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Alignment Health Heart & Diabetes (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Heart & Diabetes (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health Heart & Diabetes (HMO C-SNP) in 2025, please refer to our full plan details page.
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 3.5 out of 5 stars in 2025.
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.
Important:
Alignment Health Heart & Diabetes (HMO C-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 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.
For Alignment Health Heart & Diabetes (HMO C-SNP), 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 Heart & Diabetes (HMO C-SNP) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays or coinsurance amounts depending on the drug tier and pharmacy type. For example, you'll pay no copay for preferred generic drugs at a standard or mail-order pharmacy. For standard generic drugs, the copay is $40.00, while preferred brand drugs have a $100.00 copay. Non-preferred drugs have 33% coinsurance. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Alignment Health Heart & Diabetes (HMO C-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, and outpatient services, including substance abuse, require a copay. Emergency services have a copay, while primary care, preventive services, and home health services have no copay. The plan also includes coverage for hearing, vision, and dental services, with specific limits and cost-sharing. You'll find coverage for ambulance services, transportation, home infusion, and medical equipment, but with potential copays or coinsurance. Services like Cardiac Rehabilitation are not covered, and some other services have limitations or require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $125 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will pay a $250 copay.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered. Outpatient hospital services have an $85 copay, while outpatient substance abuse services have a copay of $15 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Alignment Health Heart & Diabetes (HMO C-SNP) plan, with a $15 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a $100 copay. Transportation Services to a plan-approved health-related location are covered for 32 one-way trips per year, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered by this plan. Emergency Services have a $75 copay and no coinsurance; however, Worldwide Emergency Transportation is not covered, and Worldwide Emergency Services have a maximum plan benefit of $25,000.
Primary Care See details
The Alignment Health Heart & Diabetes (HMO C-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, podiatry services, other health care professional 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 and psychiatric services are not covered, and the plan has a 20% coinsurance for opioid treatment program services.
Preventive Services See details
Preventive Services, including Medicare-covered services, are covered with no copay. This plan also covers Personal Emergency Response Systems, In-Home Support Services, Support for Caregivers of Enrollees, and Fitness Benefits, with the Support for Caregivers of Enrollees benefit having a maximum coverage amount of $300 per year.
Hearing Services See details
Hearing services include routine hearing exams and fitting/evaluation for hearing aids, each covered once per year. Prescription hearing aids (all types) are covered with a copay between $195 and $1750, up to two per year, while 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 Heart & Diabetes (HMO C-SNP) plan covers vision services, including eye exams, eyeglasses, and contact lenses. Routine eye exams are covered once per year, and the plan covers one pair of contact lenses, eyeglasses, eyeglass lenses, and eyeglass frames per year, with a combined maximum benefit of $200 for eyewear.
Dental Services See details
Dental services are covered, with a maximum plan benefit of $2,000 every year. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered, but have visit or time limitations. Orthodontic services are covered under Diagnostic and Preventive Dental. Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are covered. However, Adjunctive General Services, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but 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 under the Alignment Health Heart & Diabetes (HMO C-SNP) plan, but require prior authorization and a doctor's referral.
Medical Equipment See details
Medical Equipment benefits are covered, with Durable Medical Equipment (DME) subject to a coinsurance of 0% to 20% and Prosthetics/Medical Supplies - Non-Medicare benefit covered with no coinsurance or copay, but Diabetic Equipment and its sub-services are not covered. Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under the Alignment Health Heart & Diabetes (HMO C-SNP) plan, with no copay for covered services. Therapeutic Radiological Services are covered with a coinsurance of at most 20%, while Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Alignment Health Heart & Diabetes (HMO C-SNP) plan with no copay and no coinsurance, but prior authorization and a referral are required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Alignment Health Heart & Diabetes (HMO C-SNP) plan. Specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor referral, with a copay of $0 for days 1-20 and $100 per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the Alignment Health Heart & Diabetes (HMO C-SNP) plan, acupuncture, over-the-counter (OTC) items, digital health technology support, and meal benefits are covered. OTC items have a maximum benefit of $30.00 every month. Several other services are not covered, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more.
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