Align ChoiceElite (PPO)

Align ChoiceElite (PPO) is a PPO plan offered by Sanford Health available for enrollment in 2025 to people living in South Dakota. This plan received an overall rating of 3.5 out of 5 stars in 2026.

It's important to know that Align ChoiceElite (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 Align ChoiceElite (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 Align ChoiceElite (PPO) Medicare prescription drug plan features a $300 annual drug deductible. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when using preferred pharmacies or preferred mail-order services. Tier 2 generic drugs are also highly affordable, costing as little as a $4 copay for a one-month supply at preferred locations compared to a $10 copay at standard locations. For brand-name and specialty medications, Tier 3 preferred brand drugs require a $42 copay at preferred pharmacies or a $47 copay at standard pharmacies for a one-month supply. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring a 29% coinsurance across all pharmacy types. Utilizing preferred pharmacies and preferred mail-order options throughout the plan year will consistently offer the lowest out-of-pocket costs.

Additional Benefits

The Align ChoiceElite (PPO) Medicare plan offers robust medical coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits, preventive screenings, and home health care. Specialist visits range from a $0 to $50 copay, while inpatient hospital stays require a $300 daily copay for the first five days and no copay for days six through 90. Outpatient hospital services, emergency care, and ambulance services are also covered with fixed copays and no coinsurance. For supplemental care, the plan provides routine dental cleanings and exams with no copay or coinsurance up to a $1,000 annual maximum. Routine hearing exams and prescription hearing aids feature no copay, while routine vision exams have no copay but require a 20% coinsurance. Additionally, members receive an $85 quarterly allowance for over-the-counter items with no copay, while durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance.