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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 2026, 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 3.5 out of 5 stars in 2026.
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 $350.00 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 features an annual drug deductible of $350. Under this plan, you will pay no copay for Tier 1 preferred generic drugs at preferred pharmacies and preferred mail-order services, while standard options charge a low copay starting at $4. Additionally, Tier 6 select care drugs are available with no copay across all network pharmacies and mail-order services. For Tier 2 generic and Tier 3 preferred brand medications, copays start as low as $4 and $42 respectively when using preferred pharmacies or preferred mail order. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs at 50% coinsurance and Tier 5 specialty drugs at 29% coinsurance.
Additional Benefits
The Align ChoicePlus (PPO) plan provides robust medical coverage designed to minimize out-of-pocket costs with no copays for primary care, home health services, and annual physical exams. For inpatient hospital stays, members pay a $300 daily copay for the first five days and no copay for days six through 90, with no coinsurance. Specialist doctor visits are highly affordable, ranging from no copay up to a $50 copay. Essential supplemental benefits like dental care and routine hearing exams are covered with no copay, though annual benefit limits apply. Urgent care carries a $45 copay, while emergency room visits have a $120 copay, both of which are waived if you are admitted to the hospital. For major needs like durable medical equipment and dialysis, you will pay no copay and a 20% coinsurance.
Inpatient Hospital See details
Align ChoicePlus (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $300 daily copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under the Align ChoicePlus (PPO) plan are covered with no coinsurance, featuring a $40 to $200 copay for outpatient hospital services and a $450 copay per stay for observation services. Ambulatory surgical center services require a $300 copay, outpatient substance abuse sessions carry a $30 copay, and outpatient blood services are provided with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Align ChoicePlus (PPO) covers partial hospitalization services with a $55 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Align ChoicePlus (PPO), with ground and air ambulance services requiring a $290 copay and no coinsurance. While some transportation services are covered, transportation to plan-approved health-related locations or any health-related locations is not covered.
Emergency Services See details
Emergency services under Align ChoicePlus (PPO) are covered with a $120 copay and no coinsurance, while urgently needed services require a $45 copay and no coinsurance, with both copays waived if 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 plan benefit limit of $250.
Primary Care See details
Align ChoicePlus (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. Therapy services require a $40 copay, psychiatric services have a $15 copay, and podiatry has a $30 to $45 copay, all with no coinsurance. Chiropractic care is partially covered with a $20 copay and no coinsurance for routine care (other chiropractic services are not covered), while mental health specialty services are not covered.
Preventive Services See details
Align ChoicePlus (PPO) offers partial coverage for preventive services, with no copay and no coinsurance for annual physical exams, kidney disease education, and select screenings, while the memory fitness benefit has a $5 copay. However, many additional services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, and therapeutic massage.
Hearing Services See details
Align ChoicePlus (PPO) offers hearing services with no copay and no coinsurance, though the benefit is only partially covered. Covered services include one routine hearing exam per year and prescription hearing aids up to a $700 annual limit, but fitting or evaluation exams, OTC hearing aids, and inner ear, outer ear, or over-the-ear prescription aids are not covered.
Vision Services See details
Align ChoicePlus (PPO) partially covers vision services, offering routine eye exams with no copay and 20% coinsurance, alongside eyewear with no copay and no coinsurance up to a $100 annual combined limit. Other eye exam services, eyeglass lenses, and eyeglass frames are not covered.
Dental Services See details
Align ChoicePlus (PPO) dental services are partially covered with no copay and no coinsurance, featuring an annual maximum benefit of $750 for select services. Covered treatments include oral exams, cleanings, x-rays, restorative care, endodontics, periodontics, and oral surgery, while fluoride, implants, prosthodontics, adjunctive general services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Align ChoicePlus (PPO) with no copay, although prior authorization is required. Associated Medicare Part B chemotherapy and other drugs carry a coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Align ChoicePlus (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under the Align ChoicePlus (PPO) plan with no copay and a 20% coinsurance for durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts. This benefit is partially covered because diabetic supplies are not covered, and prior authorization is required for certain items.
Diagnostic and Radiological Services See details
Align ChoicePlus (PPO) diagnostic and radiological services are partially covered, with laboratory services excluded and prior authorization required. Covered diagnostic procedures and tests require a $10 copay with no coinsurance, while radiological benefits feature no copay for diagnostic radiology, a $15 copay for outpatient X-rays, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Align ChoicePlus (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Align ChoicePlus (PPO) plan with no coinsurance, and while some services are covered, specific options such as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) are not covered.
Skilled Nursing Facility (SNF) See details
Align ChoicePlus (PPO) covers Skilled Nursing Facility (SNF) services with Medicare-defined copays and coinsurance, requiring prior authorization but waiving the standard three-day prior hospital stay. Additional days of care beyond the standard Medicare-covered limit are not covered.
Other Services See details
Align ChoicePlus (PPO) partially covers other services, offering over-the-counter items and a chronic illness meal benefit with no copay and no coinsurance, while acupuncture is not covered. The over-the-counter benefit provides up to $70 every three months via reimbursement, and the meal benefit requires a referral.
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