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Align ChoiceElite (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Align ChoiceElite (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Align ChoiceElite (PPO) in 2025, please refer to our full plan details page.
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 4.5 out of 5 stars in 2025.
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.
For Align ChoiceElite (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $64.00. 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 a $150.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $3000.00 (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 $3000.00 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 Align ChoiceElite (PPO) plan has a $150 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For preferred generic drugs, you'll pay a $4 copay at a preferred pharmacy and $10 at a standard pharmacy. Standard generic drugs have a $42 copay at a preferred pharmacy and $47 at a standard pharmacy. Preferred and Non-Preferred brand drugs have 50% and 31% coinsurance, respectively. Specialty tier drugs have no copay.
Additional Benefits
The Align ChoiceElite (PPO) plan offers a range of benefits, including coverage for inpatient hospital stays with a $150 copay for the first four days, and no copay for days 5-90. This plan also includes coverage for outpatient services with varying copays, and covers emergency services with a $75 copay. Additional benefits include coverage for primary care, preventive services, hearing and vision services, and dental services. The plan also provides coverage for home infusion, dialysis, medical equipment, and diagnostic services. There is also an OTC benefit up to $80 every three months, and a meal benefit with a doctor's referral.
Inpatient Hospital See details
Inpatient Hospital coverage under the Align ChoiceElite (PPO) plan includes both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, each with a $150 copay for days 1-4, and no copay for days 5-90; additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $25 and $150, and Ambulatory Surgical Center (ASC) Services with a $150 copay. Outpatient Substance Abuse Services and Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Align ChoiceElite (PPO) plan, with a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Align ChoiceElite (PPO) plan. Ground and Air Ambulance Services have a $240 copay, and no coinsurance. 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. Emergency services have a $75 copay, and urgently needed services have a $40 copay; both have no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $250.
Primary Care See details
The Align ChoiceElite (PPO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $10 copay, and routine chiropractic care has a $20 copay for up to 12 visits per year. Occupational therapy and physical therapy services have a $25 copay, and physician specialist services have a copay that ranges from $0 to $50. Mental health specialty services, podiatry services, individual and group sessions for psychiatric services are not covered.
Preventive Services See details
The Align ChoiceElite (PPO) plan covers preventive services, including annual physical exams and other preventive services. There is a $5 copay for the Fitness Benefit, which covers Memory Fitness.
Hearing Services See details
The Align ChoiceElite (PPO) plan covers hearing exams, including routine hearing exams once per year, and prescription hearing aids up to $1,000 per year for both ears combined. Fitting/evaluation for hearing aids, prescription hearing aids for the inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
The Align ChoiceElite (PPO) plan covers vision services including routine eye exams with a 20% coinsurance, and eyewear with a combined maximum of $200 per year for both in-network and out-of-network services. Contact lenses and eyeglasses (lenses and frames) are covered, limited to one pair per year, and eyeglass lenses and frames are not covered.
Dental Services See details
The Align ChoiceElite (PPO) plan covers a variety of dental services. The plan covers oral exams (2 visits per year), dental x-rays (one bitewing x-ray per year, one full mouth x-ray every 5 years), prophylaxis (cleaning) (2 visits per year), restorative services (1 visit every two years), endodontics (root canal therapy - 1 per lifetime), periodontics (1 visit every three years), prosthodontics, removable (1 per lifetime), maxillofacial prosthetics (1 per lifetime), prosthodontics, fixed (1 per lifetime), and oral and maxillofacial surgery (1 per lifetime). Fluoride treatments, implant services, and orthodontics are not covered by this plan.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Align ChoiceElite (PPO), including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. The plan has a $35 copay for Medicare Part B Insulin Drugs and a $100 copay for Medicare Part B Chemotherapy/Radiation Drugs. Coinsurance may apply for all services, with a minimum of 0% and a maximum of 20%.
Dialysis Services See details
Dialysis Services are covered under the Align ChoiceElite (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits are covered by the Align ChoiceElite (PPO) plan, including Durable Medical Equipment (DME) with 20% coinsurance and no copay. Prosthetic Devices, Medical Supplies, and Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance, while Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
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 up to $250, and Therapeutic Radiological Services have a coinsurance of 20%. Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the Align ChoiceElite (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Align ChoiceElite (PPO) plan, but specific services like Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. There is a copay for some services, but more information is needed to determine the exact cost.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered days or non-Medicare-covered stays. Prior authorization is required, and cost-sharing details are available within the plan documents.
Other Services See details
Other services include coverage for Over-the-Counter (OTC) Items with a maximum benefit of $80.00 every three months, and a Meal Benefit that requires a doctor's referral. Acupuncture, 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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