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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 2025, 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 4.5 out of 5 stars in 2025.
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 $89.00. 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:
Sign up for Alignment Health My Choice (PPO)
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Drug Coverage
The Alignment Health My Choice (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay depending on the drug tier and pharmacy. For example, standard generic drugs have a $5 copay at a standard pharmacy, while preferred brand drugs have a $100 copay at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs. If you qualify for the low-income subsidy, your Part D premium will be reduced to $10.60.
Additional Benefits
The Alignment Health My Choice (PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have copays, while outpatient services and primary care visits have copays, and some services like physical therapy have no copay. The plan also covers preventive, hearing, vision, and dental services with specific coverage details, as well as ambulance, emergency, and home health services. Additional benefits include coverage for medical equipment, dialysis, and home infusion services with coinsurance or copays. Other services include coverage for skilled nursing facility, cardiac rehabilitation, and diagnostic and radiological services. The plan provides an over-the-counter benefit, but excludes certain services like acupuncture and private duty nursing.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $150 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you pay a $120 copay for days 1-10, and no copay for days 11-90. Additional days for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services for the Alignment Health My Choice (PPO) plan include coverage for outpatient hospital services with a $195 copay. Additionally, outpatient substance abuse services have a $40 copay for both individual and group sessions, and outpatient blood services are covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Alignment Health My Choice (PPO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Alignment Health My Choice (PPO) plan. Ground and Air Ambulance Services have a $250 copay, and there is no coinsurance; however, 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 Alignment Health My Choice (PPO) plan. Emergency Services have an $85 copay with no coinsurance, while Urgently Needed Services have no copay or coinsurance. Worldwide Emergency Services are covered up to a maximum of $25,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health My Choice (PPO) plan covers primary care physician services with a $5 copay. Chiropractic services, routine chiropractic care, individual and group sessions for mental health specialty services, podiatry services, and occupational therapy services are not covered. Physician specialist services have a $35 copay, while individual and group sessions for psychiatric services have a $40 copay. Physical therapy and speech-language pathology services have no copay or coinsurance. Opioid treatment program services have 20% coinsurance. Additional telehealth benefits are available for some services.
Preventive Services See details
The Alignment Health My Choice (PPO) plan covers preventive services including annual physical exams, glaucoma screenings, diabetes self-management training, digital rectal exams, and EKGs following a welcome visit. Additional preventive services are covered, but require prior authorization, and some services like health education and in-home safety assessments are not covered.
Hearing Services See details
Hearing exams, fitting/evaluation for hearing aids, and routine hearing exams are covered, with one routine hearing exam and one fitting/evaluation per year. Prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
The Alignment Health My Choice (PPO) plan covers vision services including routine eye exams with no copay, and eyewear with a combined maximum of $150 every two years for in-network services. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered, with a limit of one pair or set every two years, but upgrades are not covered.
Dental Services See details
Dental services are partially covered by the Alignment Health My Choice (PPO) plan, with Medicare Dental Services covered, but Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Alignment Health My Choice (PPO) plan, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and between 0% and 20% coinsurance, while Other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation Drugs have between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Alignment Health My Choice (PPO) plan and require prior authorization and a doctor's referral. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical equipment is covered by the Alignment Health My Choice (PPO) plan, with Durable Medical Equipment (DME) subject to 0-20% coinsurance and no copay, and Prosthetics/Medical Supplies and Medical Supplies both subject to 20% coinsurance and no copay. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered, while Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $150.00. Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a $15.00 copay.
Home Health Services See details
Home Health Services are covered by the Alignment Health My Choice (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Alignment Health My Choice (PPO), but the specific sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, for days 21-51, the copay is $160, and for days 52-100, there is no copay.
Other Services See details
Other Services include Over-the-Counter (OTC) Items with a maximum benefit of $20.00 every month, but Acupuncture, Meal Benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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