Align ChoiceElite (PPO) H8385-002-0 Plan Details
Align ChoiceElite (PPO) H8385-002-0 Plan Details
When selecting a Medicare Advantage plan for 2025, it's important to compare all your options. Align ChoiceElite (PPO) is among the plans you can review side-by-side with others, ensuring you find the coverage that suits your needs. You can easily enroll online or reach out to a licensed agent for personalized guidance.
- Doctor Visits
- Foot Care
- Chiropractic
- Urgent & Emergency
- Mental Health
- Rehab Services
- Equipment & Supplies
- Diag, Lab, Imaging
- Part B Drugs
- Dental
- Hearing Aids
- Vision
- Prescriptions
Align ChoiceElite Overview
| Plan ID H8385-002-0 Overview | |
|---|---|
| Health Plan ID: | H8385-002-0 |
| Medicare Advantage Plan Type: | PPO |
| Plan Year: | 2025 |
| Monthly Premium: | $64.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $3,500.00 (In-Network) |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Enhanced, $150.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | See List |
| Insured By: | Align powered by Sanford Health Plan |
| We're Here to Help You Enroll |
|---|
Cost-Sharing Overview
With Align ChoiceElite , you'll have cost-sharing expenses, which are the out-of-pocket costs for approved healthcare services. The table below provides a summary of the typical in-network out-of-pocket costs associated with plan H8385-002-0.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | Not Covered |
| Specialist: | $50 Copay |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $75 Copay |
| Urgent care: | $40 Copay |
| Ground ambulance: | $150 Copay |
| Inpatient hospital care: | $150.00 per day for days 1 through 4 $0.00 per day for days 5 and beyond |
| Skilled Nursing Facility: |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | 20% Coinsurance |
| Routine Foot Care: | Not Covered |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $10 Copay |
| Routine chiropractic: | Not Covered |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | $15 Copay |
| Outpatient group therapy: | $15 Copay |
| Inpatient psychiatric hospital care: | $150.00 per day for days 1 through 4 $0.00 per day for days 5 and beyond |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | $25 Copay |
| Occupational therapy: | $25 Copay |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | Not Covered |
| Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
| Prosthetics: | 20% Coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | $250 Copay Prior Authorization Required |
| Lab services: | Not Covered |
| Outpatient x-rays: | $15 Copay Prior Authorization Required |
| Diagnostic tests and procedures: | Not Covered |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered): | 20% Coinsurance |
This section details the dental services covered under your plan including, Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Medicare Covered Preventive Dental | Not Covered |
| Oral exam | |
| Dental x-rays | |
| Cleaning | |
| Periodontics | |
| Endodontics | |
| Restorative Services |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | Covered Limits may apply |
| Hearing aids | Covered Limits may apply |
| Hearing exam | Not Covered |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | 20% Coinsurance |
| Routine eye exam (in-network) | Covered Limits may apply |
| Eyewear benefits | Eyeglasses: Yes Contact Lenses: Yes Eyeglass Lenses: No Eyeglass Frames: No Eyewear Upgrades: No |
Maximum eyewear benefit: | $200.00 Every year |
Certain preventive services are covered 100% by Align ChoiceElite as a Part B benefit.
Part D Prescription Drug Costs & Benefits
Part D Plan Premium
While the prescription drug plan (Part D) premium is included in the overall plan cost, some plans may have additional costs or provide assistance through the Low-Income Subsidy (LIS) program. Also known as Extra Help, LIS is a Social Security program that assists individuals with limited income and resources in reducing or eliminating Part D expenses. It is not part of a Medicare Advantage plan.
The following table outlines the prescription drug plan premium details of this plan.
| Basic Part D Premium: | $32.20 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $32.20 |
| Low Income Premium Subsidy: | $50.63 |
| Low Income Premium Subsidy CMS Pays: | $32.20 |
| Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
This plan's Part D deductible is $150.00 per year. You'll pay this amount at the pharmacy before Align powered by Sanford Health Plan begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the monthly premium and deductible, Align ChoiceElite may have costs when you pick up your prescriptions. The following table describes pharmacy out-of-pocket costs by drug tier.
| Drug Tier | Retail | Mail Order | |
|---|---|---|---|
| Preferred Generic* | $0.00 | $4.00 | |
| Generic* | $4.00 | $10.00 | |
| Preferred Brand | $42.00 | $47.00 | |
| Non-Preferred Drug | 50.00% | 50.00% | |
| Specialty Tier | 31.00% | 31.00% | |
| Select Care Drugs* | $0.00 | $0.00 | |
| *Deductible does not apply. | |||
Understanding CMS Star Ratings
Each year, the Centers for Medicare & Medicaid Services (CMS) evaluates health and drug plans using a comprehensive 5-star rating system. These ratings offer valuable insights into the quality of care, member satisfaction, and overall plan performance.
When selecting a Medicare Advantage plan, looking at the star ratings can help you gauge how well a plan might meet your healthcare needs, making it easier to choose a plan with confidence.
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | Not enough data available |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Plan Availability
Align ChoiceElite (H8385-002-0) is available in the following locations (click to open):
Eligibility Requirements for Align ChoiceElite
You are eligible to enroll in Align ChoiceElite if you meet the following conditions:
- You qualify for Medicare Part A and Part B.
- You live in the plan’s service area.
If these criteria describe your situation, you’re eligible to sign up for Align ChoiceElite and take advantage of its full range of benefits.
When Can I Enroll in Align ChoiceElite ?
Knowing when you can enroll in Align ChoiceElite is essential. Here are the main enrollment periods:
- Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday and ends three months after, giving you a seven-month window to enroll in Medicare.
- Annual Enrollment Period (AEP): The AEP, from October 15 to December 7, allows you to make changes to your Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): Running from January 1 to March 31, the MA OEP lets you switch plans or return to Original Medicare if you are currently enrolled in a Medicare Advantage plan.
- Special Enrollment Periods (SEPs): Life events such as moving or losing coverage may qualify you for a SEP, enabling you to enroll or make changes outside the usual periods.
If you're uncertain about the right time to enroll, Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) for guidance from a licensed insurance agent.
How to Enroll in Align ChoiceElite
Getting started with Align ChoiceElite is simple. Here are your options:
- Online Enrollment: Easily enroll online using a secure form. Visit the MedicareEnrollment.com enrollment page and follow the steps to complete your enrollment.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent will guide you through the process and answer any questions.
- Through Medicare.gov: Enroll through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the instructions to join a Medicare Advantage plan.
- Directly with the Plan: You can also enroll directly with Align ChoiceElite . The plan's contact information is available below in the "Contact" section.
Be sure to enroll during the appropriate period to ensure your coverage begins without delay.
Contact Align powered by Sanford Health Plan
| Website: | Align powered by Sanford Health Plan Plan Page |
|---|---|
| Providers: | Align powered by Sanford Health Plan Providers Page |
| Formulary: | Align powered by Sanford Health Plan Formulary Page |
| Pharmacy: | Align powered by Sanford Health Plan Pharmacy Page |
| New Member Health Plan Help: | (888)605-9277 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (888)605-9277 |
| New Member Part D TTY Users: | 711 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, you can do so on the Social Security Administration website. For more information about the Medicare Part C program, visit the official Medicare website or call 1-800-MEDICARE.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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