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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 North 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 $3500.00 (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 $3500.00 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'll 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. Specialty tier drugs have no copay.
Additional Benefits
The Align ChoiceElite (PPO) plan offers coverage for a variety of services, including inpatient hospital stays with a $150 copay for the first four days, and outpatient services with copays ranging from $15 to $200. The plan also covers primary care visits, hearing services, vision services, and dental services. Additional benefits include ambulance services, emergency services, and home health services with no copay. The plan also provides coverage for medical equipment, diagnostic and radiological services, and dialysis services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including acute and psychiatric services. For days 1-4, the copay is $150, and there is no copay for days 5-90.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay of $25-$200, observation services, ambulatory surgical center services with a $150 copay, and outpatient substance abuse services with a $15 copay for both individual and group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by 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 $150 copay, with no coinsurance, while transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered by the Align ChoiceElite (PPO) plan. Emergency Services have a $75 copay, and Urgently Needed Services have a $40 copay, with no coinsurance for either. Worldwide Emergency Services are covered, with a maximum benefit coverage of $250.
Primary Care See details
The Align ChoiceElite (PPO) plan covers primary care physician services, chiropractic services with a $10 copay, occupational therapy services with a $25 copay, physician specialist services with a copay between $0 and $50, and physical therapy and speech-language pathology services with a $25 copay. Mental health specialty services, podiatry services, and individual and group sessions for psychiatric services are also covered. Additional telehealth benefits and opioid treatment program services are covered.
Preventive Services See details
The Align ChoiceElite (PPO) plan covers preventive services, including annual physical exams, kidney disease education, and other preventive services such as glaucoma screening and diabetes self-management training. Additional preventive services include a fitness benefit with a $5 copay. Some services, such as in-home safety assessments, are not covered.
Hearing Services See details
Hearing services under the Align ChoiceElite (PPO) plan include hearing exams and prescription hearing aids, with a maximum benefit of $1000 every year for both in and out-of-network services. Routine hearing exams are covered once per year, and the fitting/evaluation for hearing aids, prescription hearing aids (inner ear, outer ear, and over the ear), and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for routine eye exams with a 20% coinsurance, eyewear with a combined maximum of $200 per year, contact lenses (1 pair per year), and eyeglasses (lenses and frames) with 1 pair per year. Eyeglass lenses and frames are not covered.
Dental Services See details
The Align ChoiceElite (PPO) plan covers oral exams with 2 visits per year, dental x-rays with one bitewing x-ray per year and one full mouth x-ray every 5 years, prophylaxis (cleaning) with 2 visits per year, and orthodontic services up to $1,000 per year. Fluoride treatment, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs, there is a $100 copay and a coinsurance between 0% and 20%. Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Align ChoiceElite (PPO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered by the Align ChoiceElite (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies has a 20% coinsurance, while Diabetic Supplies are not covered, and Diabetic Therapeutic Shoes/Inserts has a 20% coinsurance.
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 of up to $250, Therapeutic Radiological Services have a coinsurance of 20%, and 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. 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. There is a copay for Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. The plan requires prior authorization, and the cost sharing details are not provided.
Other Services See details
The Align ChoiceElite (PPO) plan covers Over-the-Counter (OTC) items with a maximum benefit of $80 every three months, and meal benefits that require a doctor's referral. Acupuncture, Dual Eligible SNPs, 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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