A non-government entity
Alignment Health smartHMO (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health smartHMO (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health smartHMO (HMO) in 2026, please refer to our full plan details page.
Alignment Health smartHMO (HMO) is a HMO plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in Maricopa, Pima, Santa Cruz. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Alignment Health smartHMO (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 smartHMO (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 smartHMO (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. Additionally, this plan comes with a Part B Premium reduction of $127.00. You must continue to pay paying your reduced 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 a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3900.00 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 smartHMO (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Alignment Health smartHMO (HMO) plan features an enhanced alternative drug benefit with an annual prescription drug deductible of $615.00. After meeting this deductible, Tier 1 preferred generic drugs have no copay at standard pharmacies or through standard mail. Other tiers require a $30.00 copay for Tier 2 standard generics, 40% coinsurance for Tier 3 preferred brands, 25% coinsurance for Tier 4 non-preferred drugs, and a $2.00 copay for Tier 5 specialty drugs. These cost-sharing rates apply until your total drug costs reach $2,100.00. Once your yearly out-of-pocket drug costs hit this $2,100.00 threshold, you enter the catastrophic coverage phase and pay nothing for covered Part D prescriptions.
Additional Benefits
The Alignment Health smartHMO (HMO) plan offers affordable medical coverage with no copays for preventive services and urgent care. Inpatient hospital stays require a $375 daily copay for days 1 through 7 and no copay thereafter, while outpatient hospital visits have a $200 copay. Primary care visits feature no coinsurance, specialist visits require a $20 copay, and emergency services carry a $120 copay. Supplemental benefits include routine dental care with a $10 copay for exams and a $20 copay for cleanings, alongside routine vision exams and a $100 eyewear allowance. Skilled nursing facility care is covered with no copay for the first 20 days and a $100 daily copay for days 21 through 100. Additionally, durable medical equipment and dialysis services require a 20% coinsurance and no copay.
Inpatient Hospital See details
Inpatient hospital care is covered by Alignment Health smartHMO (HMO), though upgrades and non-Medicare-covered stays are not covered. For acute stays, you will pay a $375 copay per day for days 1 through 7 and no copay for days 8 through 90, while psychiatric stays require a $120 copay per day for days 1 through 10 and no copay for days 11 through 90, with no coinsurance required for either service.
Outpatient Services See details
Alignment Health smartHMO (HMO) covers outpatient services with no coinsurance, including outpatient hospital services for a $200 copay and ambulatory surgical center services for a $50 copay. Outpatient substance abuse sessions require a $35 copay, and outpatient blood services feature no deductible, though prior authorization and referrals are required for most services.
Partial Hospitalization See details
Alignment Health smartHMO (HMO) covers partial hospitalization benefits with a $55 copay and no coinsurance. These services require prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered under Alignment Health smartHMO (HMO), as transportation services to health-related locations are not covered. Covered ground ambulance services require a $100 copay and air ambulance services require a $200 copay, with no coinsurance required for either service.
Emergency Services See details
Alignment Health smartHMO (HMO) covers emergency services with a $120 copay and no coinsurance, and urgently needed services with no copay and no coinsurance. Worldwide emergency and urgent services are partially covered up to a $25,000 maximum limit, though worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits are partially covered by Alignment Health smartHMO (HMO), as podiatry services and routine chiropractic care are not covered. Covered services require no coinsurance for most visits and a 20% coinsurance for opioid treatment, with copays ranging from $10 for mental health sessions to $20 for specialists and psychiatric services.
Preventive Services See details
Preventive services are partially covered by Alignment Health smartHMO (HMO) with no copay or coinsurance for covered benefits such as annual physicals, kidney disease education, and diabetes self-management training. While memory fitness and optional personal emergency response systems are covered, several additional services—including health education, weight management, alternative therapies, and in-home support—are not covered.
Hearing Services See details
Alignment Health smartHMO (HMO) partially covers hearing services, offering one routine hearing exam and one fitting/evaluation for hearing aids per year with no deductible and no specified copay or coinsurance. Prescription hearing aids and over-the-counter hearing aids are not covered.
Vision Services See details
Alignment Health smartHMO (HMO) partially covers vision services with no deductible, though specific copay and coinsurance information is not specified. The coverage includes one routine eye exam annually and a $100 combined eyewear allowance every two years, but upgrades are not covered.
Dental Services See details
Dental services are partially covered by Alignment Health smartHMO (HMO), featuring unlimited oral exams and fluoride treatments for a $10 copay, cleanings for a $20 copay, and x-rays for a $30 copay, all with no coinsurance. Restorative, endodontic, periodontic, prosthodontic, oral surgery, implant, and orthodontic services are not covered.
Home Infusion bundled Services See details
Alignment Health smartHMO (HMO) covers home infusion bundled services with prior authorization, featuring a $35 copay and 0% to 20% coinsurance for Part B insulin drugs. Other covered Part B chemotherapy, radiation, and home infusion drugs have no copay and 0% to 20% coinsurance, and step therapy may apply.
Dialysis Services See details
Dialysis Services are covered by the Alignment Health smartHMO (HMO) plan with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive these services.
Medical Equipment See details
Medical Equipment is partially covered by Alignment Health smartHMO (HMO), as diabetic supplies are not covered. Covered benefits, including durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, require prior authorization and are subject to a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by the Alignment Health smartHMO (HMO) with no copays. Under diagnostic services, some services are covered with no copay and no coinsurance, but diagnostic procedures and lab services are not covered; meanwhile, therapeutic radiological services are covered with a 20% coinsurance and no copay, but diagnostic radiological and outpatient X-ray services are not covered.
Home Health Services See details
Home health services are covered under the Alignment Health smartHMO (HMO) plan, with prior authorization and a doctor referral required for care.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice by the Alignment Health smartHMO (HMO) plan. While the plan indicates some services are covered, all specific sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered.
Skilled Nursing Facility (SNF) See details
Alignment Health smartHMO (HMO) partially covers Skilled Nursing Facility (SNF) services, requiring a doctor referral and prior authorization, while excluding additional days beyond those covered by Medicare. Covered stays feature no copay for days 1 through 20, a $100 daily copay for days 21 through 100, and no coinsurance.
Other Services See details
Alignment Health smartHMO (HMO) partially covers Other Services, providing coverage for Digital Health Technology Support with no maximum benefit limit. Acupuncture, Over-the-Counter (OTC) items, meal benefits, and Dual Eligible SNPs with Highly Integrated Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved