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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 2025, 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 4 out of 5 stars in 2025.
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 $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 $4500.00 (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 $4500.00 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:
Sign up for Align ChoicePlus (PPO)
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Drug Coverage
The Align ChoicePlus (PPO) plan has an enhanced alternative drug benefit. The plan has a $300 deductible for prescription drugs. In the initial coverage phase, after the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, you will pay a $4 copay at a preferred pharmacy for preferred generic drugs. For specialty tier drugs, there is no copay. Once your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The Align ChoicePlus (PPO) plan offers a range of benefits including inpatient and outpatient hospital services with varying copays and coinsurance. It also covers emergency and preventive services, primary care with copays, and home health services with no copay. Additional benefits include hearing and vision services, with coverage for hearing exams and hearing aids up to a $1000 annual maximum, and routine eye exams with 20% coinsurance. Dental services are included with a $1,000 annual maximum. The plan also covers ambulance, home infusion, dialysis, medical equipment, and diagnostic services, with varying copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but additional days and non-Medicare covered stays for both are not covered. For days 1-4, there is a $200 copay, and for days 5-90, there is no copay.
Outpatient Services See details
Outpatient Services, under the Align ChoicePlus (PPO) plan, include coverage for Outpatient Hospital Services with a $30-$200 copay and 20% coinsurance, Observation Services with a $450 copay, Ambulatory Surgical Center (ASC) Services with a $300 copay, and Individual and Group Sessions for Outpatient Substance Abuse with a $30 copay. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial hospitalization is covered with a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Align ChoicePlus (PPO) plan. Ground and Air Ambulance Services have a copay of $240, with no coinsurance, while 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 ChoicePlus (PPO) plan. Emergency Services have a $90 copay and no coinsurance, while Urgently Needed Services have a $35 copay and no coinsurance. Worldwide Emergency Services have a maximum plan benefit coverage of $250.
Primary Care See details
The Align ChoicePlus (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, specialist services with a copay between $0-$50, podiatry services with a copay between $30-$45, other health care professional services with a $45 copay, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits, and opioid treatment program services. Individual and group sessions for mental health and psychiatric services are not covered.
Preventive Services See details
Preventive Services are covered under the Align ChoicePlus (PPO) plan, including Medicare-covered preventive services, annual physical exams, health education, kidney disease education services, and other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. The plan also covers a fitness benefit with a $5 copay. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
The Align ChoicePlus (PPO) plan covers hearing exams and prescription hearing aids, with a maximum benefit of $1000 per year for hearing aids. Routine hearing exams are covered once per year, but fitting/evaluation for hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with a 20% coinsurance. Eyewear is covered up to a combined maximum of $100 per year for both in-network and out-of-network services. Contact lenses and eyeglasses (lenses and frames) are covered once per year, but eyeglass lenses and frames are not covered.
Dental Services See details
The Align ChoicePlus (PPO) plan includes a dental services benefit with a $1,000 annual maximum for in-network and out-of-network services. This plan covers oral exams (2 per year), dental x-rays (1 per year), prophylaxis (cleaning) (2 per year), endodontics (1 per lifetime), periodontics (1 visit every three years), prosthodontics, removable (1 visit), maxillofacial prosthetics (1 visit), prosthodontics, fixed (1 visit), and oral and maxillofacial surgery (1 visit). Fluoride treatment, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with a $35 copay for Medicare Part B Insulin Drugs, and a $100 copay for Medicare Part B Chemotherapy/Radiation Drugs. Other Medicare Part B Drugs are covered.
Dialysis Services See details
Dialysis Services are covered by the Align ChoicePlus (PPO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment with a 20% coinsurance and Prosthetic Devices with a 20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by the Align ChoicePlus (PPO) plan. Diagnostic services, including diagnostic procedures and lab services, are not covered. Diagnostic Radiological Services have a copay of at most $375, Therapeutic Radiological Services have a copay of at most $60, and Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by Align ChoicePlus (PPO), with no copay or coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Align ChoicePlus (PPO) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered. Prior authorization is required, and the cost sharing details for coinsurance and copay are available in the plan documents.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items with a maximum benefit of $70 every three months, and meal benefits with a doctor referral. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and many other services are not covered.
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