A non-government entity
Alignment Health My Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health My Choice (PPO). 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 (PPO) in 2026, please refer to our full plan details page.
Alignment Health My Choice (PPO) is a PPO plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in Sacramento, Placer & Yolo , SJ, ST, Santa Cruz. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Alignment Health My 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 Alignment Health My 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 Alignment Health My Choice (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $77.00. 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 combined Maximum Out-Of-Pocket cost of $6000.00 (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 $6000.00 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 Alignment Health My Choice (PPO) plan features an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, standard pharmacy and standard mail-order prescriptions incur a $5 copay for Tier 1 preferred generics, a $40 copay for Tier 2 standard generics, and a $5 copay for Tier 5 specialty drugs. Tier 3 preferred brands require a 32% coinsurance, while Tier 4 non-preferred drugs require a 33% coinsurance. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Additionally, beneficiaries who qualify for the low-income subsidy (LIS) can reduce their Part D premium from $77.00 to $65.00.
Additional Benefits
The Alignment Health My Choice (PPO) plan offers affordable access to essential medical care, featuring a low $5 copay for primary care visits and a $35 copay for specialists with no coinsurance. For hospital stays, inpatient acute care costs a $150 copay for days 1 through 5, and outpatient hospital services require a $195 copay with no coinsurance. Emergency room visits require an $85 copay, while urgent care visits and Medicare-covered preventive services are available with no copay. Additional benefits include routine vision and hearing exams with no deductible, a $150 eyewear allowance every two years, and a $20 monthly over-the-counter item allowance. While skilled nursing facility stays are covered with no copay for the first 20 days, some specialized services like dental, hearing aids, and transportation are highly limited or not covered under this plan. For medical equipment and dialysis services, members can expect to pay up to a 20% coinsurance with no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Alignment Health My Choice (PPO), as non-Medicare-covered stays and acute upgrades are not covered. For covered acute stays, there is a $150 copay for days 1-5 and no copay for days 6-90, while psychiatric stays require a $120 copay for days 1-10 and no copay for days 11-90, with no coinsurance required for either service.
Outpatient Services See details
Alignment Health My Choice (PPO) covers outpatient services with no coinsurance, featuring a $195 copay for outpatient hospital services and a $40 copay for outpatient substance abuse sessions. Outpatient blood services have no copay, coinsurance, or deductible, and most services require a doctor referral and prior authorization.
Partial Hospitalization See details
Partial hospitalization is covered under the Alignment Health My Choice (PPO) plan with a $55.00 copay and no coinsurance. This benefit requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Alignment Health My Choice (PPO) covers ground and air ambulance services with a $250 copay and no coinsurance, and this copay is waived if you are admitted to the hospital. Prior authorization is required for ambulance services, but transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Alignment Health My Choice (PPO) covers emergency services with an $85 copay and no coinsurance, and urgently needed services with no copay and no coinsurance. Worldwide emergency and urgent care are also covered up to a $25,000 maximum limit, though worldwide emergency transportation is not covered.
Primary Care See details
Primary Care benefits are covered under Alignment Health My Choice (PPO) with a $5 copay and no coinsurance for primary care visits, a $35 copay and no coinsurance for specialists, and a $40 copay and no coinsurance for psychiatric sessions. Opioid treatment has a 20% coinsurance and no copay, while podiatry services are not covered and chiropractic services are partially covered with routine chiropractic excluded. Some mental health specialty services are covered, but individual and group sessions are not.
Preventive Services See details
Preventive services are partially covered by Alignment Health My Choice (PPO), which offers Medicare-covered zero-dollar preventive services with no copays or coinsurance. While annual physical exams, kidney disease education, and memory fitness are covered, other supplemental benefits are not covered, including health education, weight management, alternative therapies, and in-home support.
Hearing Services See details
Hearing services are partially covered by Alignment Health My Choice (PPO), which offers one routine hearing exam and one fitting/evaluation for hearing aids annually with no deductible. However, prescription hearing aids and over-the-counter hearing aids are not covered under this plan.
Vision Services See details
Vision Services are partially covered by Alignment Health My Choice (PPO) because eyewear upgrades are not covered. The plan features no deductibles, covering one routine eye exam annually and providing a combined eyewear allowance of $150 every two years for contacts, lenses, and frames.
Dental Services See details
Alignment Health My Choice (PPO) covers some dental services, specifically Medicare dental services which require prior authorization and a doctor referral. Other sub-services, including restorative, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics, are not covered, and specific copay or coinsurance details are not provided.
Home Infusion bundled Services See details
Alignment Health My Choice (PPO) covers Home Infusion bundled Services with prior authorization, offering Medicare Part B insulin drugs for a $35 copay and no coinsurance to 20% coinsurance. Covered Part B chemotherapy, radiation, and other drugs require no copay and have no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Alignment Health My Choice (PPO) with 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive these services.
Medical Equipment See details
Alignment Health My Choice (PPO) covers medical equipment with no copays, featuring coinsurance ranging from no coinsurance to 20% for durable medical equipment and a flat 20% coinsurance for prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic equipment is only partially covered by the plan, as diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Alignment Health My Choice (PPO), as diagnostic procedures, tests, and lab services are not covered. For covered benefits, members pay a $15 copay and no coinsurance for outpatient x-ray services, a $150 copay and no coinsurance for diagnostic radiological services, and 20% coinsurance and no copay for therapeutic radiological services.
Home Health Services See details
Alignment Health My Choice (PPO) covers Home Health Services, though members must obtain a doctor referral and prior authorization to receive care.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Alignment Health My Choice (PPO) plan, meaning no copay or coinsurance benefits are available. None of the sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered in practice.
Skilled Nursing Facility (SNF) See details
Alignment Health My Choice (PPO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and days 52 to 100, and a $160 copay for days 21 to 51. Prior authorization and a doctor referral are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Alignment Health My Choice (PPO) provides partial coverage for other services, which includes a $20 monthly reimbursement allowance with no copay or coinsurance for select over-the-counter (OTC) items. Acupuncture, meal benefits, and highly integrated dual-eligible SNP services are not covered.
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