay or coinsurance, up to a maximum plan benefit of $250.
Primary Care See details
Align ChoiceElite (PPO) covers primary care, telehealth, and opioid treatment services with no copay and no coinsurance, while specialist visits have a $0 to $25 copay and no coinsurance. Physical, occupational, and speech therapies require a $25 copay and no coinsurance, whereas chiropractic care is partially covered with a $10 to $20 copay and no coinsurance, excluding other chiropractic services. Podiatry is not covered, and while some mental health and psychiatric services are covered with no copay and no coinsurance, individual and group sessions are not.
Preventive Services See details
Preventive services under the Align ChoiceElite (PPO) are covered with no copay and no coinsurance for annual physical exams, kidney disease education, and diabetes self-management. Additional preventive services are partially covered, offering health education and a memory fitness benefit with a $5 copay and no coinsurance, though services like in-home safety assessments, personal emergency response systems, and medical nutrition therapy are not covered.
Hearing Services See details
Align ChoiceElite (PPO) provides partially covered hearing services with no copay and no coinsurance, including one routine hearing exam per year and prescription hearing aids up to an $800 annual limit. Fitting and evaluations, OTC hearing aids, and inner, outer, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Align ChoiceElite (PPO) offers partially covered vision services with no deductibles, including one routine eye exam per year with no copay and 20% coinsurance, though other eye exams are not covered. Eyewear is covered with no copay or coinsurance up to a $200 annual limit for one pair of contacts or complete eyeglasses, though individual eyeglass lenses and frames are not covered.
Dental Services See details
Align ChoiceElite (PPO) dental services are partially covered with no copay and no coinsurance for preventive and comprehensive care, including exams, cleanings, x-rays, fillings, endodontics, periodontics, and oral surgery. Comprehensive services are subject to a $1,000 annual maximum, while fluoride, implants, prosthodontics, adjunctive general services, and orthodontics are not covered.
Home Infusion bundled Services See details
Align ChoiceElite (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Align ChoiceElite (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Align ChoiceElite (PPO) partially covers medical equipment with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic supplies are not covered under this plan, and prior authorization is required for durable medical equipment and prosthetics.
Diagnostic and Radiological Services See details
Align ChoiceElite (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Diagnostic procedures have a $10 copay, lab services a $5 copay, outpatient X-rays a $15 copay, and therapeutic radiology a $60 copay, while diagnostic radiology services have no copay.
Home Health Services See details
Home Health Services are covered by Align ChoiceElite (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Align ChoiceElite (PPO) partially covers Cardiac Rehabilitation Services with no coinsurance, but standard Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered. Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) is covered with a $20 copay and no coinsurance.
Skilled Nursing Facility (SNF) See details
Align ChoiceElite (PPO) partially covers Skilled Nursing Facility (SNF) services, requiring prior authorization and Medicare-defined copays and coinsurance, while waiving the three-day prior hospital stay requirement. Additional days beyond the standard Medicare-covered limit are not covered under this plan.
Other Services See details
Align ChoiceElite (PPO) partially covers other services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit provides up to $85 every three months via reimbursement, and the meal benefit requires a referral.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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