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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 2025, 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 4 out of 5 stars in 2025.
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 $79.00. 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 $200.00 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 $2750.00 (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 $2750.00 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) plan has a $200 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance for your medications, depending on the drug tier and pharmacy you use. For preferred generic drugs, you'll pay a $4 copay at preferred pharmacies, and $10 at standard pharmacies. Specialty tier drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Align ChoiceElite (PPO) plan offers a range of benefits, including inpatient hospital stays with a $150 copay for the first four days, and no copay for days 5-90. Outpatient services have varying copays and coinsurance, while emergency services have a $90 copay. This plan also covers primary care, preventive services, hearing, vision, dental, and home infusion services, with specific cost-sharing details for each. Additional benefits include ambulance services with a $200 copay, and coverage for medical equipment with 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $150 for days 1-4, and no copay for days 5-90. Additional days for inpatient hospital-acute, non-Medicare-covered stays for inpatient hospital-acute, upgrades for inpatient hospital-acute, and additional days for inpatient hospital psychiatric, and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for outpatient hospital services with a $30-$150 copay and 20% coinsurance, observation services with a $125 copay, ambulatory surgical center services with a $100 copay, and individual and group substance abuse sessions with a $15 copay. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Align ChoiceElite (PPO) plan, with a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Align ChoiceElite (PPO) plan. Ground and Air Ambulance Services have a $200 copay, with 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 the Align ChoiceElite (PPO) plan. Emergency Services have a $90 copay, and Urgently Needed Services have a $30 copay, but both have no coinsurance. Worldwide Emergency Services are covered up to a maximum of $250.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Other Health Care Professional, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services have a $10 copay, Routine Chiropractic Care has a $20 copay for 12 visits per year, while Occupational Therapy Services, and Physical Therapy and Speech-Language Pathology Services have a $25 copay. Physician Specialist Services have a copay between $0 and $25. Mental Health Specialty Services, Podiatry Services, and Psychiatric Services are not covered.
Preventive Services See details
The Align ChoiceElite (PPO) plan covers preventive services, including annual physical exams and other services not usually covered by Medicare. Additional preventive services may have a copay, and the fitness benefit has a $5 copay. Some services, such as In-Home Safety Assessment, are not covered.
Hearing Services See details
Hearing Services includes coverage for routine hearing exams, with one exam covered every year, but does not cover fitting/evaluation for hearing aids. Prescription hearing aids are covered, with a maximum benefit of $1000 per year for both ears combined. However, inner ear, outer ear, and over the ear prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
The Align ChoiceElite (PPO) plan covers vision services, including routine eye exams with a 20% coinsurance and eyewear with a combined maximum of $200 every year. Contact lenses and eyeglasses (lenses and frames) are covered, with one pair available every year. However, eyeglass lenses and frames are not covered.
Dental Services See details
Dental services include coverage for oral exams (2 per year), dental x-rays (1 per year), prophylaxis (cleaning, 2 per year), and other services, while fluoride treatment, implant services, and orthodontics are not covered. Orthodontic services have a maximum benefit of $1,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B insulin drugs, chemotherapy/radiation drugs, and other Medicare Part B drugs. For Medicare Part B insulin drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B chemotherapy/radiation drugs, there is a $100 copay and a coinsurance between 0% and 20%. Other Medicare Part B drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Align ChoiceElite (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits are covered by the Align ChoiceElite (PPO) plan, with 20% coinsurance for Durable Medical Equipment, Prosthetic Devices, Medical Supplies, and Diabetic Therapeutic Shoes/Inserts, and no copay. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Align ChoiceElite (PPO) plan. Diagnostic Procedures/Tests and Lab Services are not covered. For Diagnostic Radiological Services, the copay is at most $250, for Therapeutic Radiological Services, the copay is at most $60, and for Outpatient X-Ray Services, the copay is $15.
Home Health Services See details
Home Health Services are covered by the Align ChoiceElite (PPO) plan with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Align ChoiceElite (PPO) plan, but the plan does not specify the copay or coinsurance for this benefit. However, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered and require prior authorization. The cost sharing details for copay and coinsurance can be found elsewhere, but additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Align ChoiceElite (PPO) plan's "Other Services" benefit covers over-the-counter (OTC) items with a maximum benefit of $80 every three months, and meal benefits with a doctor referral. This plan does not cover 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, or Self-Directed Personal Assistance Services.
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