A non-government entity
Alignment Health My Choice (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health My Choice (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health My Choice (HMO) in 2025, please refer to our full plan details page.
Alignment Health My Choice (HMO) is a HMO plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in LA, Orange, San Bernardino & Riverside Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Alignment Health My Choice (HMO) 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 Alignment Health My Choice (HMO).
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 Alignment Health My Choice (HMO), 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $498.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 Alignment Health My Choice (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy. For example, you'll pay a $5 copay for preferred generic drugs at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy (LIS), your premium may be reduced, and you will pay $0.00.
Additional Benefits
The Alignment Health My Choice (HMO) plan offers a variety of benefits, including coverage for inpatient and outpatient services with varying copays. The plan also provides coverage for emergency services with a $10 copay, as well as primary care, preventive, hearing, vision, and dental services, each with their own specific cost structures and limitations. Additional benefits include ambulance and transportation services, home health services with no copay, and coverage for home infusion, dialysis, and medical equipment. This plan also covers acupuncture, over-the-counter items, and a meal benefit, but does not cover certain services like diagnostic and radiological services, cardiac rehabilitation, and certain types of home care.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered by the plan, but non-Medicare-covered stays and upgrades for acute care are not covered. For inpatient psychiatric care, there is a $120 copay for days 1-10, and no copay for days 11-90. Additional days for inpatient psychiatric are covered for 40 days.
Outpatient Services See details
Outpatient Services, including hospital services, ambulatory surgical center services, and outpatient substance abuse services, are covered. Outpatient substance abuse services have a copay of $50 for both individual and group sessions, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Alignment Health My Choice (HMO) plan, with a $55 copay. Prior authorization and a doctor referral are required for coverage.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and air ambulance services have a $75 copay, and the copay is waived if you are admitted to the hospital. Transportation services to a plan-approved health-related location are covered for up to 22 one-way trips per year, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered under the Alignment Health My Choice (HMO) plan. Emergency Services have a $10 copay and no coinsurance, while Urgently Needed Services have no copay or coinsurance. Worldwide Emergency Services have a maximum plan benefit coverage of $25,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health My Choice (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, podiatry services, other health care professional services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Mental Health Specialty Services are only partially covered, as individual and group sessions are not covered. Individual and group sessions for psychiatric services have a $20 copay. Opioid treatment program services have a 20% coinsurance.
Preventive Services See details
The Alignment Health My Choice (HMO) plan covers preventive services including Medicare-covered services, an annual physical exam, and other preventive services, with some services requiring prior authorization. Additionally, the plan covers Personal Emergency Response Systems (PERS), In-Home Support Services, Support for Caregivers of Enrollees (with a $300 annual maximum), and Fitness Benefits.
Hearing Services See details
Hearing services include routine hearing exams and fitting/evaluation for hearing aids, both covered once per year, and prescription hearing aids. The plan covers prescription hearing aids with a copay between $195 and $1750 per year, but does not cover prescription hearing aids for the inner, outer, or over the ear. OTC hearing aids are not covered.
Vision Services See details
The Alignment Health My Choice (HMO) plan covers vision services including routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, with no deductible. Routine eye exams are covered once per year. Eyewear has a combined maximum benefit of $200 per year. Upgrades are not covered.
Dental Services See details
Dental services include oral exams with a $10 copay, dental x-rays with a $30 copay, prophylaxis (cleaning) with a $20 copay, and fluoride treatment with a $10 copay. Restorative services have a copay ranging from $20 to $400, while endodontics have a copay between $25 and $350. Periodontics have a copay from $15 to $550, and prosthodontics (removable) have a copay of $20 to $570. Prosthodontics (fixed) have a copay from $40 to $400, and oral and maxillofacial surgery has a copay of $25 to $250. Adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Alignment Health My Choice (HMO) plan. The copay for Dialysis Services is $30.00, and a doctor referral and prior authorization are required.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0-20% coinsurance and Prosthetics/Medical Supplies with no copay and coverage for Medicare-covered prosthetic devices, as well as Medical Supplies with 20% coinsurance; however, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Prosthetic Devices are not covered. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are not covered by the Alignment Health My Choice (HMO) plan. The plan does not cover any of the sub-services, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services.
Home Health Services See details
Home Health Services are covered by the Alignment Health My Choice (HMO) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered by the Alignment Health My Choice (HMO) plan, but none of the sub-services are covered, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Alignment Health My Choice (HMO) plan, but require prior authorization and a doctor's referral. You will have no copay for days 1-20, and a $30 copay for days 21-100; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Alignment Health My Choice (HMO) plan covers acupuncture with no copay, over-the-counter items with a $20 monthly maximum, and a meal benefit for chronic illnesses or medical conditions. The plan does not cover 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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