Alignment Health Advantage PPO (PPO)
Alignment Health Plan · PPO · 2026 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $45
- Higher than most plans here
- Most you pay in a year for covered care in network
- $4,201
- Higher than most plans here
- Drug deductible
- $0
- Tied for lowest here
- Medicare star rating
- No rating yet
In plain English
Compared with the 59 other plans in San Diego County that the same person could join.
What stands out
- $90 for the emergency room, lower than most plans here
- No drug deductible, tied for lowest here
- Dental, vision and hearing extras included
Watch out for
- $45 monthly premium, higher than most plans here
- Up to $4,201 a year for covered care, higher than most plans here
- $20 for specialist visits, higher than most plans here
- Dental: plan pays up to $1,000 a year, less than most plans here
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$540$540 in premiums + $0 for careHigher than most plans here2 checkups and 2 lab tests.
- A busier year$655$540 in premiums + $115 for careHigher than most plans here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$2,170$540 in premiums + $1,630 for careHigher than most plans here6 checkups, 12 specialist visits, 6 lab tests, 2 scans, an ambulance ride, an ER visit and a 5-day hospital stay.
The visit counts are examples we chose to show how costs add up, not a prediction. Your costs depend on the care you get.
What you pay for care
Your cost each time, at doctors and hospitals in the plan’s network.
- Primary care visit$0
- Specialist visit$20Higher than most plans hereReferral neededPlan approval may be needed
- Urgent care$20
- Emergency room$90Lower than most plans here
- Hospital stay$250 a day for days 1 to 3, then $0 for days 4 to 90Referral neededPlan approval may be needed
- Lab tests$0Referral neededPlan approval may be needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center$100Referral neededPlan approval may be needed
- Outpatient hospital care$200Higher than most plans here
- X-rays$15Higher than most plans hereReferral neededPlan approval may be needed
- MRI, CT and other scans$150Highest of 23 plans hereReferral neededPlan approval may be needed
- Ground ambulance$250Plan approval may be needed
- Skilled nursing facility$0 for days 1 to 20, then $100 a day for days 21 to 51, then $0 for days 52 to 100Referral neededPlan approval may be needed
From the costs the plan filed with Medicare for 2026. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 59 other plans in San Diego County that the same person could join. Read the plan’s 2026 booklet (PDF)
What medicines cost
| Drug tier | Network pharmacy |
|---|---|
| 1Preferred Generic | $0 |
| 2Generic | $5 |
| 3Preferred Brand | $40 |
| 4Non-Preferred Drug | 32% of the price |
| 5Specialty Tier | 33% of the price |
| 6Select Care Drugs | $5 |
For a 1-month supply. Covered insulin costs at most $35 for a month’s supply. Your medicine’s tier is on the plan’s drug list; check it below.
Check my medicines
See if this plan covers each medicine you take in 2026, and what a month costs.
Type the name on the bottle. Add the strength to narrow it down.
Add each medicine once. We’ll show if this plan covers it, what a month costs, and any rules.
Extras
Help Original Medicare doesn’t give you.
- Dental IncludedCleanings and exams: $0. Some bigger dental work included, more with an optional add-on you can buy.Cleanings and exams: plan pays up to $1,000 a year. Plan pays up to $1,000 a year for all dental.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear: plan pays up to $150 every two years.
- Hearing IncludedHearing test: $0.
- Over-the-counter items IncludedUp to $10 a month for things like vitamins, pain relief and bandages.Unused money does not carry over.
- Fitness IncludedIncludes gym or fitness classes.
- Rides to care Not included
Is my doctor in this plan?
Look up your doctors, then confirm with their office.
Call each doctor’s office and ask:
“Do you take Alignment Health Advantage PPO (PPO), plan number H8832-001, for 2026?”