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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 Sonoma, San Mateo Counties. 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 $107.00. 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 has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying copays depending on the drug tier and pharmacy type, ranging from $5 to $100 for a 30-day supply. For non-preferred drugs, you'll pay 33% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. The plan's premium may be reduced if you qualify for the low-income subsidy, with a Part D premium of $23.80.
Additional Benefits
The Alignment Health My Choice (PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services, like substance abuse treatment, also have copays. The plan provides coverage for emergency services with a copay and includes preventive services, primary care, and specialist visits with copays. Additional benefits include hearing and vision services, with coverage for exams and eyewear, and dental services are also covered. The plan covers home health, skilled nursing facilities, and medical equipment with different cost-sharing structures, such as copays or coinsurance. Other services like over-the-counter items are included, with a monthly allowance.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $225 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, there is 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 include coverage for Outpatient Hospital Services with a $250 copay, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services with a $40 copay for both individual and group sessions, and Outpatient Blood Services. Prior authorization is required for all services.
Partial Hospitalization See details
Partial hospitalization is covered by 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. Medicare-covered Ground and Air Ambulance Services have a $250 copay, with no coinsurance, and the copay is waived if admitted to the hospital. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Alignment Health My Choice (PPO) plan, with an $85 copay and no coinsurance for emergency services and no copay or coinsurance for urgently needed services. Worldwide Emergency Services are covered up to a maximum of $25,000, while Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services have a $5 copay, while Occupational Therapy and Physical Therapy/Speech-Language Pathology Services have no copay and no coinsurance. Physician Specialist Services have a $35 copay, and Psychiatric Services have a $40 copay for individual and group sessions. Opioid Treatment Program Services have 20% coinsurance. Chiropractic Services, Individual Sessions for Mental Health Specialty Services, and Group Sessions for Mental Health Specialty Services are not covered, while Routine Chiropractic Care is not covered.
Preventive Services See details
The Alignment Health My Choice (PPO) plan covers preventive services, including annual physical exams, with no copay or coinsurance. Additional preventive services are covered, though some services like health education and counseling services are not covered.
Hearing Services See details
Hearing Services include coverage for routine hearing exams and fitting/evaluation for hearing aids, each limited to one visit per year, with no copay or coinsurance, but prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams, eyewear (frames and lenses), and contact lenses. This plan covers one routine eye exam per year. Eyewear has a combined maximum benefit of $150 per year for in-network services. One pair of contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered every year. Upgrades are not covered.
Dental Services See details
Dental services are 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 are not covered. Medicare dental services are covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%, and for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Alignment Health My Choice (PPO) plan, requiring prior authorization and a doctor's referral. You are responsible for 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment with a 0-20% coinsurance and Prosthetic Devices with a 20% coinsurance, but Durable Medical Equipment for use outside the home is not covered. Medical Supplies and Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance, while Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
The Alignment Health My Choice (PPO) plan covers diagnostic and radiological services, but diagnostic procedures, tests, and lab services are not covered. Diagnostic Radiological Services have a copay of $150, while Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $15 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, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Alignment Health My Choice (PPO) plan, 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. Additional days beyond Medicare-covered, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items, with a maximum benefit of $20.00 per month, as well as Digital Health Technology Support. Acupuncture, Meal Benefit, 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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