Alignment Health My Choice (PPO)

Alignment Health My Choice (PPO) is a PPO plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in Sonoma, San Mateo Counties. 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.

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:

Drug Coverage

The Alignment Health My Choice (PPO) Medicare plan features an Enhanced Alternative drug benefit with no prescription drug deductible, meaning your coverage begins right away. During the initial coverage phase, standard pharmacy and standard mail orders require a $5 copay for preferred generic and specialty drugs, or a $40 copay for standard generics. Preferred brand and non-preferred drugs have a 32% and 33% coinsurance respectively, which apply until total drug costs reach $2,100. After reaching $2,100 in yearly out-of-pocket costs, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. For those who qualify for Extra Help or the low-income subsidy, the monthly Part D premium is reduced from $106 to $94.

Additional Benefits

Alignment Health My Choice (PPO) offers affordable coverage for core medical needs, featuring a $5 copay for primary care visits, a $35 copay for specialists, and no coinsurance for either service. Inpatient hospital acute stays require a $225 daily copay for days one through five, followed by no copay for days six through 90. Emergency room visits have an $85 copay, while urgently needed services require no copay and no coinsurance. For routine and supplemental care, members receive annual vision and hearing exams with no deductibles, alongside a $150 annual allowance for eyewear and a $20 monthly reimbursement for over-the-counter items. Medical equipment and dialysis services are covered with no copay and up to 20 percent coinsurance. However, certain benefits such as cardiac rehabilitation, routine chiropractic care, and routine dental services are not covered under this plan.