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Alignment Health the ONE + Walgreens (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health the ONE + Walgreens (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health the ONE + Walgreens (HMO) in 2025, please refer to our full plan details page.
Alignment Health the ONE + Walgreens (HMO) is a HMO plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in Maricopa. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Alignment Health the ONE + Walgreens (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Alignment Health the ONE + Walgreens (HMO).
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 Alignment Health the ONE + Walgreens (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3499.00 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:
Sign up for Alignment Health the ONE + Walgreens (HMO)
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Drug Coverage
The Alignment Health the ONE + Walgreens (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay for your prescriptions, with costs varying based on the drug tier and pharmacy. For example, you'll pay a $3 copay for preferred generic drugs at standard and mail order pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Alignment Health the ONE + Walgreens (HMO) plan offers a wide range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. This plan also covers ambulance and transportation services, emergency services, and a variety of primary care services, including psychiatric services. Preventive services like annual physical exams have no copay, and the plan also covers hearing, vision, and dental services with specific allowances and copays. Additional benefits include coverage for home infusion services, dialysis, and medical equipment. The plan also covers skilled nursing facility stays, and other services such as acupuncture and over-the-counter items. However, certain services like some diagnostic and radiological services, cardiac rehabilitation services, and various other specialized services are either not covered or have limitations.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $225 copay for days 1-5 and no copay for days 6-90. For Inpatient Hospital Psychiatric, you pay a $120 copay for days 1-10, and no copay for days 11-90. Additional days are covered for Inpatient Hospital-Acute, and for Inpatient Hospital Psychiatric, there are 40 additional days per benefit period. Non-Medicare-covered stays and upgrades are not covered for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $150 copay, ambulatory surgical center services with a $100 copay, and outpatient substance abuse services with a $50 copay for individual and group sessions. This plan also covers outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the plan and requires prior authorization and a doctor referral. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Alignment Health the ONE + Walgreens (HMO). Ground and Air Ambulance Services have a $200 copay, and there is no coinsurance. Transportation Services to a plan-approved health-related location are covered for 24 one-way trips per year.
Emergency Services See details
Emergency Services are covered under the Alignment Health the ONE + Walgreens (HMO) plan. Emergency Services have a copay of $125, and no coinsurance.
Primary Care See details
The Alignment Health the ONE + Walgreens (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Individual and group sessions for psychiatric services have a $20 copay.
Preventive Services See details
The Alignment Health the ONE + Walgreens (HMO) plan covers preventive services, including annual physical exams, with no copay. Additionally, the plan covers Personal Emergency Response Systems, In-Home Support Services, Support for Caregivers of Enrollees (with a maximum benefit of $300 per year), and Fitness Benefits, with no copay. Some services like Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, and others are not covered.
Hearing Services See details
Hearing Services include coverage for routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids (all types) with a copay between $195 and $1750. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams, eyewear, and contact lenses. Routine eye exams are covered once per year, and eyewear has a combined maximum benefit of $300 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered once per year.
Dental Services See details
The Alignment Health the ONE + Walgreens (HMO) plan covers a variety of dental services, including oral exams (1 visit every six months), dental x-rays (1 every three years), prophylaxis (cleaning) (1 visit every six months), and fluoride treatment (1 visit every six months). Other covered services include restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. The plan has a maximum benefit of $2,000 per year for dental services, and does not cover adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Alignment Health the ONE + Walgreens (HMO) plan, with a copay between $30.00 and $30.00. Prior authorization and a doctor's referral are required for coverage.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment with no copay and a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with no copay and a 20% coinsurance. Diabetic Therapeutic Shoes/Inserts are covered with a coinsurance between 20% and 20%. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by the Alignment Health the ONE + Walgreens (HMO) plan. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered, while Therapeutic Radiological Services are covered with a coinsurance of at most 20% and no copay.
Home Health Services See details
Home Health Services are covered by Alignment Health the ONE + Walgreens (HMO), with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $100.
Other Services See details
Other services include acupuncture, over-the-counter (OTC) items, and other services. Acupuncture is covered for up to 24 treatments per year. OTC items are covered with a maximum benefit coverage amount of $20.00 every month. Personalized health risk screenings have a copay of $75, with a maximum amount of $200.00 every two years. Meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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