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 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Align ChoiceElite (PPO) is a PPO plan offered by Sanford Health Plan available for the 2026 plan year to people living in North 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.
Below are a few key facts and commonly-asked questions about Align ChoiceElite (PPO).
The cost of a Medicare Advantage Plan is made up of four main parts.
For Align ChoiceElite (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $69.00. 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 $300.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4000.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $4000.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $4000.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $4000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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.
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
The Align ChoiceElite (PPO) Medicare plan features a $300 prescription drug deductible. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when filled through preferred pharmacies or preferred mail order. For Tier 2 generic medications, copays start as low as $4 at preferred pharmacies and preferred mail order, while standard pharmacies charge a $10 copay for a one-month supply. Tier 3 preferred brand drugs require a $42 copay at preferred pharmacies or preferred mail order, compared to a $47 copay at standard pharmacies for a one-month fill. Higher-tier prescriptions utilize coinsurance, with Tier 4 non-preferred drugs requiring a 50% coinsurance and Tier 5 specialty drugs requiring a 29% coinsurance across all pharmacy options. This tiered structure provides distinct cost differences depending on whether you choose preferred, standard, or mail-order pharmacies.
The Align ChoiceElite (PPO) plan offers comprehensive healthcare coverage with many essential services requiring no copay and no coinsurance, including primary care visits, telehealth, and preventive screenings. For inpatient hospital stays, members pay a $200 copay per day for days one through five and no copay for days six through ninety, while emergency room visits carry a $110 copay that is waived upon admission. Specialist doctor visits are also affordable, ranging from a $0 to $50 copay with no coinsurance. This plan also features valuable supplemental benefits to help lower your out-of-pocket costs, including dental, vision, and hearing coverage. Members benefit from a $1,000 annual maximum for covered dental services with no copay, a $200 yearly allowance for eyewear, and an $800 annual limit for prescription hearing aids. Additionally, the plan provides an over-the-counter reimbursement of up to $85 every three months with no copay and no coinsurance for health-related items.
Inpatient hospital care is covered by Align ChoiceElite (PPO) with no coinsurance, requiring a $200 copay for days 1 through 5 and no copay for days 6 through 90 for acute and psychiatric stays. This benefit is partially covered, as prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Align ChoiceElite (PPO) covers outpatient services with no coinsurance, featuring outpatient hospital copays between $25 and $200 and observation services at a $200 copay per stay. Ambulatory surgical center services require a $150 copay and no coinsurance, while outpatient substance abuse sessions have a $15 copay and outpatient blood services are covered with no copay or coinsurance.
Partial hospitalization is covered by the Align ChoiceElite (PPO) plan with a $55.00 copay and no coinsurance.
Align ChoiceElite (PPO) partially covers ambulance and transportation services, which includes ground and air ambulance services with a $200 copay and no coinsurance. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations are not covered.
Align ChoiceElite (PPO) covers emergency services with a $110 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance, with both copays waived if you are admitted to the hospital within three days. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance up to a maximum benefit limit of $250.
Align ChoiceElite (PPO) covers primary care, telehealth, and opioid treatment with no copay and no coinsurance, while specialist visits range from a $0 to $50 copay with no coinsurance. Physical, occupational, and speech therapies require a $25 copay with no coinsurance, and psychiatric services have a $15 copay with no coinsurance. Chiropractic care is partially covered with copays up to $20 and no coinsurance (other chiropractic services are not covered), podiatry is not covered, and some mental health specialty services are covered but individual and group sessions are not.
Preventive services are partially covered by Align ChoiceElite (PPO), featuring annual physical exams, kidney disease education, and other screenings with no copay and no coinsurance. While health education and memory fitness (which has a $5 copay and no coinsurance) are covered, several additional services, including in-home safety assessments, medical nutrition therapy, and personal emergency response systems, are not covered.
Hearing services are partially covered by Align ChoiceElite (PPO) with no copay and no coinsurance, featuring one routine hearing exam annually and prescription hearing aids up to an $800 yearly limit for both ears combined. Fitting and evaluation, over-the-counter (OTC) hearing aids, and inner, outer, or over-the-ear prescription hearing aids are not covered.
Align ChoiceElite (PPO) covers one routine eye exam annually with no copay, 20% coinsurance, and no deductible, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $200 yearly limit for one pair of contacts or complete eyeglasses, but individual eyeglass lenses and frames are not covered.
Align ChoiceElite (PPO) dental services are partially covered with no copay and no coinsurance, subject to a $1,000 annual maximum. Covered benefits include exams, cleanings, x-rays, restorative care, endodontics, periodontics, and oral surgery, while fluoride, implants, prosthodontics, and orthodontics are not covered.
Home infusion bundled services are covered by Align ChoiceElite (PPO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs require 0% (no coinsurance) to 20% coinsurance, while Part B insulin drugs have a $35 copay and 0% (no coinsurance) to 20% coinsurance.
Dialysis services are covered under the Align ChoiceElite (PPO) plan with no copay and a 20% coinsurance.
Medical equipment is partially covered by Align ChoiceElite (PPO), with diabetic supplies not covered under the plan. Covered benefits, including durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts, feature no copay and a 20% coinsurance.
Align ChoiceElite (PPO) partially covers diagnostic and radiological services, with lab services not covered and prior authorization required. Diagnostic tests require a $10 copay with no coinsurance, diagnostic radiological services have no copay, outpatient x-rays require a $15 copay, and therapeutic radiological services carry a 20% minimum coinsurance.
Home health services are covered under the Align ChoiceElite (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Align ChoiceElite (PPO) partially covers Cardiac Rehabilitation Services with no coinsurance, though standard cardiac, intensive cardiac, pulmonary, and general SET for PAD rehabilitation services are not covered. Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) is covered with a $20 copay and no coinsurance.
Skilled Nursing Facility (SNF) care is covered by Align ChoiceElite (PPO) with Medicare-defined cost-sharing and no prior three-day hospital stay required, though prior authorization is necessary. Additional days beyond the standard Medicare-covered limit are not covered.
Align ChoiceElite (PPO) partially covers other services, providing a meal benefit for chronic illnesses and an over-the-counter (OTC) item reimbursement of up to $85 every three months with no copay and no coinsurance. Acupuncture and other additional services are not covered under this plan.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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