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Align Dual Partnership (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Align Dual Partnership (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Align Dual Partnership (HMO D-SNP) in 2025, please refer to our full plan details page.
Align Dual Partnership (HMO D-SNP) is a HMO D-SNP plan offered by Sanford Health available for enrollment in 2025 to people living in North Dakota (partial). The overall rating for this plan is not yet available for 2025.
It's important to know that Align Dual Partnership (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Align Dual Partnership (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Align Dual Partnership (HMO D-SNP).
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 Dual Partnership (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $46.90. 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 Maximum Out-Of-Pocket cost of $9350.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 Dual Partnership (HMO D-SNP) plan has a $590 deductible for prescription drugs. After meeting the deductible, your costs will depend on the specific drug tier and pharmacy you use. The plan's formulary provides details on the specific drugs covered. If you qualify for the low-income subsidy (LIS), your monthly premium for Part D is $46.90. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs.
Additional Benefits
The Align Dual Partnership (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services, such as ambulance, preventive care, and home health services, have no copay. Other services, including outpatient, primary care, vision, dental, and medical equipment, typically involve a 20% coinsurance. The plan also includes additional benefits like hearing aids up to $2000 per year, and coverage for over-the-counter items with a monthly maximum of $130.00. Emergency services have a $90 copay, and transportation services are available with a maximum benefit of $360 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the Align Dual Partnership (HMO D-SNP) plan. However, additional days, non-Medicare-covered stays, and upgrades for both acute and psychiatric inpatient hospital care are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with 20% coinsurance, and Observation Services with a $100 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are also covered, with a minimum and maximum coinsurance of 20% for both individual and group sessions, respectively. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Align Dual Partnership (HMO D-SNP) plan, with a 20% coinsurance.
Ambulance and Transportation Services See details
The Align Dual Partnership (HMO D-SNP) plan covers ambulance services with no copay and a 20% coinsurance for both ground and air ambulance services. Transportation services to plan-approved health-related locations are covered, with a maximum benefit of $360 every three months, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Align Dual Partnership (HMO D-SNP), with a $90 copay for Emergency Services. Urgently Needed Services have a 20% coinsurance, and Worldwide Emergency Services are covered up to $200. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Align Dual Partnership (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a 20% coinsurance, while occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, and physical therapy and speech-language pathology services all have a 20% coinsurance. Podiatry services are not covered.
Preventive Services See details
The Align Dual Partnership (HMO D-SNP) plan covers Medicare-covered preventive services with no copay, but does not cover annual physical exams. This plan also covers additional preventive services, including Fitness Benefit with no copay, as well as Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following Welcome Visits. However, Health Education, In-Home Safety Assessments, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), and other services are not covered.
Hearing Services See details
Hearing services include coverage for hearing exams with a coinsurance of at most 20%, routine hearing exams (1 per year), and fitting/evaluation for hearing aids. Prescription Hearing Aids (all types) are covered, and the plan covers up to $2000 per year.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams are covered once per year. Eyewear, including contact lenses, has a 20% coinsurance, and a combined maximum benefit of $100 per year. Eyeglass lenses and frames are not covered.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare dental services. Other dental services have a maximum benefit of $1250 per year. Oral exams (2 per year), dental x-rays (1 every 5 years), and prophylaxis (cleaning) (2 per year) are covered. Fluoride treatment, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and 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 and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Align Dual Partnership (HMO D-SNP) plan. There is a 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered by the Align Dual Partnership (HMO D-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics and Medical Supplies have a 20% coinsurance, and Diabetic Equipment has a coinsurance of 20% for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Lab Services are not. For Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, you pay at most 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Align Dual Partnership (HMO D-SNP) plan with no copay and no coinsurance, but prior 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 Dual Partnership (HMO D-SNP) plan. The plan does not cover any of the sub-services, including 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 the plan does not provide Skilled Nursing Facility Services as a supplemental benefit under Part C. Additional days beyond Medicare-covered and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes over-the-counter items, with a maximum benefit coverage amount of $130.00 every month. Acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, 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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