Alignment Health Advantage PPO (PPO)

by Alignment Health Plan

2026 Medicare Advantage plan available in California

Plan ID H8832-002-0

Additional coverage:

RxHearingVision

Medicare Advantage PPO

Monthly plan premium $75 / mo

Annual deductible $0 / yr

Max out-of-pocket · in-network $2,850 / yr

Drug deductible $0 / yr

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Plan Overview

Alignment Health Advantage PPO (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in California and offered by the health insurance company Alignment Health Plan. This plan's network type is PPO, which determines the in-network doctors who accept the plan and whether a referral is needed.

Plan Name Alignment Health Advantage PPO (PPO)

Insurance Carrier Alignment Health Plan

Plan Type Medicare Advantage Plan With Part D Prescription Drug Coverage

Network Type PPO

Cost Summary

Alignment Health Advantage PPO (PPO) has a monthly premium cost of $75 per month, with an annual deductible of $0 and a maximum out-of-pocket cost sharing of $2,850. The most common costs people evaluate when choosing a plan are listed here; a full list of benefit costs is defined below.

Monthly Premium $75 / mo

Health portion of premium $75

Drug portion of premium $0

Annual Deductible $0 / yr

Max Out-of-Pocket · in-network $2,850 / yr

Primary doctor visit $0 copay

Specialist visit $0 copay

ER visit $75 copay

Ambulance $100 copay

Additional Benefits and Coverage

Alignment Health Advantage PPO (PPO) is a Medicare Advantage plan which includes Medicare Part D prescription drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Alignment Health Advantage PPO (PPO) includes coverage for hearing, vision.

Part D Prescription Drug Coverage Yes

Dental No

Vision Yes

Hearing Yes

Nationwide Coverage No

Other benefits

Fitness benefit Limited coverage

Over-the-counter drug benefits Limited coverage

In-home support services Not covered

Home & bathroom safety devices Not covered

Meals for short duration Not covered

Annual physical exams Limited coverage

Telehealth Limited coverage

Medical Benefits

Doctor Services

Primary doctor visit In-network: $0 copay
Out-of-network: 40% coinsurance

Specialist visit In-network: $0 copay
Out-of-network: 40% coinsurance

Tests, labs & imaging

Diagnostic tests & procedures In-network: $0 copay
Out-of-network: 40% coinsurance

Lab services In-network: $0 copay
Out-of-network: 40% coinsurance

Diagnostic radiology services (like MRI) In-network: $0 copay
Out-of-network: 40% coinsurance

Outpatient x-rays In-network: $0 copay
Out-of-network: 40% coinsurance

Emergency care $75 copay

Urgent care $0 copay

Hospital Services

Inpatient hospital coverage In-network:
  Tier 1
  $75 per day for days 1-5
  $0 per day for days 6-90
  $0 per stay
Out-of-network:
  40% per stay

Outpatient hospital coverage In-network: $200 copay
Out-of-network: 40% coinsurance

Skilled nursing facility

Skilled nursing facility In-network:
  Tier 1
  $0 per day for days 1-20
  $50 per day for days 21-100
Out-of-network:
  40% per stay

Preventive services

Preventive services In-network: $0 copay
Out-of-network: 40% coinsurance

Ambulance

Ground ambulance In-network: $100 copay
Out-of-network: 40% coinsurance

Therapy services

Occupational therapy visit In-network: $0 copay
Out-of-network: 40% coinsurance

Physical therapy & speech & language therapy visit In-network: $0 copay
Out-of-network: 40% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist In-network: $40 copay
Out-of-network: 40% coinsurance

Outpatient individual therapy with a psychiatrist In-network: $40 copay
Out-of-network: 40% coinsurance

Outpatient group therapy visit In-network: $0 copay
Out-of-network: 40% coinsurance

Outpatient individual therapy visit In-network: $0 copay
Out-of-network: 40% coinsurance

Opioid treatment services

Opioid treatment services Covered

Other services

Durable medical equipment (like wheelchairs & oxygen) In-network: 0%-20% coinsurance
Out-of-network: 40% coinsurance

Prosthetics (like braces, artificial limbs) In-network: 20% coinsurance
Out-of-network: 40% coinsurance

Diabetes supplies In-network: $0 copay
Out-of-network: 40% coinsurance

Prescription drugs (Part D benefits)

Drug tier standard retail · 1-month supply Initial coverage Catastrophic

Preferred Generic $0.00 copay $0 copay

Generic $3.00 copay $0 copay

Preferred Brand $40.00 copay $0 copay

Non-Preferred Drug 32% coinsurance $0 copay

Specialty Tier 33% coinsurance $0 copay

Part B drugs

Chemotherapy drugs In-network: 0%-20% coinsurance
Out-of-network: 40% coinsurance

Other Part B drugs In-network: 0%-20% coinsurance
Out-of-network: 40% coinsurance

Extra Benefits

Hearing

Hearing exam In-network: $0 copay
Out-of-network: 40% coinsurance

Fitting/evaluation In-network: $0 copay
Out-of-network: 40% coinsurance

Hearing aids - prescription Not covered

Hearing aids - over the counter Not covered

Preventive dental

Oral exam Not covered

Cleaning Not covered

Fluoride treatment Not covered

Dental x-rays Not covered

Comprehensive dental

Restorative services Not covered

Endodontics Not covered

Periodontics Not covered

Prosthodontics, removable Not covered

Prosthodontics, fixed Not covered

Maxillofacial prosthetics Not covered

Implant services Not covered

Oral and maxillofacial surgery Not covered

Orthodontics Not covered

Adjunctive general services Not covered

Vision

Routine eye exam In-network: $0 copay
Out-of-network: 40% coinsurance

Contact lenses In-network: $0 copay
Out-of-network: 40% coinsurance

Eyeglasses (frames & lenses) In-network: $0 copay
Out-of-network: 40% coinsurance

Eyeglass frames (only) In-network: $0 copay
Out-of-network: 40% coinsurance

Eyeglass lenses (only) In-network: $0 copay
Out-of-network: 40% coinsurance

Upgrades Not covered

Plan documents & tools

Plan details (carrier site)Provider directory Drug list (formulary)

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