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Alignment Health Heart & Diabetes Plus (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Heart & Diabetes Plus (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 Plus (HMO C-SNP) in 2025, please refer to our full plan details page.
Alignment Health Heart & Diabetes Plus (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. 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 Plus (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 Plus (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 Plus (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 Plus (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $13.60. 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 a $590.00 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 $8850.00 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 Heart & Diabetes Plus (HMO C-SNP)
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Drug Coverage
The Alignment Health Heart & Diabetes Plus (HMO C-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the costs for your drugs based on the tier and pharmacy you use until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy, you will pay $13.60 per month for Part D.
Additional Benefits
The Alignment Health Heart & Diabetes Plus (HMO C-SNP) plan offers a variety of benefits, including coverage for inpatient and outpatient services, with varying coinsurance amounts. Primary care, preventive, hearing, vision, and dental services are included, with specific allowances for hearing aids, eyewear, and dental services. The plan also provides transportation services, and covers ambulance services with no copay. Additional benefits include coverage for home health, medical equipment, and diagnostic services, with no copays for home health and diagnostic services. Other services include acupuncture, over-the-counter items, and a meal benefit. However, certain services like cardiac rehabilitation, podiatry, and some specialized care are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, which both require prior authorization and a doctor referral. Additional Days for Inpatient Hospital-Acute, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a 20% coinsurance, Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services, both of which have a coinsurance of at least 20%, and Outpatient Blood Services with a 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered, but requires prior authorization and a doctor referral. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Alignment Health Heart & Diabetes Plus (HMO C-SNP). All ambulance services have no copay and a 20% coinsurance, while transportation services to a plan-approved health-related location are covered for up to 50 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered. Emergency Services have a 20% coinsurance, while Urgently Needed Services have no copay or coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $75 copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health Heart & Diabetes Plus (HMO C-SNP) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Occupational Therapy Services, Individual and Group Sessions for Mental Health and Psychiatric Services, and Opioid Treatment Program Services have a 20% coinsurance. Physical Therapy and Speech-Language Pathology Services have a 20% coinsurance. Chiropractic Services, Physician Specialist Services, and Other Health Care Professional require prior authorization and a doctor referral. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams, and additional preventive services, with some services like health education, in-home safety assessments, and several others not covered. The plan also covers Personal Emergency Response Systems, Fitness Benefits, Kidney Disease Education Services, and other services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas (with prior authorization), Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing Services are covered, including hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids are covered for one visit per year, and prescription hearing aids (all types) are covered for two visits per year. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Alignment Health Heart & Diabetes Plus (HMO C-SNP) plan covers vision services, including routine eye exams once per year. Eyewear is covered with a combined maximum benefit of $500 every two years, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Upgrades are not covered.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Other dental services have a maximum benefit of $4,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay, with 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 Plus (HMO C-SNP) plan, requiring prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the Alignment Health Heart & Diabetes Plus (HMO C-SNP) plan, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Therapeutic Shoes/Inserts are also covered with 20% coinsurance, but 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 covered, with no copay. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Therapeutic Radiological Services have a coinsurance of at most 20%; however, 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 Plus (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 Plus (HMO C-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization and a doctor referral. The plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays.
Other Services See details
Other Services include acupuncture, over-the-counter items, and a meal benefit. Acupuncture is covered up to 12 treatments per year. Over-the-counter items are covered up to $200 every month, and the plan offers nicotine replacement therapy and naloxone coverage. The meal benefit is provided for chronic illness, or for a medical condition that requires the enrollee to remain at home. Services for 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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