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 San Luis Obispo and Ventura 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 $698.00 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. During the initial coverage phase, you'll pay different copays or coinsurance amounts depending on the drug tier and pharmacy. For example, standard generic drugs have a $40 copay, and preferred brand drugs have a $100 copay. 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 Part D costs will be $0.
Additional Benefits
The Alignment Health My Choice (HMO) plan offers a range of benefits with varying cost-sharing. This plan includes coverage for inpatient and outpatient services, with copays for some services such as psychiatric care, ambulance, and emergency services. Primary care and preventive services are covered, and additional benefits include dental, vision, and hearing services, with specific copays and limitations on each. Other covered services include home health, skilled nursing, and medical equipment, often with no copay or coinsurance. Diagnostic and radiological services have some coverage, and the plan also offers additional benefits like OTC items, meal benefits, and digital health technology support. However, some services, such as certain vision and dental procedures, and some rehabilitation services, may not be covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with prior authorization and a doctor's referral required. Inpatient Hospital Psychiatric care has a copay of $120 for days 1-10, and no copay for days 11-90. Additional days for Inpatient Hospital Psychiatric are covered up to 40 days.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient substance abuse services have a copay of $50 for individual and group sessions, and outpatient blood services have a waived deductible of three pints.
Partial Hospitalization See details
Partial Hospitalization is covered by the Alignment Health My Choice (HMO) plan, requiring 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, with prior authorization required. Ground Ambulance Services have a $100 copay, and Air Ambulance Services have a $200 copay. Transportation Services to a plan-approved health-related location are covered for 22 one-way trips per year, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Alignment Health My Choice (HMO) plan, with a $100 copay and no coinsurance. Urgently Needed Services are covered with no copay and no coinsurance, and Worldwide Emergency Services are covered with a maximum plan benefit of $50,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health My Choice (HMO) plan covers Primary Care Physician Services, Occupational Therapy Services (no copay, no coinsurance), Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services (no copay, no coinsurance). This plan also covers Psychiatric Services (with a $20 copay for individual and group sessions) and Opioid Treatment Program Services (with 20% coinsurance). Chiropractic Services, Mental Health Specialty Services (individual and group sessions), and Podiatry Services are not covered.
Preventive Services See details
The Alignment Health My Choice (HMO) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, kidney disease education services, and other preventive services. Some additional preventive services, such as health education, in-home safety assessments, medical nutrition therapy, and several others are not covered.
Hearing Services See details
The Alignment Health My Choice (HMO) plan covers hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids (all types) with a copay between $195 and $1750, with a limit of 2 hearing aids per year, but does not cover prescription hearing aids for the inner or outer ear, or over-the-ear hearing aids, and does not cover OTC hearing aids. Routine hearing exams and fitting/evaluation for hearing aids are covered once per year.
Vision Services See details
The Alignment Health My Choice (HMO) plan covers vision services, including routine eye exams with one visit per year, and eyewear. Eyewear includes contact lenses (1 pair per year), eyeglasses (1 pair per year), eyeglass lenses (1 pair per year), and eyeglass frames (1 frame per year) with a combined maximum benefit of $100 per year. Upgrades are not covered.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments. Restorative services have a copay of $20-$400, endodontics have a copay of $25-$350, periodontics have a copay of $15-$550, prosthodontics (removable) have a copay of $20-$570, prosthodontics (fixed) have a copay of $40-$400, and oral and maxillofacial surgery have 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, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with prior authorization and a doctor's referral, and require a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by the Alignment Health My Choice (HMO) plan, with no copay. Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a coinsurance between 20% and 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under the Alignment Health My Choice (HMO) plan. While there is no copay for these services, diagnostic procedures, lab services, diagnostic radiological services, and outpatient X-ray services are not covered; therapeutic radiological services have a coinsurance of at most 20%.
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 authorization and a referral are required. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by 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 and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Alignment Health My Choice (HMO) plan covers Over-the-Counter (OTC) items with a maximum benefit of $20.00 every month, and it also covers meal benefits and digital health technology support. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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