Alignment Health My Choice (HMO)

Alignment Health My Choice (HMO) is a HMO plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in San Luis Obispo and Ventura Counties. This plan received an overall rating of 4 out of 5 stars in 2026.

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.

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:

Drug Coverage

The Alignment Health My Choice (HMO) plan features an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, which lasts until total drug costs reach $2,100, you will pay a $3 copay for Tier 1 preferred generics and a $40 copay for Tier 2 standard generics at standard pharmacies. For higher-tier medications, the plan requires a 32% coinsurance for Tier 3 preferred brands, a 33% coinsurance for Tier 4 non-preferred drugs, and a $5 copay for Tier 5 specialty drugs. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and will pay nothing for covered Part D prescription drugs. Additionally, those who qualify for the low-income subsidy, or Extra Help, can reduce their Part D premium to no cost. Make sure to check the plan's formulary to confirm coverage for your specific prescriptions.

Additional Benefits

The Alignment Health My Choice (HMO) plan offers comprehensive medical coverage with no copay for preventive services, routine annual physicals, and the first 20 days of a skilled nursing facility stay. Emergency care requires a $100 copay that is waived upon hospital admission, while urgent care services and up to 22 one-way transportation trips per year are available with no copay. Standard inpatient hospital stays are covered with no coinsurance, and inpatient psychiatric care features a $120 copay for the first 10 days before dropping to no copay for days 11 through 90. Specialty benefits include annual routine vision and hearing exams with no copay, alongside allowances for eyewear and covered prescription hearing aids. Preventive dental services also feature no copay, while comprehensive dental procedures require copays ranging from $15.00 to $570.00. Additionally, members receive a $20 monthly reimbursement for over-the-counter items, and durable medical equipment is covered with no copay and coinsurance up to 20%.