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Alignment Health Advantage PPO (PPO)

H8832 - 001 - 0

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Alignment Health Advantage PPO (PPO) is a Medicare Advantage Plan by Alignment Health Plan.

This page features plan details for 2025 Alignment Health Advantage PPO (PPO) H8832 – 001 – 0 available in LA, OC, SD, Fresno, Madera, Ventura.

Locations

Alignment Health Advantage PPO (PPO) is offered in the following locations.

California

Fresno County, California

Los Angeles County, California

Click to see more locations

Plan Overview

Alignment Health Advantage PPO (PPO) offers the following coverage and cost-sharing.

Insurer:	Alignment Health Plan
Health Plan Deductible:	$0
MOOP:	$8,950 In and Out-of-network $4,151 In-network
Drugs Covered:	Yes

Ready to sign up for Alignment Health Advantage PPO (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

Alignment Health Advantage PPO (PPO) has a monthly premium of $45.00. 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	$45.00	$0.00	$	$

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

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

Drug Deductible:	$0.00
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 D	LIS Full
$0.00	$0.00

Initial Coverage Phase

After you pay your $0.00 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.

30 Day

60 Day

90 Day

30 Day

Tier	Std. Pharm	Std. Mail
1) Preferred Generic
2) Generic	$5.00 Copay	$5.00 Copay
3) Preferred Brand	$40.00 Copay	$40.00 Copay
4) Non-Preferred Drug	$100.00 Copay	$100.00 Copay
6) Select Care Drugs	$5.00 Copay	$5.00 Copay

60 Day

Tier	Std. Pharm	Std. Mail
1) Preferred Generic
2) Generic	$10.00 Copay	$10.00 Copay
3) Preferred Brand	$80.00 Copay	$80.00 Copay
4) Non-Preferred Drug	$200.00 Copay	$200.00 Copay
6) Select Care Drugs	$10.00 Copay	$10.00 Copay

90 Day

Tier	Std. Pharm	Std. Mail
1) Preferred Generic
2) Generic	$15.00 Copay	$15.00 Copay
3) Preferred Brand	$120.00 Copay	$120.00 Copay
4) Non-Preferred Drug	$300.00 Copay	$300.00 Copay
6) Select Care Drugs

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

Alignment Health Advantage PPO (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 (Limits Apply)
- Out-of-Network: No Coins – No Copay (Limits Apply)
Oral and Maxillofacial Surgery
- In-Network: No Coins – No Co pay (Limits Apply)
- Out-of-Network: No Coins – No Copay (Limits Apply)
Periodontics
- In-Network: No Coins – No Co pay (Limits Apply)
- Out-of-Network: No Coins – No Copay (Limits Apply)
Prosthodontics, fixed
- In-Network: No Coins – No Co pay (Limits Apply)
- Out-of-Network: No Coins – No Copay (Limits Apply)
Prosthodontics, removable
- In-Network: No Coins – No Co pay (Limits Apply)
- Out-of-Network: No Coins – No Copay (Limits Apply)
Restorative Services
- In-Network: No Coins – No Co pay (Limits Apply)
- Out-of-Network: No Coins – No Copay (Limits Apply)

Diagnostic and Preventive Dental

Dental X-Rays
- In-Network: No Coins – No Copay
- Out-of-Network: No Coins – No Copay
Fluoride Treatment
- 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 radiology services (e.g., MRI)
- In-Network: $150 copay (Authorization Required)
- Out-of-Network: 40% coinsurance (Authorization Required)
Outpatient x-rays
- In-Network: $15 copay (Authorization Required)
- Out-of-Network: 40% coinsurance (Authorization Required)
Diagnostic tests and procedures
- Out-of-Network: 40% coinsurance (Authorization Required)
Lab services
- In-Network: $0 copay (Authorization Required)
Diagnostic tests and procedures
- In-Network: $0 copay (Authorization Required)
Lab services
- Out-of-Network: 40% coinsurance (Authorization Required)

Doctor visits

Specialist
- In-Network: $20 copay per visit
Primary
- In-Network: $0 copay
- Out-of-Network: 40% coinsurance per visit
Specialist
- Out-of-Network: 40% coinsurance per visit

Emergency care/Urgent care

Urgent care
- $20 copay per visit (always covered)
Emergency
- $90 copay per visit (always covered)

Foot care (podiatry services)

Foot exams and treatment
- Out-of-Network: 40% coinsurance
- In-Network: $0 copay
Routine foot care
- Not covered

Ground ambulance

- In-Network: $250 copay
- Out-of-Network: 40% coinsurance

Health plan deductible

- $0

Hearing

Hearing aids – over the ear
- Not covered
Fitting/evaluation
- Out-of-Network: 40% coinsurance (Limits Apply)
Hearing aids – outer ear
- Not covered
Hearing aids OTC
- Not covered
Medicare-Covered Hearing Exam
- Out-of-Network: 40% coinsurance
Fitting/evaluation
- In-Network: $0 copay (Limits Apply)
Hearing aids – inner ear
- Not covered
Medicare-Covered Hearing Exam
- In-Network: $0 copay

Inpatient hospital coverage

- Out-of-Network: 40% per stay (Authorization Required)
- In-Network: $250 per day for days 1 through 3
  $0 per day for days 4 through 90 (Authorization Required)

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

- $8,950 In and Out-of-network
  $4,151 In-network

Medical equipment/supplies

Diabetes supplies
- In-Network: $0 copay (Authorization Required)
- Out-of-Network: 40% coinsurance per item (Authorization Required)
Durable medical equipment (e.g., wheelchairs, oxygen)
- Out-of-Network: 40% coinsurance per item (Authorization Required)
Prosthetics (e.g., braces, artificial limbs)
- Out-of-Network: 40% coinsurance per item (Authorization Required)
- In-Network: 20% coinsurance per item (Authorization Required)
Durable medical equipment (e.g., wheelchairs, oxygen)
- In-Network: 0-20% coinsurance per item (Authorization Required)

Medicare Part B drugs

Chemotherapy
- In-Network: 0-20% coinsurance (Authorization Required)
Other Part B drugs
- In-Network: 0-20% coinsurance (Authorization Required)
Chemotherapy
- Out-of-Network: 40% coinsurance (Authorization Required)
Other Part B drugs
- Out-of-Network: 40% coinsurance (Authorization Required)

Mental health services

Outpatient group therapy visit
- Out-of-Network: 40% coinsurance
Outpatient individual therapy visit with a psychiatrist
- In-Network: $40 copay
- Out-of-Network: 40% coinsurance
Outpatient group therapy visit
- In-Network: $0 copay
Outpatient group therapy visit with a psychiatrist
- In-Network: $40 copay
Outpatient individual therapy visit
- In-Network: $0 copay
Inpatient hospital – psychiatric
- In-Network: $120 per day for days 1 through 10
  $0 per day for days 11 through 90 (Authorization Required)
- Out-of-Network: 40% per stay (Authorization Required)
Outpatient group therapy visit with a psychiatrist
- Out-of-Network: 40% coinsurance
Outpatient individual therapy visit
- Out-of-Network: 40% coinsurance

Optional supplemental benefits

- Yes

Other health plan deductibles?

- In-Network: No

Outpatient hospital coverage

- Out-of-Network: 40% coinsurance per visit (Authorization Required)
- In-Network: $200 copay per visit (Authorization Required)

Preventive care

- Out-of-Network: 40% coinsurance
- In-Network: $0 copay

Rehabilitation services

Physical therapy and speech and language therapy visit
- In-Network: $0 copay (Authorization Required)
Occupational therapy visit
- In-Network: $0 copay (Authorization Required)
Physical therapy and speech and language therapy visit
- Out-of-Network: 40% coinsurance (Authorization Required)
Occupational therapy visit
- Out-of-Network: 40% coinsurance (Authorization Required)

Skilled Nursing Facility

- In-Network: $0 per day for days 1 through 20
  $100 per day for days 21 through 51
  $0 per day for days 52 through 100 (Authorization Required)
- Out-of-Network: 40% per stay (Authorization Required)

Transportation

- Not covered

Vision

Eyeglass frames
- In-Network: $0 copay (Limits Apply)
Routine eye exam
- In-Network: $0 copay (Limits Apply)
Eyeglasses (frames and lenses)
- In-Network: $0 copay (Limits Apply)
Other
- Not covered
Upgrades
- Not covered
Contact lenses
- In-Network: $0 copay (Limits Apply)
- Out-of-Network: 40% coinsurance (Limits Apply)
Eyeglass frames
- Out-of-Network: 40% coinsurance (Limits Apply)
Routine eye exam
- Out-of-Network: 40% coinsurance (Limits Apply)
Eyeglass lenses
- In-Network: $0 copay (Limits Apply)
- Out-of-Network: 40% coinsurance (Limits Apply)
Eyeglasses (frames and lenses)
- Out-of-Network: 40% coinsurance (Limits Apply)

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

- Covered

Options+

Comprehensive Dental

Restorative Services, Endodontics, Periodontics, Prosthodontics, removable, Prosthodontics, fixed, Oral and Maxillofacial Surgery
- Monthly Premium: $48.00

Diagnostic and Preventive Dental

Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Fluoride Treatment
- Monthly Premium: $48.00

Hearing Aids

Prescription Hearing Aids (all types)
- Monthly Premium: $48.00

Over-the-Counter (OTC) Items

Over-the-Counter (OTC) Items
- Monthly Premium: $48.00

Preventive and Other Defined Supplemental Services

Personal Emergency Response System (PERS)
- Monthly Premium: $48.00

Transportation Services

Transportation Services – Plan Approved Health-related Location
- Monthly Premium: $48.00

Worldwide Emergency/Urgent Coverage

Worldwide Emergency Coverage, Worldwide Urgent Coverage
- Monthly Premium: $48.00

Ready to sign up for Alignment Health Advantage PPO (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

Alignment Health Advantage PPO (PPO)

Locations

Plan Overview

Premium Breakdown

Drug Info

Part D Premium Reduction

Initial Coverage Phase

Catastrophic Coverage Phase

Additional Benefits

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

Comprehensive Dental

Diagnostic and Preventive Dental

Diagnostic procedures/lab services/imaging

Doctor visits

Emergency care/Urgent care

Foot care (podiatry services)

Ground ambulance

Health plan deductible

Hearing

Inpatient hospital coverage

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

Medical equipment/supplies

Medicare Part B drugs

Mental health services

Optional supplemental benefits

Other health plan deductibles?

Outpatient hospital coverage

Preventive care

Rehabilitation services

Skilled Nursing Facility

Transportation

Vision

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

Options+

Comprehensive Dental

Diagnostic and Preventive Dental

Hearing Aids

Over-the-Counter (OTC) Items

Preventive and Other Defined Supplemental Services

Transportation Services

Worldwide Emergency/Urgent Coverage

Table of Contents

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