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Alameda Alliance Wellness (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alameda Alliance Wellness (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alameda Alliance Wellness (HMO D-SNP) in 2026, please refer to our full plan details page.
Alameda Alliance Wellness (HMO D-SNP) is a HMO D-SNP plan offered by Alameda Alliance for Health available for enrollment in 2026 to people living in Alameda County. The overall rating for this plan is not yet available for 2026.
It's important to know that Alameda Alliance Wellness (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Alameda Alliance Wellness (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Alameda Alliance Wellness (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Alameda Alliance Wellness (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $12.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Alameda Alliance Wellness (HMO D-SNP) offers structured prescription drug coverage with an annual drug deductible of $615.00. For individuals who qualify for the low-income subsidy, also known as Extra Help, the Part D premium is reduced to $12.00. During the initial coverage phase, you will pay cost-sharing for covered medications until your total drug expenses reach $2,100.00. After reaching $2,100.00 in yearly out-of-pocket drug costs, you enter the catastrophic coverage phase where you will have no copay for covered Medicare Part D drugs. This ensures you pay nothing for your covered prescriptions for the remainder of the plan year, though costs may still apply for excluded drugs. Prospective members should consult the plan’s formulary to confirm coverage for their specific medications.
Additional Benefits
The Alameda Alliance Wellness (HMO D-SNP) plan offers comprehensive medical coverage, with most outpatient services requiring no copay and a standard 20% coinsurance. This cost-sharing structure applies to primary care and specialist visits, emergency services, diagnostic testing, and durable medical equipment. Inpatient hospital stays and skilled nursing facility care feature Medicare-defined coinsurance with no copays, while home health services are fully covered with no copay and no coinsurance. For supplemental benefits, members receive routine hearing and vision exams with no copay and up to 20% coinsurance, alongside allowances for prescription hearing aids and eyewear. Dental care is partially covered, offering select services with no copay and no coinsurance, and the plan includes a $50 monthly allowance for over-the-counter items. However, certain benefits such as cardiac rehabilitation, routine chiropractic care, and routine transportation services are not covered under this plan.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Alameda Alliance Wellness (HMO D-SNP) with prior authorization required, featuring Medicare-defined coinsurance and no copay. Specific sub-services that are not covered include upgrades, additional days, and non-Medicare-covered stays for both acute and psychiatric inpatient hospital care.
Outpatient Services See details
Outpatient services are covered by Alameda Alliance Wellness (HMO D-SNP) with no copay and a 20% coinsurance. This includes outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services, some of which require prior authorization and a doctor referral.
Partial Hospitalization See details
Partial hospitalization is covered by Alameda Alliance Wellness (HMO D-SNP) with a 20% coinsurance and no copay. Prior authorization is required to receive these benefits.
Ambulance and Transportation Services See details
Alameda Alliance Wellness (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. For transportation services, some services are covered, but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Alameda Alliance Wellness (HMO D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, with the coinsurance waived if you are admitted to the hospital within three days. Worldwide emergency services are partially covered up to a $25,000 maximum, but worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Alameda Alliance Wellness (HMO D-SNP) offers primary care benefits with no copay and a 20% coinsurance for most services, including primary care, specialist, and mental health visits. However, these benefits are only partially covered because podiatry services and routine chiropractic care are not covered.
Preventive Services See details
Alameda Alliance Wellness (HMO D-SNP) covers Medicare-covered zero-dollar preventive services with no copay or coinsurance, plus kidney disease education and select screenings at a 20% coinsurance with no copay. Annual physical exams are not covered. For additional preventive services, some services are covered but sub-services like fitness, health education, and weight management are not covered.
Hearing Services See details
Alameda Alliance Wellness (HMO D-SNP) covers hearing exams with no copay and up to 20% coinsurance, which includes one routine exam and one fitting evaluation yearly. Prescription hearing aids are partially covered with a $775 annual maximum benefit per ear, while OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Alameda Alliance Wellness (HMO D-SNP) provides partially covered vision services with no copay and a 20% coinsurance, which includes one annual routine eye exam and a $150 eyewear allowance every two years for contact lenses or eyeglasses. However, individual eyeglass lenses, eyeglass frames, and upgrades are not covered, and covered services require a doctor referral and prior authorization.
Dental Services See details
Alameda Alliance Wellness (HMO D-SNP) partially covers dental services, offering Medicare-covered dental care with a 20% coinsurance and no copay, and select services like oral exams, restorative care, and prosthodontics with no copay and no coinsurance. However, several sub-services are not covered, including dental X-rays, cleanings, fluoride treatments, endodontics, periodontics, implants, maxillofacial prosthetics, oral surgery, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Alameda Alliance Wellness (HMO D-SNP) with prior authorization, requiring a $35 copay and no coinsurance to 20% coinsurance for Medicare Part B insulin. Other covered Part B chemotherapy, radiation, and miscellaneous drugs require no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Alameda Alliance Wellness (HMO D-SNP) with no copay and a 20% coinsurance, although a doctor referral is required.
Medical Equipment See details
Alameda Alliance Wellness (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for these covered services, and durable medical equipment may be limited to preferred vendors.
Diagnostic and Radiological Services See details
Alameda Alliance Wellness (HMO D-SNP) covers diagnostic and radiological services, including lab work, diagnostic tests, therapeutic radiology, and outpatient X-rays, with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required for these services.
Home Health Services See details
Home Health Services are covered by Alameda Alliance Wellness (HMO D-SNP) with no copay and no coinsurance. Prior authorization and a doctor referral are required to access these benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Alameda Alliance Wellness (HMO D-SNP) plan, as all sub-services, including intensive cardiac, pulmonary, and supervised exercise therapy for peripheral artery disease, are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Alameda Alliance Wellness (HMO D-SNP), requiring Medicare-defined coinsurance and no copay. Prior authorization, a doctor referral, and a three-day prior inpatient hospital stay are required, but additional days beyond the standard Medicare-covered limits are not covered.
Other Services See details
Other Services are partially covered by Alameda Alliance Wellness (HMO D-SNP), which features a $50 monthly allowance for over-the-counter (OTC) items with no copay or coinsurance. Acupuncture, Meal Benefits, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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