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 2025, 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 2025.
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 $14.80. 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 $150.00 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:
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Drug Coverage
The Saint Alphonsus Health Plan Choice (PPO) plan has a $150 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions, depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, you'll pay a $10 copay for preferred generic drugs at a preferred pharmacy, or 25% coinsurance for standard generic drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Saint Alphonsus Health Plan Choice (PPO) offers a wide range of benefits with varying cost-sharing. For hospital stays, you'll pay a copay for the first few days, but the rest of your stay is covered. Outpatient services have copays that vary by service, and there are copays for services like ambulance, emergency care, and specialist visits. Preventive services, routine eye exams, and many dental services have no copay. The plan also covers hearing exams, vision services, and home health services with no copays. Prescription hearing aids, eyewear, and a yearly allowance for over-the-counter items are included.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, the copay is $300 for days 1-5, and no copay for days 6-90. Inpatient Hospital Psychiatric has a copay of $300 for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays, additional days, and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services, with a copay of $5.00 - $275.00. Observation services have no copay, while Ambulatory Surgical Center (ASC) Services have a $275 copay. Outpatient Substance Abuse services have a copay of $35.00 for both individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Saint Alphonsus Health Plan Choice (PPO), with a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $250 copay, and air ambulance services have a $300 copay, but there is no coinsurance for either. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Saint Alphonsus Health Plan Choice (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $35 copay, and Worldwide Emergency Transportation has a copay between $250 and $300; all services have no coinsurance.
Primary Care See details
The Saint Alphonsus Health Plan Choice (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, mental health specialty services with a $35 copay, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a copay between $0 and $35, and opioid treatment program services with a $35 copay, while podiatry services are not covered. Routine chiropractic care is also not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, and additional preventive services. Annual physical exams have no copay. Other preventive services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, have no copay.
Hearing Services See details
The Saint Alphonsus Health Plan Choice (PPO) plan covers hearing exams with a $35 copay, and routine hearing exams with no copay. Prescription hearing aids (all types) are covered with a copay between $599 and $899, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Routine eye exams have no copay, while other eye exams have a copay between $0 and $35. Eyewear has no copay, and a combined maximum benefit of $125 per year for both in-network and out-of-network services.
Dental Services See details
Dental services include Medicare dental services with a $35 copay, and other dental services with no copay. Restorative Services and Oral and Maxillofacial Surgery have a 50% coinsurance, Endodontics and Periodontics have a 70% coinsurance.
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, while 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 Saint Alphonsus Health Plan Choice (PPO) with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered items, and Diabetic Equipment, which may have coinsurance and copays depending on the specific service. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a $30 copay, lab services with a $5 copay, diagnostic radiological services with a $150 copay, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $20 copay. Prior authorization is required for all diagnostic services.
Home Health Services See details
Home Health Services are covered by the Saint Alphonsus Health Plan Choice (PPO) with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but specific services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are not covered. There is a copay for the covered services, but the exact amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Saint Alphonsus Health Plan Choice (PPO) plan. For days 1-20 and 56-100, there is no copay, but for days 21-55, there is a $214 copay.
Other Services See details
Other Services includes acupuncture with a $20 copay and a limit of 6 treatments per year, along with over-the-counter items with no copay and a $100 benefit every three months, and a meal benefit with no copay. The plan does not cover services for Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and other services.
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