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Alignment Health My Choice CalPlus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health My Choice CalPlus (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 CalPlus (HMO) in 2025, please refer to our full plan details page.
Alignment Health My Choice CalPlus (HMO) is a HMO plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in SoCal and NorCal. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Alignment Health My Choice CalPlus (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 CalPlus (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 CalPlus (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 $3499.00 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:
Sign up for Alignment Health My Choice CalPlus (HMO)
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Drug Coverage
The Alignment Health My Choice CalPlus (HMO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. For preferred generic drugs and standard mail, the copay is $3.00. For standard generic drugs, the copay is $40.00. For preferred brand drugs, the copay is $100.00. For non-preferred drugs, you pay 33% coinsurance. For specialty tier drugs, the copay is $5.00. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Alignment Health My Choice CalPlus (HMO) plan offers a range of benefits, including inpatient hospital stays, outpatient services, and emergency care. Many primary care and preventive services have no copay, while specialized services like mental health and hearing aids have varying copays. Additional benefits include dental, vision, and home health services, along with coverage for medical equipment and transportation. The plan also covers some prescription hearing aids and offers an OTC allowance, but excludes certain services like cardiac rehabilitation and additional hours of care.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is no copay for days 1-4 and 11-90, but there is a $100 copay for days 5-10. For Inpatient Hospital Psychiatric, the copay is $120 for days 1-10, with no copay for days 11-90.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $200 copay, Ambulatory Surgical Center (ASC) Services with a $100 copay, and outpatient substance abuse services, including individual and group sessions, each with a $40 copay. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor's referral. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Alignment Health My Choice CalPlus (HMO) plan. Ground and air ambulance services have a $175 copay, but no coinsurance, and the copay is waived if admitted to the hospital. Transportation Services to a plan-approved health-related location are covered for up to 12 one-way trips per year using medical transport, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Alignment Health My Choice CalPlus (HMO) plan. Emergency Services have an $85 copay and no coinsurance, while Urgently Needed Services have no copay or coinsurance. Worldwide Emergency Services have a maximum plan benefit coverage of $12,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered, with no coinsurance for occupational therapy, physical therapy, and speech-language pathology services. Chiropractic Services and Mental Health Specialty Services are covered, but routine chiropractic care, and individual and group sessions for mental health specialty services are not covered. Individual and group psychiatric sessions have a $40 copay. Podiatry Services are not covered.
Preventive Services See details
Preventive services, including annual physical exams, are covered by the Alignment Health My Choice CalPlus (HMO) plan. Additional preventive services, such as Personal Emergency Response System (PERS), In-Home Support Services, Support for Caregivers of Enrollees, and Fitness Benefits are covered. The plan also covers Kidney Disease Education Services, and Other Preventive Services including Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas (prior authorization required), Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered. Prescription hearing aids (all types) are covered with a copay between $195 and $1750, while prescription hearing aids for inner ear, outer ear, and over the ear are not covered, as are OTC hearing aids.
Vision Services See details
The Alignment Health My Choice CalPlus (HMO) plan covers vision services, including routine eye exams with one visit per year, and eyewear, with a combined maximum of $100 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with one pair or set covered per year; however, upgrades are not covered.
Dental Services See details
Dental services include coverage for oral exams, dental X-rays, prophylaxis (cleaning), fluoride treatment, restorative services with a copay of $20-$400, endodontics with a copay of $25-$350, periodontics with a copay of $15-$550, prosthodontics (removable) with a copay of $20-$570, prosthodontics (fixed) with a copay of $40-$400, and oral and maxillofacial surgery with a copay of $25-$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, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the Alignment Health My Choice CalPlus (HMO) plan, requiring prior authorization and a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance, and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic Equipment is covered, but 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, with some services not covered. There is no copay for covered services, and therapeutic radiological services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered under the Alignment Health My Choice CalPlus (HMO) plan, 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 technically covered, but not in practice. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Alignment Health My Choice CalPlus (HMO) plan, requiring prior authorization and a doctor's referral. There is no copay for days 1-20, but there is a $50 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Alignment Health My Choice CalPlus (HMO) plan's "Other Services" benefit covers over-the-counter (OTC) items with a maximum benefit coverage amount of $20.00 every month, as well as meal benefits and digital health technology support. 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, and Self-Directed Personal Assistance Services are not covered.
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