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Align ChoicePlus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Align ChoicePlus (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Align ChoicePlus (PPO) in 2026, please refer to our full plan details page.
Align ChoicePlus (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 ChoicePlus (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 ChoicePlus (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 ChoicePlus (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 $450.00 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 $4800.00 (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 $4800.00 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 ChoicePlus (PPO) Medicare prescription drug plan features an annual drug deductible of $450. Under this plan, you will pay no copay for Tier 6 select care drugs at all pharmacies, and no copay for Tier 1 preferred generic drugs when using preferred retail or mail-order pharmacies. For Tier 2 generic drugs, copays start at $4 for a one-month supply at preferred pharmacies and increase to $10 at standard pharmacies. Tier 3 preferred brand drugs require a $42 copay for a one-month supply at preferred pharmacies and a $47 copay at standard pharmacies. Higher-tier prescriptions are covered under coinsurance, with Tier 4 non-preferred drugs requiring a 50% coinsurance and Tier 5 specialty drugs requiring a 27% coinsurance. This plan offers various savings opportunities depending on whether you choose preferred, standard, or mail-order pharmacy services.
Additional Benefits
The Align ChoicePlus (PPO) plan offers robust health coverage, featuring primary care, telehealth visits, and annual physical exams with no copay and no coinsurance. For specialized medical needs, specialist visits range from no copay to a $50 copay, while emergency care requires a $120 copay. Inpatient hospital stays are covered with no coinsurance, requiring a $300 daily copay for the first five days and no copay for days six through ninety. Additional benefits include routine dental, vision, and hearing exams with no copay, alongside a $750 annual maximum for comprehensive dental care and a $700 allowance for prescription hearing aids. Members also receive a $70 quarterly over-the-counter reimbursement and home health services with no copay or coinsurance. Most diagnostic tests, outpatient services, and physical therapies are covered with fixed copayments and no coinsurance.
Inpatient Hospital See details
Align ChoicePlus (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $300 daily copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization is required, and some services such as additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Align ChoicePlus (PPO) outpatient services include outpatient hospital care with a $30 to $200 copay and 20% coinsurance, and ambulatory surgical center visits with a $300 copay and no coinsurance. Outpatient substance abuse sessions require a $30 copay and no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the Align ChoicePlus (PPO) plan with a $55.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Align ChoicePlus (PPO) covers Medicare-covered ground and air ambulance services with a $240 copay and no coinsurance, while plan-approved and health-related transportation services are not covered.
Emergency Services See details
Align ChoicePlus (PPO) covers emergency services with a $120 copay and urgently needed services with a $35 copay, both featuring no coinsurance and waived copays if admitted to the hospital within three days. Worldwide emergency, urgent, and transportation services are also covered with no copay or coinsurance, subject to a $250 maximum plan benefit limit.
Primary Care See details
Align ChoicePlus (PPO) covers primary care, telehealth, and opioid treatment with no copay and no coinsurance, while specialist visits range from a $0 to $50 copay with no coinsurance. Physical, occupational, and speech therapies require a $40 copay and no coinsurance, whereas chiropractic care is partially covered with copays up to $20 and no coinsurance (other chiropractic services are not covered). Some mental health and psychiatric services are covered with no copay and no coinsurance, though individual and group sessions are not covered.
Preventive Services See details
Preventive services under the Align ChoicePlus (PPO) are partially covered, featuring no copay and no coinsurance for annual physical exams, kidney disease education, and various screenings. Health education and memory fitness benefits are covered with a $5 copay and no coinsurance, but other services such as medical nutrition therapy, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Align ChoicePlus (PPO) offers partial coverage for hearing services with no copay and no coinsurance, including one routine hearing exam per year and prescription hearing aids up to a $700 annual maximum. Fitting and evaluation for hearing aids, OTC hearing aids, and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Align ChoicePlus (PPO) vision services are partially covered with no deductibles, offering one routine eye exam per year with no copay and 20% coinsurance, while other eye exam services are not covered. Covered eyewear features no copay and no coinsurance up to a $100 combined annual maximum for one pair of contacts or eyeglasses per year, though separate eyeglass lenses and frames are not covered.
Dental Services See details
Align ChoicePlus (PPO) provides partially covered dental services with no copay and no coinsurance for covered care, subject to a $750 annual maximum for comprehensive services. Covered benefits include select oral exams, cleanings, dental x-rays, fillings, root canals, periodontics, and oral surgery, while fluoride treatments, implants, orthodontics, prosthodontics, other diagnostic services, and adjunctive general services are not covered.
Home Infusion bundled Services See details
Align ChoicePlus (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Align ChoicePlus (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Align ChoicePlus (PPO) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic equipment is partially covered, offering diabetic therapeutic shoes and inserts with no copay and a 20% coinsurance, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Align ChoicePlus (PPO) covers diagnostic and radiological services with no coinsurance, although prior authorization is required. Diagnostic tests and lab services carry a $10 copay, outpatient X-rays require a $20 copay, therapeutic radiological services have a $60 copay, and diagnostic radiological services are available with no copay.
Home Health Services See details
Home health services are covered under the Align ChoicePlus (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by Align ChoicePlus (PPO) with no coinsurance, though Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) services are not covered. Covered services require a $30 copay for cardiac and intensive cardiac rehabilitation, and a $15 copay for pulmonary rehabilitation.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Align ChoicePlus (PPO) with prior authorization and require Medicare-defined copays and coinsurance. The plan waives the standard three-day inpatient hospital stay requirement prior to admission, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services under Align ChoicePlus (PPO) are partially covered, providing a chronic illness meal benefit (referral required) and a $70 quarterly over-the-counter (OTC) reimbursement with no copay and no coinsurance. Acupuncture, nicotine replacement therapy, naloxone, and some CMS-listed OTC drugs are not covered.
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