Alignment Health Balance Plus 004 (PPO)
Plan information effective January 1, 2027.
Plan costs & ratings
Availability
Available in 3 California countiesSan Diego County, CA, San Joaquin County, CA, Stanislaus County, CA
Available Cities
This plan is available in 47+ cities in California.
Benefits
In-Network: 20% coinsurance per visit
Out-of-Network: 20% coinsurance per admission (Unlimited days per admission).
Out-of-Network: 20% coinsurance per admission
In-Network: 20% coinsurance per visit (waived if admitted within 3 days)
In-Network: $0 copay for Medicare-covered urgently-needed-care visits
In-Network: 20% coinsurance per trip (NOT waived if admitted)
In-Network: $0 copay
This plan includes: Eye Exams, Eyewear.
In-Network: $0 copay for Medicare-covered Hearing Services
In-Network: $0 copay; Limit of 50 visits every year (within a 50-mile radius).
In-Network: $0 copay for Fitness Benefit.
Highlights
- PPO plan for full duals with CKD with the flexibility to see providers in-network and out-of-network plus a $200/month Essentials Allowance*.
Notes
- Drug deductible details: $0 Deductible on Tier(s) 1, 2, 6; 700.00 Deductible on Tier(s) 3, 4, 5
- In-Network: Copay and coinsurance based on 2027 Medicare defined cost shares.
Plan Overview
Plan identifiers
Carrier contact
Network & documents
PPO plan for full duals with CKD with the flexibility to see providers in-network and out-of-network plus a $200/month Essentials Allowance*.