A non-government entity
Saint Alphonsus Health Plan Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Saint Alphonsus Health Plan Choice (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Saint Alphonsus Health Plan Choice (PPO) in 2026, please refer to our full plan details page.
Saint Alphonsus Health Plan Choice (PPO) is a PPO plan offered by Trinity Health Corporation available for enrollment in 2025 to people living in Select Counties in Idaho. The overall rating for this plan is not yet available for 2026.
It's important to know that Saint Alphonsus Health Plan Choice (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 Saint Alphonsus Health Plan Choice (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 Saint Alphonsus Health Plan Choice (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. Additionally, this plan comes with a Part B Premium reduction of $7.00. You must continue to pay paying your reduced 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 $250.00 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 $6100.00 (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 $6100.00 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 Saint Alphonsus Health Plan Choice (PPO)
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Drug Coverage
The Saint Alphonsus Health Plan Choice (PPO) features a $250 annual prescription drug deductible. Under this plan, you will pay no copay for Tier 1 preferred generic drugs filled at a preferred pharmacy or through standard mail order. For Tier 2 generic medications, standard mail order prescriptions also have no copay, while a preferred retail pharmacy charges a low $6 copay for a one-month supply. Brand-name and specialty medications are subject to coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 25% coinsurance across preferred and standard pharmacies, as well as standard mail order. Tier 4 non-preferred drugs and Tier 5 specialty drugs both require 30% coinsurance for a one-month supply.
Additional Benefits
The Saint Alphonsus Health Plan Choice (PPO) offers comprehensive medical coverage featuring no copays or coinsurance for preventive care and primary care doctor visits, while specialist visits require a $35 copay. For hospital care, inpatient stays require a $350 daily copay for the first five days and no copay for additional days, while outpatient services range from a $5 to $350 copay with no coinsurance. Emergency room visits carry a $130 copay, and urgent care is covered with a $50 copay, both with no coinsurance. This plan also provides essential supplemental benefits, including routine dental services with no copay up to a $1,000 annual limit. Routine vision and hearing exams are covered with no copay, with up to $125 annually for eyewear and prescription hearing aid copays ranging from $599 to $899. Furthermore, members can take advantage of a $50 quarterly over-the-counter allowance and home health services with no copays or coinsurance.
Inpatient Hospital See details
Saint Alphonsus Health Plan Choice (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $350 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute care days are covered at no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Saint Alphonsus Health Plan Choice (PPO) covers outpatient services with no coinsurance, featuring copays ranging from $5.00 to $350.00 for outpatient hospital services and $340.00 per stay for observation services. Ambulatory surgical center services have a $350.00 copay and no coinsurance, outpatient substance abuse sessions carry a $35.00 copay and no coinsurance, and outpatient blood services are provided with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Saint Alphonsus Health Plan Choice (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Saint Alphonsus Health Plan Choice (PPO) covers ground ambulance services with a $250 copay and air ambulance services with a $300 copay, with no coinsurance required for either. Some transportation services are covered, but transportation to plan-approved health-related locations and any other health-related locations is not covered.
Emergency Services See details
Saint Alphonsus Health Plan Choice (PPO) covers emergency services with a $130 copay (waived if admitted within 48 hours) and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency and urgent care are covered with a $130 copay, while worldwide emergency transportation has a copay of $250 to $300, with no coinsurance required for any of these services.
Primary Care See details
Saint Alphonsus Health Plan Choice (PPO) offers primary care physician services with no copay and no coinsurance, while specialist, therapy, psychiatric, and mental health services require a $35 copay and no coinsurance. Telehealth and other professional services range from no copay to a $35 copay with no coinsurance, but podiatry, routine chiropractic, and other chiropractic services are not covered.
Preventive Services See details
Saint Alphonsus Health Plan Choice (PPO) offers preventive services with no copay and no coinsurance, which includes coverage for annual physical exams, kidney disease education, and glaucoma screenings. Additional preventive services are partially covered, as fitness benefits and remote access technologies are included, but health education, weight management, nutritional benefits, and in-home safety assessments are not covered.
Hearing Services See details
Saint Alphonsus Health Plan Choice (PPO) covers hearing exams with a $35 copay and no coinsurance for Medicare-covered visits, while annual routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with a $599 to $899 copay and no coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Saint Alphonsus Health Plan Choice (PPO) offers partially covered vision services with no deductibles and no coinsurance, featuring one routine eye exam per year and eyewear with no copay up to a combined $125 annual limit. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Saint Alphonsus Health Plan Choice (PPO) offers partially covered dental services with an annual combined benefit limit of $1,000, excluding maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental services require a $35 copay and no coinsurance, preventive and diagnostic care has no copay and no coinsurance, and other covered services like restorative care, endodontics, periodontics, and oral surgery feature no copay with a 50% to 70% coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Saint Alphonsus Health Plan Choice (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other Part B drugs have a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Saint Alphonsus Health Plan Choice (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits under the Saint Alphonsus Health Plan Choice (PPO) feature no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts. Diabetic supplies are covered with no copay and no coinsurance, and prior authorization is required for most medical equipment and supplies.
Diagnostic and Radiological Services See details
Saint Alphonsus Health Plan Choice (PPO) covers diagnostic services with no coinsurance, requiring a $5 copay for lab services and a $30 copay for diagnostic procedures. Covered radiological services include outpatient X-rays with a $20 copay, diagnostic radiological services with a $200 copay, and therapeutic radiological services with a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Saint Alphonsus Health Plan Choice (PPO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Saint Alphonsus Health Plan Choice (PPO) offers Cardiac Rehabilitation Services with no coinsurance, meaning some services are covered, though cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. These excluded services carry copays of $25 for cardiac and intensive cardiac rehab, and $15 for pulmonary and SET for PAD services.
Skilled Nursing Facility (SNF) See details
Saint Alphonsus Health Plan Choice (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay requirement. There is no copay for days 1 to 20 and days 61 to 100, a $218 copay per day for days 21 to 60, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Saint Alphonsus Health Plan Choice (PPO) covers acupuncture with a $20 copay, no coinsurance, and prior authorization required for up to 6 treatments per year. Over-the-counter items up to $50 every three months and chronic illness meal benefits are also fully covered with no copay and no coinsurance.
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