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Align ChoicePlus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Align ChoicePlus (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Align ChoicePlus (PPO) in 2025, please refer to our full plan details page.
Align ChoicePlus (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 ChoicePlus (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 ChoicePlus (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 ChoicePlus (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $4500.00 (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 $4500.00 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:
Sign up for Align ChoicePlus (PPO)
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Drug Coverage
The Align ChoicePlus (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 used. For preferred generic drugs, you'll pay a $4 copay at a preferred pharmacy and a $10 copay at a standard pharmacy. For specialty drugs, there is no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Align ChoicePlus (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $175 copay for the first four days, and no copay for days 5-90. Emergency services cost $90, and primary care has no copay. The plan covers outpatient services, hearing exams, vision services, and dental services, each with different copays, coinsurance, and coverage limits. Additional benefits include coverage for ambulance, home infusion, and medical equipment, along with other services like OTC items and meal benefits.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered by the Align ChoicePlus (PPO) plan. For days 1-4, there is a $175 copay, and for days 5-90, there is no copay; 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 of $40-$200, Observation Services with a $450 copay, Ambulatory Surgical Center (ASC) Services with a $300 copay, and Outpatient Substance Abuse Services with a $30 copay for both individual and group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Align ChoicePlus (PPO) plan. There is a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Align ChoicePlus (PPO) plan. Ground and Air Ambulance Services have a $240 copay, with no coinsurance, while 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 by the Align ChoicePlus (PPO) plan. Emergency Services have a $90 copay and no coinsurance, while Urgently Needed Services have a $45 copay and no coinsurance. Worldwide Emergency Services has a maximum benefit coverage of $250.
Primary Care See details
The Align ChoicePlus (PPO) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy services have a $40 copay, and physical therapy and speech-language pathology services have a $40 copay. Physician specialist services have a copay between $0 and $50. Mental health specialty services are not covered.
Preventive Services See details
The Align ChoicePlus (PPO) plan covers preventive services, including Medicare-covered services, annual physical exams, health education, kidney disease education services, and other preventive services like glaucoma screenings and diabetes self-management training. The plan's fitness benefit has a copay of $5. Some services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, and more.
Hearing Services See details
The Align ChoicePlus (PPO) plan covers hearing exams, with one routine hearing exam covered every year. Prescription hearing aids are covered up to a maximum of $1,000 per year for both ears combined, while fitting/evaluation for hearing aids, prescription hearing aids for inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with 20% coinsurance, and eyewear with a combined maximum benefit of $105 every year. Contact lenses and eyeglasses (lenses and frames) are covered, each with a limit of one per year, while eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental Services are covered, including oral exams (2 per year), dental x-rays (1 per year), prophylaxis (cleaning, 2 per year), restorative services (1 every two years), endodontics (1 lifetime), periodontics (1 every three years), prosthodontics (1 lifetime), maxillofacial prosthetics (1 lifetime), prosthodontics, fixed (1 lifetime), and oral and maxillofacial surgery (1 lifetime). Fluoride treatment, implant services, and orthodontics are not covered, while orthodontic services are covered up to a maximum of $750 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Align ChoicePlus (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs with a $100 copay and 0-20% coinsurance. Other Medicare Part B Drugs are also covered with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Align ChoicePlus (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment with 20% coinsurance and Prosthetic Devices with 20% coinsurance, while Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Medical Supplies and Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, however, Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a copay of up to $375, Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the Align ChoicePlus (PPO) plan with no copay and no coinsurance, but authorization is required. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Align ChoicePlus (PPO) plan. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered stays and non-Medicare-covered stays are not covered. The plan requires prior authorization and refers to additional information for copay and coinsurance details.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum plan benefit coverage amount of $65 every three months, and Meal Benefit with a doctor referral, but does not cover Acupuncture, Dual Eligible SNPs with Highly Integrated Services, or various other services. The plan does not offer Nicotine Replacement Therapy (NRT) or Naloxone coverage as a Part C OTC benefit.
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