If you are a watch lover who wants to have a high-quality replica watch but don't want to spend too much money, www.watchesreplica.to will be your best choice.

2023 Align ChoiceElite (PPO)

Align ChoiceElite (PPO) H8385-002 is a 2023 Medicare Advantage Plan or Part-C by Sanford Health Plan available to residents in North Dakota. This plan includes extra prescription drug (Part-D) coverage. Sanford Health Plan Align ChoiceElite (PPO) has a monthly premium of $49.00 and has an in-network maximum out-of-pocket limit of $4,000 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $4,000 out-of-pocket. This can be an extremely nice safety net.

Sanford Health Plan works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Align ChoiceElite (PPO) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Sanford 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 Sanford Health Plan except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in North Dakota.



2023 Sanford Health Plan Medicare Advantage Plan Overview

Name:Align ChoiceElite (PPO)
Plan ID:H8385 002 0
Provider:Sanford Health Plan
Year:2023
Type:Local PPO
Combined Premium (C+D):$49.00/mo
Part C Premium:$7.80/mo
MOOP:$4,000/yr
Part D (Drug) Premium:$41.20/mo
Part D Supplemental Premium$0/mo
Total Part D Premium:$41.20/mo
Drug Deductible:$150.00/yr
Tiers with No Deductible:1
Gap Coverage:No
Benchmark:Not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan: H8385-003




What type of plan is Align ChoiceElite (PPO)

Align ChoiceElite (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 Align ChoiceElite (PPO) cost?


Monthly Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Sanford Health Plan charges a $49.00 consolidated premium. The Part C premium is $7.80 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. Align ChoiceElite (PPO) has a monthly drug premium of $41.20 and a $150.00 drug deductible. This Sanford Health Plan plan offers a $41.20 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 $0. This Premium covers any enhanced plan benefits offered by Sanford Health Plan above and beyond the standard PDP benefits. This can include extra coverage in the gap, lower co-payments, and coverage of non-Part D drugs. The Part D Total Premium is $41.20. 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.


Sanford 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 extra coverage. This Sanford Health Plan plan does not offer extra 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 Align ChoiceElite (PPO) medicare insurance offers a $1.30 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $11.30 for 75% low-income subsidy $21.30 for 50% and $31.20 for 25%.


Full Assistance Premium:$1.30
75% Assistance Premium:$11.30
50% Assistance Premium:$21.30
25% Assistance Premium:$31.20


MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Align ChoiceElite (PPO) by Sanford Health Plan MOOP is $4,000. Once you spend $4,000 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

Align ChoiceElite (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.

Drug Tier Copay
Preferred
Pharmacy		 Copay
Nonpreferred
Pharmacy
Tier 1 $0 $4
Tier 2 $4 $10
Tier 3 $42 $47
Tier 4 $100 $100
Tier 5 30% 30%

The complete Align ChoiceElite (PPO) Formulary.
*Initial Coverage Phase and 30 day supply





2023 Summary of Benefits


The benefit information provided is a summary of what Align ChoiceElite (PPO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Sanford 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.

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


Contact lenses


In-Network Vision$0 copay
Out-of-Network Vision0-50% coinsurance


Eyeglass frames


VisionNot covered


Eyeglass lenses


VisionNot covered


Eyeglasses (frames and lenses)


In-Network Vision$0 copay
Out-of-Network Vision0-50% coinsurance


Other


VisionNot covered


Routine eye exam


Out-of-Network Vision0-50% coinsurance
In-Network Vision$0 copay


Upgrades


Out-of-Network Vision0-50% coinsurance
In-Network Vision$0 copay



TransportationNot covered
In-Network Skilled Nursing Facility$0 per day for days 1 through 20
$184 per day for days 21 through 42
$0 per day for days 43 through 100
Out-of-Network Skilled Nursing Facility$184 per stay
$0 per day for days 1 through 20
$184 per day for days 21 through 100


Occupational therapy visit


Out-of-Network Rehabilitation services$10-90 copay or 20% coinsurance
In-Network Rehabilitation services$25 copay


Physical therapy and speech and language therapy visit


In-Network Rehabilitation services$40 copay
Out-of-Network Rehabilitation services$10-90 copay or 20% coinsurance


Cleaning


In-Network Preventive dental$0 copay
Out-of-Network Preventive dental50% coinsurance


Dental x-ray(s)


In-Network Preventive dental$0 copay
Out-of-Network Preventive dental50% coinsurance


Fluoride treatment


Preventive dentalNot covered


Oral exam


In-Network Preventive dental$0 copay
Out-of-Network Preventive dental50% coinsurance



In-Network Preventive care$0 copay
Out-of-Network Preventive care$0 copay
In-Network Outpatient hospital coverage$200 copay per visit
Out-of-Network Outpatient hospital coverage$10-450 copay or 20% coinsurance per visit
In-Network Other health plan deductibles?No
Optional supplemental benefitsNo


Inpatient hospital - psychiatric


In-Network Mental health services$350 per stay
Out-of-Network Mental health servicesIn 2023 the amounts for each benefit period are:
$1,600 deductible for days 1 through 60
$400 copay per day for days 61 through 90


Outpatient group therapy visit


Out-of-Network Mental health services$10-90 copay or 20% coinsurance
In-Network Mental health services$15 copay


Outpatient group therapy visit with a psychiatrist


Out-of-Network Mental health services$10-90 copay or 20% coinsurance
In-Network Mental health services$15 copay


Outpatient individual therapy visit


Out-of-Network Mental health services$10-90 copay or 20% coinsurance
In-Network Mental health services$15 copay


Outpatient individual therapy visit with a psychiatrist


In-Network Mental health services$15 copay
Out-of-Network Mental health services$10-90 copay or 20% coinsurance


Chemotherapy


Out-of-Network Medicare Part B drugs0-20% coinsurance
In-Network Medicare Part B drugs$100 copay or 20% coinsurance


Other Part B drugs


Out-of-Network Medicare Part B drugs0-20% coinsurance
In-Network Medicare Part B drugs20% coinsurance


Diabetes supplies


In-Network Medical equipment/supplies$0 copay
Out-of-Network Medical equipment/supplies0-20% coinsurance per item


Durable medical equipment (e.g., wheelchairs, oxygen)


Out-of-Network Medical equipment/supplies0-20% coinsurance per item
In-Network Medical equipment/supplies20% coinsurance per item


Prosthetics (e.g., braces, artificial limbs)


In-Network Medical equipment/supplies20% coinsurance per item
Out-of-Network Medical equipment/supplies0-20% coinsurance per item



Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$4,000 In and Out-of-network
$4,000 In-network
In-Network Inpatient hospital coverage$350 per stay
Out-of-Network Inpatient hospital coverageIn 2023 the amounts for each benefit period are:
$1,600 deductible for days 1 through 60
$400 copay per day for days 61 through 90


Fitting/evaluation


HearingNot covered


Hearing aids


In-Network Hearing$0 copay
Out-of-Network Hearing0-50% coinsurance


Hearing exam


In-Network Hearing$0 copay
Out-of-Network Hearing0-50% coinsurance



Health plan deductible$0
Out-of-Network Ground ambulance$240 copay
In-Network Ground ambulance$150 copay


Foot exams and treatment


In-Network Foot care (podiatry services)$35 copay or 20% coinsurance
Out-of-Network Foot care (podiatry services)$10-90 copay or 20% coinsurance


Routine foot care


Foot care (podiatry services)Not covered


Emergency


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


Urgent care


Emergency care/Urgent care$30 copay per visit (always covered)


Primary


Out-of-Network Doctor visits$10-90 copay or 20% coinsurance per visit
In-Network Doctor visits$0 copay


Specialist


Out-of-Network Doctor visits$10-90 copay or 20% coinsurance per visit
In-Network Doctor visits$0 copay


Diagnostic radiology services (e.g., MRI)


Out-of-Network Diagnostic procedures/lab services/imaging$10-450 copay or 20% coinsurance
In-Network Diagnostic procedures/lab services/imaging$0-140 copay


Diagnostic tests and procedures


In-Network Diagnostic procedures/lab services/imaging$0 copay
Out-of-Network Diagnostic procedures/lab services/imaging$10-450 copay or 20% coinsurance


Lab services


In-Network Diagnostic procedures/lab services/imaging$0 copay
Out-of-Network Diagnostic procedures/lab services/imaging$10-450 copay or 20% coinsurance


Outpatient x-rays


Out-of-Network Diagnostic procedures/lab services/imaging$10-450 copay or 20% coinsurance
In-Network Diagnostic procedures/lab services/imaging$15 copay


Diagnostic services


Comprehensive dentalNot covered


Endodontics


In-Network Comprehensive dental50% coinsurance
Out-of-Network Comprehensive dental50% coinsurance


Extractions


In-Network Comprehensive dental50% coinsurance
Out-of-Network Comprehensive dental50% coinsurance


Non-routine services


Comprehensive dentalNot covered


Periodontics


Out-of-Network Comprehensive dental50% coinsurance
In-Network Comprehensive dental50% coinsurance


Prosthodontics, other oral/maxillofacial surgery, other services


Out-of-Network Comprehensive dental50% coinsurance
In-Network Comprehensive dental50% coinsurance


Restorative services


In-Network Comprehensive dental50% coinsurance
Out-of-Network Comprehensive dental50% coinsurance



In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?No




Coverage Area

(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 Align ChoiceElite (PPO) requires you to live in that plan’s service area. The service area is listed below:

State: North Dakota Medicare
County:Barnes County MA Plans

Burleigh County MA Plans

Cass County MA Plans

Grand Forks County MA Plans

Griggs County MA Plans

McLean County MA Plans

Mercer County MA Plans

Morton County MA Plans

Nelson County MA Plans

Oliver County MA Plans

Ramsey County MA Plans

Ransom County MA Plans

Richland County MA Plans

Steele County MA Plans

Stutsman County MA Plans

Traill County MA Plans

Walsh County MA Plans



Go to top

How much does Align ChoiceElite (PPO) cost?

Sanford Health Plan charges a $49.00 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 Align ChoiceElite (PPO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Align ChoiceElite (PPO) by Sanford Health Plan MOOP is $4,000. Once you spend $4,000 you will pay nothing for Part A or Part B covered services.

What type of plan is Align ChoiceElite (PPO)?

Align ChoiceElite (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.



Source:CMS. Data as of Oct 1, 2022.

Last updated on

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra 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.

      Site Search:

MedicareHelp.org is a privately-owned Non-governmental agency. The government website can be found at HealthCare.gov.

Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment depends on the plan’s contract renewal.

Every year, Medicare evaluates plans based on a 5-star rating system.