Alignment Health My Choice (PPO) H4961-003 is a 2023 Medicare Advantage Plan or Part-C by Alignment Health Plan available to residents in California. This plan includes additional prescription drug (Part-D) coverage. Alignment Health Plan Alignment Health My Choice (PPO) has a monthly premium of $97.00 and has an in-network maximum out-of-pocket limit of $4,200 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay
$4,200 out-of-pocket. This can be an extremely nice safety net.
Alignment Health Plan works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Alignment Health My Choice (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance)
and Part B (Medical Insurance) coverage from Alignment Health Plan and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all
the benefits of Original Medicare from Alignment Health Plan except hospice care. Original Medicare still provides you with hospice care if you sign up for
Medicare Advantage in California.
What type of plan is Alignment Health My Choice (PPO)
Alignment Health My Choice (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network, but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.
How much does Alignment Health My Choice (PPO) cost?
A monthly premium is the fee you pay to the plan in exchange for coverage. Alignment Health Plan charges a $97.00 consolidated premium. The Part C premium is $17.00 this charge covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
Part-D Deductible and Premium
An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. Alignment Health My Choice (PPO) has a monthly drug premium of $25.50 and a $0 drug deductible. This Alignment Health Plan plan offers a $25.50 Part-D Basic Premium that is Not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $54.50. This Premium covers any enhanced plan benefits offered by Alignment Health Plan above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments, and coverage of non-Part D drugs. The Part D Total Premium is $80.00. The Part D Total Premium is the addition of supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.
Alignment Health Plan Gap Coverage
In 2023 once you and your plan provider have spent $4660 on covered drugs. (Combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Alignment Health Plan plan does offer additional coverage through the gap.
Extra Help Premium Assistance
The Low Income Subsidy (LIS) Extra Helps people with Medicare pay for prescription drugs and lowers the costs of Medicare prescription drug coverage. Income limits are based on the Federal Poverty Level (FPL), which changes every year in February or March. The 2022 income limit is $1,719 ($2,309 for couples) per month. Depending on your income level you may be eligible for a full 75%, 50%, 25% premium assistance. The Alignment Health My Choice (PPO) medicare insurance offers a $54.50 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $60.90 for 75% low-income subsidy $67.20 for 50% and $73.60 for 25%.
Full Assistance Premium:
75% Assistance Premium:
50% Assistance Premium:
25% Assistance Premium:
The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Alignment Health My Choice (PPO) by Alignment Health Plan MOOP is $4,200. Once you spend $4,200 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.
Formulary and Drug Coverage
Alignment Health My Choice (PPO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.
By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.
The benefit information provided is a summary of what Alignment Health My Choice (PPO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Alignment Health Plan helps
get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.
Prosthodontics, other oral/maxillofacial surgery, other services
In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
Alignment Health My Choice (PPO) Reviews
Is Alignment Health My Choice (PPO) a good plan? Alignment Health My Choice (PPO) received a 3.5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance.
Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare Alignment Health My Choice Reviews among several different plans.
2022 Overall Rating
Part C Summary Rating
Part-D Summary 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
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing
Staying Healthy, Screening, Testing, & Vaccines
Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Monitoring Physical Activity
Managing Chronic And Long Term Care for Older Adults
SNP Care Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Reducing Risk of Falling
Improving Bladder Control
Member Experience with H4961-003 Health Plan
Total Experience Rating
Getting Needed Care
Health Care Quality
Rating of Health Plan
Member Complaints and Changes in Plans Performance
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement
Health Plan Customer Service Rating for Alignment Health Plan
Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language
Drug Plan Customer Service Ratings
Call Center, TTY, Foreign Language
Ratings For Member Complaints and Changes in the Drug Plans Performance
(Click county or state to compare all available Advantage plans)
The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Alignment Health My Choice (PPO) requires you to live in that plan’s service area. The service area is listed below:
How much does Alignment Health My Choice (PPO) cost?
Alignment Health Plan charges a $97.00 consolidated monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage of Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
How much is Alignment Health My Choice (PPO) MOOP?
The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Alignment Health My Choice (PPO) by Alignment Health Plan MOOP is $4,200. Once you spend $4,200 you will pay nothing for Part A or Part B covered services.
What type of plan is Alignment Health My Choice (PPO)?
Alignment Health My Choice (PPO) is a Local PPO. A (PPO) is a Medicare plan that has contracts with a network of preferred providers. You do not need to select a primary care physician and you do not need referrals to see other providers in the network.
Is Alignment Health My Choice (PPO) a good plan?
Alignment Health My Choice (PPO) received a 3.5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance.
Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit.
Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.
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*Licensed Agent Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options.