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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 Pima, Santa Cruz Counties. 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 $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 has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay varying copays or coinsurance depending on the drug tier and pharmacy type. For example, you will pay no copay for preferred generic drugs at a standard pharmacy, while you will pay a $40 copay for standard generic drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered 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 comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. Emergency services have a $75 copay, while ambulance services cost $100. The plan also covers primary care, preventive, hearing, vision, dental, and home health services, with specific copays and annual limits for some. Additional benefits include coverage for home infusion, dialysis, medical equipment, and skilled nursing facilities, with associated coinsurance or copays. The plan also provides coverage for other services like acupuncture, OTC items, and transportation, each with specific limitations. However, certain services like cardiac rehabilitation, additional hours of care, and some dental and vision upgrades are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $125 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, the copay is $120 for days 1-10, and no copay for days 11-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Additional Days for Inpatient Hospital Psychiatric are covered with no copay for up to 40 additional days. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Non-Medicare-covered stay for Inpatient Hospital Psychiatric is not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have an $85 copay, ambulatory surgical center services have a $40 copay, and individual and group outpatient substance abuse sessions have a copay between $25 and $25.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor's referral. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Alignment Health the ONE + Walgreens (HMO) plan. Ground and air ambulance services have a $100 copay, and there is no coinsurance. Transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year. Transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered. Emergency Services have a $75 copay, and Worldwide Emergency Services coverage has a maximum benefit of $10,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health the ONE + Walgreens (HMO) plan covers primary care physician services, chiropractic services (with a limit of 24 visits per year), 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 mental health specialty services and podiatry services are not covered. For individual and group psychiatric sessions, there is a $20 copay. For opioid treatment program services, there is a 20% coinsurance.
Preventive Services See details
The Alignment Health the ONE + Walgreens (HMO) plan covers various preventive services, including annual physical exams, with no copay. Additional covered services include Personal Emergency Response System (PERS), In-Home Support Services, Support for Caregivers of Enrollees (with a $300 annual maximum), and Fitness Benefits. However, the plan does not cover Health Education, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, or Counseling Services.
Hearing Services See details
Hearing Services includes routine hearing exams and fitting/evaluation for hearing aids, with one visit covered per year. Prescription hearing aids are covered with a copay between $195 and $1750, and two visits are covered per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Alignment Health the ONE + Walgreens (HMO) plan covers vision services including routine eye exams with no copay, and eyewear including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, with a combined maximum benefit of $300 every year, but upgrades are not covered. You are eligible for one routine eye exam, one pair of contact lenses, one pair of eyeglasses (lenses and frames), one pair of eyeglass lenses, and one eyeglass frame every year.
Dental Services See details
The Alignment Health the ONE + Walgreens (HMO) plan covers various dental services, including oral exams (1 visit every six months), dental x-rays (1 visit every three years), prophylaxis (cleaning) (1 visit every six months), fluoride treatments (1 visit every six months), restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. This plan has a maximum benefit of $2,000 per year for other dental services, and does not cover adjunctive general services, maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and the coinsurance ranges from 0% to 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Alignment Health the ONE + Walgreens (HMO) plan and require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment with 0-20% coinsurance and Prosthetic Devices with 20% coinsurance. Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance, while 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 under the Alignment Health the ONE + Walgreens (HMO) plan. While there is no copay for any services, Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered; however, Therapeutic Radiological Services are covered with a coinsurance of at most 20%.
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 not in practice, as Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Alignment Health the ONE + Walgreens (HMO), with a doctor's referral and prior authorization required. 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, with a limit of 24 treatments per year. OTC items are covered with a maximum benefit coverage amount of $25.00 every month, and other services include personalized health risk screening, which has a $75 copay and a maximum amount of $200.00 every two years. Meal benefit, 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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