Alignment Health Advantage PPO (PPO)
Alignment Health Plan · PPO · 2026 coverage
New name in 2027
In 2027 this plan is called Alignment Health Advantage 002 (PPO). Read your letter for what else changes.
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $75
- Higher than most plans here
- Most you pay in a year for covered care in network
- $2,850
- Lower than most plans here
- Drug deductible
- $0
- Most you pay for covered drugs in a year
- $2,100
- Medicare star rating
- No rating yet
In plain English
Compared with the 25 other plans in Santa Clara County that the same person could join.
What stands out
- At most $2,850 a year for covered care, lower than most plans here
- $375 for a 5-day hospital stay, lower than most plans here
- $75 for the emergency room, lower than most plans here
- No drug deductible
Watch out for
- $75 monthly premium, higher than most plans here
- No dental extra, though most plans here have one
- You need a referral to see a specialist
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$900$900 in premiums + $0 for careHigher than most plans here2 checkups and 2 lab tests.
- A busier year$900$900 in premiums + $0 for careHigher than most plans here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$1,450$900 in premiums + $550 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$0Referral neededPlan approval may be needed
- Urgent care$0
- Emergency room$75Lower than most plans here
- Hospital stay$75 a day for days 1 to 5, then $0 for days 6 to 90Lower than most plans hereReferral neededPlan approval may be needed
- Lab tests$0Referral neededPlan approval may be needed
More care: surgery, scans, mental health, therapy, home health and more
- Outpatient surgery center$100Referral neededPlan approval may be needed
- Outpatient hospital care$200
- X-rays$0Referral neededPlan approval may be needed
- MRI, CT and other scans$0Referral neededPlan approval may be needed
- Ground ambulance$100Lower than most plans herePlan approval may be needed
- Skilled nursing facility$0 for days 1 to 20, then $50 a day for days 21 to 100Referral neededPlan approval may be needed
- Mental health therapy visit$0Tied for lowest hereReferral neededPlan approval may be needed
- Psychiatrist visit$40Tied for highest hereReferral neededPlan approval may be needed
- Physical or speech therapy$0Referral neededPlan approval may be needed
- Occupational therapy$0Referral neededPlan approval may be needed
- Home health care$0Referral neededPlan approval may be needed
- Medical equipment, like a walker or oxygen0% to 20%Depends on the servicePlan approval may be needed
- Kidney dialysis$0Referral neededPlan approval may be needed
- Chemotherapy and radiation drugs0% to 20%Depends on the servicePlan approval may be needed
- Other drugs given at a clinic0% to 20%Depends on the servicePlan approval may be needed
- Heart rehab$0Referral neededPlan approval may be needed
- Foot doctor (podiatrist)$0Referral neededPlan approval may be needed
- Chiropractor$0Referral neededPlan approval may be needed
Seeing doctors outside the network
This plan also pays for care outside its network. You usually pay 40% of the cost for Medicare-covered care there.
The most you pay in a year for covered care, in and out of network together, is $5,150 (in network alone: $2,850).
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 25 other plans in Santa Clara County that the same person could join. Read the plan’s 2026 booklet (PDF)
Is my doctor in this plan?
Look up your doctors, then confirm with their office.
Add your doctors once. We’ll check them against each plan you look at.
Before you choose, call each doctor’s office and ask:
“Do you take Alignment Health Advantage PPO (PPO), plan number H8832-002, for 2026?”
What medicines cost
The most you pay for covered drugs in 2026 is $2,100. After that, covered drugs cost $0 for the rest of the year.
| Drug tier | Network pharmacy |
|---|---|
| 1Preferred Generic | $0 |
| 2Generic | $3 |
| 3Preferred Brand | $40 |
| 4Non-Preferred Drug | 32% of the price |
| 5Specialty Tier | 33% of the price |
| 6Select Care Drugs | $3 |
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 Not includedYou can buy it as an add-on. See below.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear: plan pays up to $200 a year.
- Hearing IncludedHearing test: $0.
- Over-the-counter items IncludedUp to $20 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 Included26 one-way rides to medical visits a year.
- Extra help for some members IncludedIf you have certain long-term health conditions: pest control, pet services and general support for living.The plan decides who qualifies.
Add-ons you can buy
Optional. Each costs extra every month, on top of the plan premium.
- Enhanced Dental$36 a month · Adds dentalPays up to $1,500 a year.
Help paying for this plan
Programs that can lower your Medicare costs if your income is limited.
Extra Help with drug costs
The drug part of this plan’s premium is already $0, so Extra Help would not lower the premium (the $75 medical part stays).
Extra Help also lowers what you pay for each medicine.
See who can get Extra HelpHelp with your Part B premium
A Medicare Savings Program can pay your Part B premium, and for some people more of their Medicare costs.
See who can get a Medicare Savings ProgramContact the plan
- Call about joining(888) 979-2247 · TTY 711
- Plan websitewww.alignmenthealthplan.com
- Full 2026 rulesRead the plan’s booklet (PDF)
From the details the plan filed with Medicare for 2026. To check whether a doctor takes this plan, call the doctor’s office, not the plan.