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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 2026, 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 Pima, Santa Cruz Counties. This plan received an overall rating of 4 out of 5 stars in 2026.
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 $2499.00 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 Alignment Health the ONE + Walgreens (HMO) plan features an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, which lasts until total drug costs reach $2,100, you will pay no copay for Tier 1 preferred generic drugs at standard pharmacies and standard mail-order services. Tier 2 standard generics require a $40 copay, while Tier 5 specialty drugs cost a $5 copay. For other tiers, you will pay a 40% coinsurance for Tier 3 preferred brand drugs and a 33% coinsurance for Tier 4 non-preferred drugs. After your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, individuals qualifying for the low-income subsidy will pay nothing for their Part D coverage.
Additional Benefits
The Alignment Health the ONE + Walgreens (HMO) plan offers comprehensive medical coverage with no copays for preventive services, annual physicals, and urgent care. Inpatient hospital stays require a $125 daily copay for the first six days, while outpatient hospital services feature an $85 copay with no coinsurance. Emergency care is covered with a $75 copay that is waived upon admission, and ground or air ambulance services have a $100 copay. For everyday health needs, members receive a $300 annual eyewear allowance, dental care with low preventive copays starting at $10, and a $50 monthly over-the-counter reimbursement allowance with no copays. The plan also includes up to 24 one-way transportation trips per year to plan-approved locations at no cost. Specialized medical services like dialysis and durable medical equipment are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Alignment Health the ONE + Walgreens (HMO) covers inpatient acute hospital stays with a $125 daily copay for days 1 to 6 and psychiatric stays with a $120 daily copay for days 1 to 10, with no copay or coinsurance for subsequent days. While additional days are covered, non-Medicare-covered stays and acute care upgrades are not covered.
Outpatient Services See details
Outpatient services are covered by Alignment Health the ONE + Walgreens (HMO) with no coinsurance, featuring an $85 copay for outpatient hospital services and a $40 copay for ambulatory surgical center visits. Outpatient substance abuse sessions require a $25 copay, while outpatient blood services are provided with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Alignment Health the ONE + Walgreens (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. This benefit requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Alignment Health the ONE + Walgreens (HMO) covers ground and air ambulance services with a $100 copay and no coinsurance, with the copay waived upon hospital admission. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations, while transportation to any health-related location is not covered.
Emergency Services See details
Alignment Health the ONE + Walgreens (HMO) covers emergency services with a $75 copay and no coinsurance, which is waived if admitted to the hospital within 48 hours, and urgently needed services with no copay or coinsurance. Worldwide emergency services are partially covered up to a maximum benefit of $10,000, though worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits are partially covered by Alignment Health the ONE + Walgreens (HMO), as podiatry services and mental health specialty services are not covered. Covered services include psychiatric sessions with a $20 copay and opioid treatment services with a 20% coinsurance.
Preventive Services See details
Alignment Health the ONE + Walgreens (HMO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and glaucoma screenings. Additional preventive services are partially covered, excluding health education, weight management, alternative therapies, nutritional benefits, in-home safety assessments, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, therapeutic massage, adult day health, palliative care, smoking cessation, disease management, telemonitoring, remote access, bathroom safety, and counseling.
Hearing Services See details
Alignment Health the ONE + Walgreens (HMO) partially covers hearing services, offering one routine exam and one fitting evaluation per year with no deductible or coinsurance, and up to two prescription hearing aids with a copay of $195 to $1,750 and no coinsurance. OTC hearing aids, along with inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by Alignment Health the ONE + Walgreens (HMO) with no deductible, which includes one annual routine eye exam and a $300 yearly allowance for eyewear like contacts and eyeglasses, while upgrades are not covered and copay or coinsurance details are not specified.
Dental Services See details
Dental Services are partially covered by Alignment Health the ONE + Walgreens (HMO), with preventive copays ranging from $10 to $30 and no coinsurance. While various restorative and surgical benefits are covered up to a $2,000 annual limit, adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Alignment Health the ONE + Walgreens (HMO) with prior authorization, featuring no copay and coinsurance ranging from no coinsurance to 20% for chemotherapy, radiation, and other Part B drugs. Medicare Part B insulin drugs are also covered under this benefit, requiring a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Alignment Health the ONE + Walgreens (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to receive this covered benefit.
Medical Equipment See details
Alignment Health the ONE + Walgreens (HMO) covers durable medical equipment with no copay and coinsurance ranging from no coinsurance to 20%, and prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic equipment is partially covered, offering therapeutic shoes and inserts with no copay and 20% coinsurance, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Alignment Health the ONE + Walgreens (HMO), with covered therapeutic radiological services requiring no copay and a 20% coinsurance. However, diagnostic procedures, lab services, diagnostic radiological services, and outpatient x-ray services are not covered under this plan.
Home Health Services See details
Home health services are covered by Alignment Health the ONE + Walgreens (HMO), requiring both a doctor referral and prior authorization before receiving care.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Alignment Health the ONE + Walgreens (HMO) plan. In practice, none of the individual sub-services are covered, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Alignment Health the ONE + Walgreens (HMO) partially covers Skilled Nursing Facility (SNF) services, requiring prior authorization and a doctor referral. There is no copay and no coinsurance for days 1 to 20, and a $100 daily copay with no coinsurance for days 21 to 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Alignment Health the ONE + Walgreens (HMO) partially covers Other Services, offering acupuncture, digital health support, and a $50 monthly over-the-counter reimbursement allowance with no copays or coinsurance. Personalized health risk screenings are covered with a $75 copay and no coinsurance, while meal benefits and highly integrated Dual Eligible SNP services are not covered.
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