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Alignment Health Freedom (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Freedom (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health Freedom (PPO) in 2026, please refer to our full plan details page.
Alignment Health Freedom (PPO) is a PPO plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in Stanislaus, San Joaquin and San Diego. The overall rating for this plan is not yet available for 2026.
It's important to know that Alignment Health Freedom (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 Alignment Health Freedom (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 Alignment Health Freedom (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $12.00. 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 $615.00 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 $11950.00 (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 $11950.00 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 Alignment Health Freedom (PPO) plan features an enhanced alternative drug benefit with a $615 annual prescription drug deductible. After meeting this deductible, you will pay a 25% coinsurance for preferred generic, standard generic, and non-preferred drugs, and a 30% coinsurance for preferred brand drugs at standard pharmacies and through standard mail. Notably, there is no copay for specialty tier drugs during this initial coverage phase. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D prescription drugs. Additionally, individuals who qualify for the low-income subsidy can receive a reduced Part D premium of $12.
Additional Benefits
The Alignment Health Freedom (PPO) plan generally offers a consistent cost structure for medical services, featuring no copay and a twenty percent coinsurance for primary care, specialist visits, outpatient procedures, and diagnostic services. Emergency care, ambulance services, and medical equipment also carry no copay and a twenty percent coinsurance, while standard preventive care and annual physicals are fully covered with no copay or coinsurance. Inpatient hospital stays and skilled nursing facility care are available with Medicare-defined copays and coinsurance. For supplemental care, this plan provides routine hearing and vision coverage, including a five hundred dollar eyewear allowance every two years, alongside dental benefits that feature a three hundred dollar maximum benefit every three months for select services. Additionally, members can access up to fifty one-way transportation trips annually and home health services, though cardiac rehabilitation and over-the-counter items are not covered. Prior authorizations or doctor referrals are required for many of these specialized and outpatient services.
Inpatient Hospital See details
Alignment Health Freedom (PPO) partially covers inpatient acute and psychiatric hospital stays, with cost-sharing set at Medicare-defined copays and coinsurance. Prior authorization and doctor referrals are required, but upgrades, non-Medicare-covered stays, and additional days are not covered.
Outpatient Services See details
Alignment Health Freedom (PPO) covers outpatient services, including hospital, observation, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. These services require prior authorization and a doctor referral, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Alignment Health Freedom (PPO) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required for these covered services.
Ambulance and Transportation Services See details
Alignment Health Freedom (PPO) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. Transportation services are partially covered, offering up to 50 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Alignment Health Freedom (PPO) covers emergency services with a 20% coinsurance and no copay, which is waived if you are admitted to the hospital within three days, and urgently needed services are covered with no copay or coinsurance. Worldwide emergency and urgent care are also covered up to a $25,000 maximum limit, though worldwide emergency transportation is not covered.
Primary Care See details
Alignment Health Freedom (PPO) partially covers Primary Care benefits, offering most services—including primary care, specialist visits, and physical therapy—with no copay and 20% coinsurance. Podiatry services are not covered under this plan.
Preventive Services See details
Preventive services are covered by Alignment Health Freedom (PPO), featuring no copay or coinsurance for annual physical exams and standard Medicare preventive care, though kidney disease education requires a 20% coinsurance. Additional benefits are partially covered, offering caregiver support and personal emergency response systems, but excluding services like weight management, therapeutic massage, and alternative therapies.
Hearing Services See details
Hearing services are partially covered by Alignment Health Freedom (PPO) with no deductible, although specific copay and coinsurance information is not provided. The plan covers one routine hearing exam and one fitting evaluation annually, as well as prescription hearing aids (all types), but does not cover OTC hearing aids or prescription hearing aids for the inner ear, outer ear, and over the ear.
Vision Services See details
Alignment Health Freedom (PPO) partially covers vision services with no deductibles, providing one routine eye exam per year and a $500 combined allowance every two years for contact lenses, eyeglasses, lenses, and frames. While these essential eyewear and exam services are covered, upgrades are not covered under this plan.
Dental Services See details
Alignment Health Freedom (PPO) partially covers dental services, with Medicare-covered dental services requiring a 20% coinsurance and no copay. While preventive care and several comprehensive treatments are covered—including a $300 maximum benefit every three months for certain services—adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Alignment Health Freedom (PPO) covers home infusion bundled services, which require prior authorization and may subject patients to step therapy. Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Alignment Health Freedom (PPO) plan with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive these services.
Medical Equipment See details
Alignment Health Freedom (PPO) provides partial coverage for medical equipment, requiring no copay and a 20% coinsurance for covered services like durable medical equipment, prosthetics, and diabetic therapeutic shoes. Prior authorization is required for covered items, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Alignment Health Freedom (PPO) with no copay and a 20% coinsurance. These services, which include lab work, diagnostic tests, therapeutic radiology, and outpatient X-rays, require prior authorization and a doctor referral.
Home Health Services See details
Home health services are covered by Alignment Health Freedom (PPO), requiring prior authorization and a doctor referral. There are no copay or coinsurance costs specified for these covered services.
Cardiac Rehabilitation Services See details
Alignment Health Freedom (PPO) does not cover Cardiac Rehabilitation Services. This non-coverage includes intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Alignment Health Freedom (PPO) with Medicare-defined copays and coinsurance, requiring prior authorization and a doctor referral. While the plan does not require a prior three-day hospital stay for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Alignment Health Freedom (PPO) provides partial coverage for other services, including digital health technology support, meal benefits for qualifying medical conditions, and up to 12 acupuncture treatments per year with prior authorization and a doctor referral. Over-the-counter (OTC) items and Dual Eligible SNPs with highly integrated services are not covered under this plan.
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