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Alignment Health Advantage PPO (PPO)

California Medicare Advantage Plan (2025 Plan)

Monthly Premium

Your Cost
$50
by Alignment Health Plan

Additional Coverage

HearingVision

Overall Government Star Rating

(coming soon)

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Plan Overview

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

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 in-network doctors who accept the health plan and whether a referral is needed.

Cost Summary

Monthly Premium
$50
Annual Deductible
$0
Max Out-of-Pocket
$2,850
Primary doctor visit
$0 copay
Specialist visit
$0 copay
ER visit
$75 copay per visit (always covered)
Ambulance
$100 copay

Alignment Health Advantage PPO (PPO) has a monthly premium cost of $50 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $5,150 In and Out-of-network $2,850 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Alignment Health Advantage PPO (PPO) are defined below.

Additional Benefits and Coverage

Yes
Part D Prescription Drug Coverage
No
Dental
Yes
Vision
Yes
Hearing

Alignment Health Advantage PPO (PPO) is a Medicare Advantage plan which does include 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.

Medicare Advantage health plans can offer even more additional benefits. Alignment Health Advantage PPO (PPO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Not covered
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Plan Benefits and Coverage Details

Monthly Premium
$50
Health Portion of Premium
$50
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$5,150 In and Out-of-network
$2,850 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
No
Doctor Lookup Link
http://www.alignmenthealthplan.com
Plan Link
http://www.alignmenthealthplan.com

Medical Benefits

Doctor Services

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

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 per visit (always covered)
Urgent care
$0 copay

Hospital Services

Inpatient hospital coverage
In-network: $75 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: 40% per stay
Outpatient hospital coverage
In-network: $200 copay per visit
Out-of-network: 40% coinsurance per visit

Skilled nursing facility

Skilled nursing facility
In-network: $0 per day for days 1 through 20
$50 per day for days 21 through 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 per item
Out-of-network: 40% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance per item
Out-of-network: 40% coinsurance per item
Diabetes supplies
In-network: $0 copay
Out-of-network: 40% coinsurance per item

Prescription Drug Benefits

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseCatastrophic coverage phase
Preferred Generic$0.00 copay$0 copay
Generic$3.00 copay$0 copay
Preferred Brand$40.00 copay$0 copay
Non-Preferred Drug$93.00 copay$0 copay
Specialty Tier33% 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 - Inner ear
Not covered
Hearing aids - Outer ear
Not covered
Hearing aids - Over the ear
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

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