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Alignment Health Heart & Diabetes AZPlus (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Heart & Diabetes AZPlus (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 AZPlus (HMO C-SNP) in 2026, please refer to our full plan details page.
Alignment Health Heart & Diabetes AZPlus (HMO C-SNP) is a HMO C-SNP plan offered by Alignment Healthcare USA, LLC available for enrollment in 2026 to people living in Maricopa, Pima, and Santa Cruz. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Alignment Health Heart & Diabetes AZPlus (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 AZPlus (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 AZPlus (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 AZPlus (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $17.00. 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 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 $2900.00 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 AZPlus (HMO C-SNP)
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Drug Coverage
The Alignment Health Heart & Diabetes AZPlus (HMO C-SNP) plan features an enhanced alternative drug benefit with an annual prescription drug deductible of $615.00. During the initial coverage phase, you will pay a 25% coinsurance for preferred generic, standard generic, and non-preferred drugs, while preferred brand drugs require a 31% coinsurance at standard pharmacies. Notably, there is no copay for specialty tier drugs during this phase. Once your annual out-of-pocket prescription costs reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for covered Part D drugs. Furthermore, individuals who qualify for the low-income subsidy can see their Part D premium reduced to $17.00.
Additional Benefits
The Alignment Health Heart & Diabetes AZPlus (HMO C-SNP) offers comprehensive healthcare coverage with no copay for Medicare-covered preventive services and no deductible for vision and hearing care. Emergency room visits require a $135 copay, which is waived if you are admitted within 48 hours, while ground ambulance services have a $100 copay. For specialized facility care, partial hospitalization carries a $100 copay, and skilled nursing facility stays require a daily copay of $20 for days 1 through 20 and $200 for days 21 through 100. This plan also features robust supplemental benefits, including dental care with no copay or coinsurance up to a $2,400 annual maximum, alongside a $300 eyewear allowance every two years. Members can access plan-approved medical transportation for up to 50 one-way trips per year with no copay, as well as a $94 monthly over-the-counter allowance. Routine hearing exams and up to two prescription hearing aids per year are also covered with no deductible.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by Alignment Health Heart & Diabetes AZPlus (HMO C-SNP), requiring prior authorization and a doctor referral for both acute and psychiatric stays. While unlimited additional days for acute care are covered, upgrades, psychiatric additional days, and non-Medicare-covered stays are not covered, with specific copay and coinsurance costs not specified in the plan details.
Outpatient Services See details
Outpatient services are covered by Alignment Health Heart & Diabetes AZPlus (HMO C-SNP), including outpatient hospital, observation, ambulatory surgical center, and blood services, which require prior authorization and a doctor referral. While specific copay and coinsurance details are not provided, there is no deductible for outpatient blood services, and although some outpatient substance abuse services are covered, individual and group sessions are not covered.
Partial Hospitalization See details
Alignment Health Heart & Diabetes AZPlus (HMO C-SNP) covers partial hospitalization benefits with a $100.00 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Alignment Health Heart & Diabetes AZPlus (HMO C-SNP), as transportation to any health-related location is not covered. Ground ambulance services require a $100 copay and no coinsurance, air ambulance services require a 20% coinsurance and no copay, and plan-approved medical transportation is covered for up to 50 one-way trips per year with no copay or coinsurance. Prior authorization is required for both ambulance and transportation services.
Emergency Services See details
Alignment Health Heart & Diabetes AZPlus (HMO C-SNP) covers emergency services with a $135 copay and no coinsurance, which is waived if you are admitted to the hospital within 48 hours. Urgently needed services are covered with no copay or coinsurance, and worldwide emergency and urgent care are partially covered up to a $25,000 maximum limit, excluding worldwide emergency transportation.
Primary Care See details
Primary Care is partially covered by Alignment Health Heart & Diabetes AZPlus (HMO C-SNP) as podiatry services are not covered, though the plan includes specialist visits, physical therapy, and routine chiropractic care. Some mental health and psychiatric services are covered, but individual and group sessions are not covered, and specific copay or coinsurance details are not specified.
Preventive Services See details
Preventive Services are partially covered by Alignment Health Heart & Diabetes AZPlus (HMO C-SNP), offering Medicare-covered preventive services with no copay and no coinsurance, as well as annual physical exams and kidney disease education. While memory fitness and personal emergency response systems are covered, additional services such as health education, in-home safety assessments, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, and caregiver support are not covered.
Hearing Services See details
Hearing services are partially covered by Alignment Health Heart & Diabetes AZPlus (HMO C-SNP) with no deductible. The plan covers one routine hearing exam and one fitting evaluation annually, plus up to two annual prescription hearing aids (all types), but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Alignment Health Heart & Diabetes AZPlus (HMO C-SNP), which offers one routine eye exam annually and a $300 combined eyewear allowance every two years with no deductible, though eyewear upgrades are not covered. Copay and coinsurance details for these covered services are not specified in the plan details.
Dental Services See details
Dental Services are partially covered by Alignment Health Heart & Diabetes AZPlus (HMO C-SNP) with no copay and no coinsurance up to a maximum benefit of $2,400 per year. While preventive and comprehensive care like exams, cleanings, and x-rays are covered, adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Alignment Health Heart & Diabetes AZPlus (HMO C-SNP) with no copay and coinsurance ranging from no coinsurance to 20% for chemotherapy, radiation, and other Part B drugs. Medicare Part B insulin drugs are also covered under this benefit with a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Alignment Health Heart & Diabetes AZPlus (HMO C-SNP) plan, requiring patients to obtain prior authorization and a doctor referral.
Medical Equipment See details
Medical equipment is covered by Alignment Health Heart & Diabetes AZPlus (HMO C-SNP) with no copays, featuring no coinsurance to 20% coinsurance for durable medical equipment and 10% coinsurance for prosthetics and medical supplies. Prior authorization is required for covered items, though diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Alignment Health Heart & Diabetes AZPlus (HMO C-SNP) provides diagnostic and radiological benefits where some services are covered with no copay and no coinsurance, requiring prior authorization and a doctor referral. However, diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient x-ray services are not covered in practice.
Home Health Services See details
Home Health Services are covered by the Alignment Health Heart & Diabetes AZPlus (HMO C-SNP) plan, though prior authorization and a doctor referral are required. Specific copay and coinsurance details for these services are not specified in the plan benefits.
Cardiac Rehabilitation Services See details
Alignment Health Heart & Diabetes AZPlus (HMO C-SNP) does not cover Cardiac Rehabilitation Services, as all sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are listed as not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by Alignment Health Heart & Diabetes AZPlus (HMO C-SNP) with a $20 daily copay for days 1 through 20 and a $200 daily copay for days 21 through 100, with no coinsurance. Prior authorization and a doctor referral are required, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Alignment Health Heart & Diabetes AZPlus (HMO C-SNP) provides partially covered Other Services with no copay and no coinsurance, including up to 12 acupuncture visits yearly, a limited-duration meal benefit, and a $94 monthly over-the-counter allowance. Highly Integrated Services for Dual Eligible SNPs are not covered under this plan.
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* 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.
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