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Align ChoiceElite (PPO)

H8385 - 002 - 0
4.5 out of 5 stars (4.5 / 5)

Align ChoiceElite (PPO) is a Medicare Advantage Plan by Align powered by Sanford Health Plan.

This page features plan details for 2025 Align ChoiceElite (PPO) H8385 – 002 – 0 available in North Dakota.

Locations

Align ChoiceElite (PPO) is offered in the following locations.

Barnes County, North Dakota
Burleigh County, North Dakota
Cass County, North Dakota

Click to see more locations

Plan Overview

Align ChoiceElite (PPO) offers the following coverage and cost-sharing.

Insurer:Align powered by Sanford Health Plan
Health Plan Deductible:$0
MOOP:$3,500 In and Out-of-network
$3,500 In-network
Drugs Covered:Yes

Ready to sign up for Align ChoiceElite (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

Align ChoiceElite (PPO) has a monthly premium of $64.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $31.80 $32.20 $ $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Align ChoiceElite (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $150.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$32.20$0.00

Initial Coverage Phase

After you pay your $150.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

Align ChoiceElite (PPO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Comprehensive Dental

  • Endodontics
    • In-Network: No Coins – No Co pay
    • Out-of-Network: No Coins – No Copay
  • Maxillofacial Prosthetics
    • Out-of-Network: No Coins – No Copay
  • Maxillofacial Prosthetics
    • In-Network: No Coins – No Co pay
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – No Co pay
    • Out-of-Network: No Coins – No Copay
  • Periodontics
    • In-Network: No Coins – No Co pay
    • Out-of-Network: No Coins – No Copay
  • Prosthodontics, fixed
    • In-Network: No Coins – No Co pay
    • Out-of-Network: No Coins – No Copay
  • Prosthodontics, removable
    • In-Network: No Coins – No Co pay
    • Out-of-Network: No Coins – No Copay
  • Restorative Services
    • In-Network: No Coins – No Co pay
    • Out-of-Network: No Coins – No Copay

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – No Copay
    • Out-of-Network: No Coins – No Copay
  • Oral Exams
    • In-Network: No Coins – No Copay
    • Out-of-Network: No Coins – No Copay
  • Prophylaxis (cleaning)
    • In-Network: No Coins – No Copay
    • Out-of-Network: No Coins – No Copay

Diagnostic procedures/lab services/imaging

  • Diagnostic tests and procedures
    • Out-of-Network: $10-450 copay or 20% coinsurance (Authorization Required)
  • Lab services
    • Out-of-Network: $10-450 copay or 20% coinsurance (Authorization Required)
  • Outpatient x-rays
    • In-Network: $15 copay (Authorization Required)
  • Lab services
    • In-Network: $0 copay (Authorization Required)
  • Outpatient x-rays
    • Out-of-Network: $10-450 copay or 20% coinsurance (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $0-250 copay (Authorization Required)
    • Out-of-Network: $10-450 copay or 20% coinsurance (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: $0 copay (Authorization Required)

Doctor visits

  • Primary
    • In-Network: $0 copay
    • Out-of-Network: $10-90 copay or 20% coinsurance per visit
  • Specialist
    • In-Network: $0-50 copay per visit
    • Out-of-Network: $10-90 copay or 20% coinsurance per visit

Emergency care/Urgent care

  • Emergency
    • $75 copay per visit (always covered)
  • Urgent care
    • $40 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • Out-of-Network: $10-90 copay or 20% coinsurance
    • In-Network: $25 copay or 20% coinsurance
  • Routine foot care
    • Not covered

Ground ambulance

    • In-Network: $150 copay
    • Out-of-Network: $240 copay

Health plan deductible

    • $0

Hearing

  • Fitting/evaluation
    • Not covered
  • Hearing aids OTC
    • Not covered
  • Medicare-Covered Hearing Exam
    • Out-of-Network: 0-50% coinsurance
  • Hearing aids
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: 0-50% coinsurance (Limits Apply)
  • Medicare-Covered Hearing Exam
    • In-Network: $0 copay

Inpatient hospital coverage

    • In-Network: $150 per day for days 1 through 4
      $0 per day for days 5 through 90 (Authorization Required)
    • Out-of-Network: $300 per day for days 1 through 4
      $0 per day for days 5 through 90 (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $3,500 In and Out-of-network
      $3,500 In-network

Medical equipment/supplies

  • Diabetes supplies
    • Out-of-Network: 0-20% coinsurance per item
  • Prosthetics (e.g., braces, artificial limbs)
    • Out-of-Network: 0-20% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • In-Network: $0 copay
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 0-20% coinsurance per item (Authorization Required)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)
  • Chemotherapy
    • Out-of-Network: 0-20% coinsurance (Authorization Required)
  • Other Part B drugs
    • Out-of-Network: 0-20% coinsurance (Authorization Required)
  • Chemotherapy
    • In-Network: $100 copay or 0-20% coinsurance (Authorization Required)

Mental health services

  • Inpatient hospital – psychiatric
    • In-Network: $150 per day for days 1 through 4
      $0 per day for days 5 through 90 (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $15 copay
  • Outpatient individual therapy visit with a psychiatrist
    • Out-of-Network: $10-90 copay or 20% coinsurance
  • Inpatient hospital – psychiatric
    • Out-of-Network: $300 per day for days 1 through 4
      $0 per day for days 5 through 90 (Authorization Required)
  • Outpatient group therapy visit
    • In-Network: $0 copay
    • Out-of-Network: $10-90 copay or 20% coinsurance
  • Outpatient individual therapy visit
    • In-Network: $0 copay
    • Out-of-Network: $10-90 copay or 20% coinsurance
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $15 copay
  • Outpatient group therapy visit with a psychiatrist
    • Out-of-Network: $10-90 copay or 20% coinsurance

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • Out-of-Network: $10-450 copay or 20% coinsurance per visit (Authorization Required)
    • In-Network: $25-200 copay per visit (Authorization Required)

Preventive care

    • Out-of-Network: $0 copay
    • In-Network: $0 copay

Rehabilitation services

  • Physical therapy and speech and language therapy visit
    • Out-of-Network: $10-90 copay or 20% coinsurance
  • Occupational therapy visit
    • In-Network: $25 copay
    • Out-of-Network: $10-90 copay or 20% coinsurance
  • Physical therapy and speech and language therapy visit
    • In-Network: $25 copay

Skilled Nursing Facility

    • Out-of-Network: Coming soon (Authorization Required)
    • In-Network: Coming soon (Authorization Required)

Transportation

    • Not covered

Vision

  • Contact lenses
    • Out-of-Network: 0-50% coinsurance (Limits Apply)
  • Eyeglass lenses
    • Not covered
  • Eyeglasses (frames and lenses)
    • Out-of-Network: 0-50% coinsurance (Limits Apply)
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: 0-50% coinsurance (Limits Apply)
  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply)
  • Other
    • Not covered
  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
  • Upgrades
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: 0-50% coinsurance (Limits Apply)
  • Eyeglass frames
    • Not covered

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Ready to sign up for Align ChoiceElite (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Need more information on Align ChoiceElite (PPO)? See 2025 Align ChoiceElite (PPO) at MedicareAdvantageRX.com.

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