Alignment Health Heart & Diabetes (HMO C-SNP)

Alignment Health Heart & Diabetes (HMO C-SNP) is a HMO C-SNP plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in Maricopa, 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 Heart & Diabetes (HMO C-SNP) 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 Heart & Diabetes (HMO C-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.

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:

Drug Coverage

The Alignment Health Heart & Diabetes (HMO C-SNP) plan offers an Enhanced Alternative prescription drug benefit with a $0 prescription drug deductible. During the initial coverage phase, you will pay no copay for tier 1 preferred generic drugs at standard pharmacies and through standard mail. For other tiers, standard pharmacies and standard mail orders require a $40 copay for tier 2 standard generics and a $5 copay for tier 5 specialty drugs. For brand name and non-preferred prescriptions, costs are based on coinsurance rather than flat copays. You will pay 40% coinsurance for tier 3 preferred brand drugs and 33% coinsurance for tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase where you pay nothing for covered Medicare Part D prescriptions.

Additional Benefits

The Alignment Health Heart & Diabetes (HMO C-SNP) plan offers robust coverage for essential medical services with clear, manageable cost-sharing. Inpatient hospital stays require a $200 daily copay for the first five days and no copay for days six through 90, while primary care visits and urgent care services are available with no copay. Additionally, emergency room visits carry a $75 copay, outpatient hospital services have a $100 copay, and skilled nursing facility stays require a $100 daily copay only after the first 20 days. This plan also features valuable supplemental benefits to support daily wellness and specialized care. Members benefit from routine vision and hearing exams with no deductible, dental care with copays ranging from $10 to $570, and up to 32 one-way medical transport trips each year. Additional perks include a $30 monthly over-the-counter item reimbursement and coverage for prescription hearing aids with copays between $195 and $1,750.