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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 2025, 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 2025.
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 $23.10. 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 $590.00 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 has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs based on the tier and pharmacy you use until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), the monthly premium for Part D is $23.10. Once your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs.
Additional Benefits
The Alignment Health Freedom (PPO) plan offers a wide range of benefits, including coverage for outpatient services, emergency services, primary care, preventive services, and more. Many services, such as routine eye exams, hearing exams, and home health services, have no copay. However, some services, like outpatient services, ambulance services, and primary care physician services, have a 20% coinsurance. Additional benefits include coverage for dental, vision, and hearing services, with specific limits and cost-sharing structures. The plan also covers medical equipment, diagnostic services, and dialysis services with coinsurance requirements. Note that specific services such as cardiac rehabilitation and additional home health services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered by the Alignment Health Freedom (PPO) plan, but additional days, non-Medicare-covered stays, and upgrades are not covered. The cost sharing details for coinsurance and copay are not provided.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services, observation services, outpatient blood services, individual outpatient substance abuse sessions, and group outpatient substance abuse sessions have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Alignment Health Freedom (PPO) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services with a 20% coinsurance, and transportation to a plan-approved health-related location with 50 one-way trips per year. 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 Alignment Health Freedom (PPO) plan. Emergency Services have a 20% coinsurance, and Urgently Needed Services have no coinsurance or copay. Worldwide Emergency Services are covered up to a maximum of $25,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health Freedom (PPO) plan covers primary care, including physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, physician specialist services, and physical therapy and speech-language pathology services have a 20% coinsurance, while chiropractic services, individual and group sessions for mental health and psychiatric services, and opioid treatment program services have a 20% coinsurance. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams, and additional preventive services, including support for caregivers of enrollees, and additional sessions of smoking and tobacco cessation counseling. Kidney Disease Education Services have a 20% coinsurance, and other preventive services such as glaucoma screening, diabetes self-management training, digital rectal exams, and EKG following Welcome Visit are covered. However, health education, in-home safety assessments, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing Services includes coverage for routine hearing exams and fitting/evaluation for hearing aids, each with one visit allowed per year, and prescription hearing aids (all types) with two visits allowed per year; however, prescription hearing aids for the inner, outer, and over the ear are not covered, and OTC hearing aids are not covered. There is no copay or coinsurance for these services.
Vision Services See details
The Alignment Health Freedom (PPO) plan covers vision services including routine eye exams with no copay, and eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, each with a limit on the number of pairs and periodicity. Eyewear has a combined maximum benefit of $500 every two years, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with 20% coinsurance. Other dental services include oral exams (1 visit every six months), dental x-rays (1 per year), prophylaxis (cleaning) (1 visit every six months), and fluoride treatment (1 per year). Orthodontic services have a maximum plan benefit of $500 every three months. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are also covered. Adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. 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 and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Alignment Health Freedom (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and preferred vendors, Prosthetics/Medical Supplies with no copay and 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance, but does not cover Durable Medical Equipment for use outside the home or Diabetic Supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. There is no copay for these services, but you pay a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Alignment Health Freedom (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Alignment Health Freedom (PPO) plan. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but prior authorization is required. The plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays, and the specific copay and coinsurance details are not provided.
Other Services See details
The Alignment Health Freedom (PPO) plan covers acupuncture, with a limit of 12 treatments per year, and also covers a meal benefit for chronic illnesses or conditions requiring you to stay home. Other services like over-the-counter items, Dual Eligible SNPs, EPSDT, and various other services are not covered.
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