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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 2026, 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 2026.
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 $18.30. 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 Maximum Out-Of-Pocket cost of $9250.00 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) prescription drug coverage features an annual drug deductible of $615. This deductible represents the amount you must pay out of pocket for your medications before the plan's coverage begins to apply. Specific drug tier details, including copays and coinsurance percentages, are not available for this plan. To determine your exact costs for specific prescriptions, it is best to consult the plan's formulary or contact the provider directly.
Additional Benefits
The Align Dual Partnership (HMO D-SNP) provides robust medical coverage with no copay and no coinsurance for inpatient hospital stays, primary care doctor visits, and home health services. For outpatient hospital care, specialist consultations, and diagnostic testing, members typically pay no copay and a 20% coinsurance. Emergency room visits require a $90 copay, which is waived upon hospital admission, while urgent care visits carry a 20% coinsurance. Supplemental benefits include dental coverage with no copay and no coinsurance up to a $1,500 annual limit, alongside Medicare-covered dental at a 20% coinsurance. Vision and hearing benefits feature no copays, though a 20% coinsurance applies to routine exams, with annual allowances of up to $2,100 for eyewear and $2,000 for prescription hearing aids. Members also receive no-copay transportation benefits up to $360 every three months and a $130 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Align Dual Partnership (HMO D-SNP) with no copay and no coinsurance for acute and psychiatric care, though prior authorization is required. Additional days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
Align Dual Partnership (HMO D-SNP) covers outpatient hospital services with a 20% coinsurance and prior authorization, while outpatient observation services require a $100 copay per stay. Ambulatory surgical center, outpatient substance abuse, and outpatient blood services are covered with no copay and a 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the Align Dual Partnership (HMO D-SNP) plan with no copay and a 20% coinsurance.
Ambulance and Transportation Services See details
Align Dual Partnership (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance up to a maximum benefit of $360 every three months for plan-approved health-related locations, though transportation to any health-related location is not covered.
Emergency Services See details
Align Dual Partnership (HMO D-SNP) covers emergency services with a $90 copay and no coinsurance, with the copay waived if admitted to the hospital within three days. Urgently needed services are covered with no copay and a 20% coinsurance up to $40 per visit. Worldwide emergency services are partially covered with no copay or coinsurance up to a $200 maximum, while worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Align Dual Partnership (HMO D-SNP) covers primary care physician and opioid treatment services with no copay and no coinsurance, and telehealth benefits are also covered. Specialist, occupational, physical, speech, mental health, and psychiatric services (referral required) have no copay and a 20% coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by Align Dual Partnership (HMO D-SNP) with no copay and no coinsurance for covered services such as kidney disease education, diabetes self-management, and memory fitness. However, several services are not covered under this plan, including annual physical exams, health education, in-home safety assessments, personal emergency response systems, and medical nutrition therapy.
Hearing Services See details
Align Dual Partnership (HMO D-SNP) covers hearing exams with no copay and a 20% coinsurance for routine visits, while OTC hearing aids are not covered. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $2,000 annual maximum, excluding inner ear, outer ear, and over-the-ear hearing aids.
Vision Services See details
Align Dual Partnership (HMO D-SNP) provides partially covered vision services with no deductible and no copay, though a 20% coinsurance applies to routine eye exams and contact lenses. Covered benefits include one routine eye exam and up to $2,100 yearly for one pair of contact lenses or eyeglasses (lenses and frames), while other eye exam services, individual eyeglass lenses, and individual eyeglass frames are not covered.
Dental Services See details
Dental services are partially covered by Align Dual Partnership (HMO D-SNP), offering Medicare-covered dental with no copay and a 20% coinsurance, and other covered dental services with no copay and no coinsurance up to a $1,500 annual maximum. Sub-services that are not covered under this plan include other diagnostic dental, fluoride treatments, other preventive dental, removable and fixed prosthodontics, maxillofacial prosthetics, implants, and orthodontics.
Home Infusion bundled Services See details
Align Dual Partnership (HMO D-SNP) covers Home Infusion bundled services with no copay, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other drugs require no copay and no coinsurance to 20% coinsurance, while Part B insulin drugs carry a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Align Dual Partnership (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Align Dual Partnership (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment and prosthetics, but there are no preferred vendor or manufacturer restrictions.
Diagnostic and Radiological Services See details
Align Dual Partnership (HMO D-SNP) partially covers diagnostic and radiological services, requiring prior authorization and offering no copays alongside a 20% coinsurance for covered services. While diagnostic procedures, therapeutic radiology, and outpatient X-ray services are covered, lab services are not covered.
Home Health Services See details
Home Health Services are covered under the Align Dual Partnership (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Align Dual Partnership (HMO D-SNP) covers some cardiac rehabilitation services with no copay and no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Align Dual Partnership (HMO D-SNP) with no copay and no coinsurance, and the plan allows for admission without a prior three-day inpatient hospital stay. This benefit is partially covered, as additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Align Dual Partnership (HMO D-SNP) partially covers other services, providing up to a $130 quarterly reimbursement for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered under this benefit.
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