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Alignment Health Platinum + Instacart (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Platinum + Instacart (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health Platinum + Instacart (HMO) in 2025, please refer to our full plan details page.
Alignment Health Platinum + Instacart (HMO) is a HMO plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in Los Angeles and Orange Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Alignment Health Platinum + Instacart (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 Platinum + Instacart (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 Platinum + Instacart (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.
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 $198.00 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 Platinum + Instacart (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay different copays or coinsurance amounts depending on the drug tier and pharmacy you use. For example, you'll pay no copay for preferred generic drugs at a standard pharmacy, while you'll pay a $30 copay for standard generic drugs at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Alignment Health Platinum + Instacart (HMO) plan offers a comprehensive range of benefits, including coverage for inpatient and outpatient services, with copays varying by service. It also covers primary care, preventive services, hearing, vision, and dental services, often with low or no copays, and covers transportation services with a $50 copay. Additionally, the plan provides coverage for ambulance services, emergency services, and home health services, and includes extra benefits like over-the-counter items and a meal benefit. This plan offers additional benefits, such as coverage for home infusion and dialysis services with coinsurance requirements, and medical equipment with varying coinsurance. There is also coverage for diagnostic and radiological services, and skilled nursing facility services. However, certain services like some dental procedures, specific therapies, and some home-based care are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including acute and psychiatric care, with prior authorization and a doctor's referral required. For Inpatient Hospital Psychiatric care, you'll pay a $120 copay for days 1-10, and no copay for days 11-90. Additional days for Inpatient Hospital Psychiatric are covered up to 40 days. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a $50 copay, outpatient substance abuse services with a $25 copay for individual and group sessions, and outpatient blood services. Outpatient hospital, substance abuse, and blood services require prior authorization and a doctor's referral.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor's referral. You will have a $55 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $50 copay for both ground and air ambulance services, and no coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 42 one-way trips per year, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Alignment Health Platinum + Instacart (HMO) plan, with a $50 copay. Worldwide Emergency Coverage has a $20 copay, while Worldwide Urgent Coverage is also covered.
Primary Care See details
The Alignment Health Platinum + Instacart (HMO) plan covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, podiatry services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Individual and group psychiatric sessions have a $5 copay, and opioid treatment program services have a 20% coinsurance.
Preventive Services See details
The Alignment Health Platinum + Instacart (HMO) plan covers preventive services including annual physical exams, additional preventive services with prior authorization, kidney disease education services, and other preventive services with no copay. This plan also covers personal emergency response systems, in-home support services, support for caregivers of enrollees, and fitness benefits. Health education, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, all covered with no deductible. Prescription hearing aids are covered, with a copay between $195 and $1750, but prescription hearing aids for the inner, outer, and over the ear are not covered, along with OTC hearing aids.
Vision Services See details
The Alignment Health Platinum + Instacart (HMO) plan covers vision services including routine eye exams, eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $300.00 every year, and upgrades are not covered.
Dental Services See details
Dental services include oral exams with a $10 copay, dental x-rays with a $30 copay, prophylaxis (cleaning) with a $20 copay, and fluoride treatment with a $10 copay. Other dental services are partially covered, with Adjunctive General Services, Maxillofacial Prosthetics, Implant Services, and Orthodontics not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization and a doctor's referral. You will pay 20% coinsurance.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered by the Alignment Health Platinum + Instacart (HMO) plan. Durable medical equipment has a coinsurance between 0% and 20%, and prosthetics and medical supplies have a 20% coinsurance, while diabetic therapeutic shoes/inserts have a 20% coinsurance, and diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered. Therapeutic Radiological Services have a coinsurance of at most 20%, and there is no copay for any services.
Home Health Services See details
Home Health Services are covered by the Alignment Health Platinum + Instacart (HMO) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. This benefit requires authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization and a doctor's referral are required.
Other Services See details
The Alignment Health Platinum + Instacart (HMO) plan covers acupuncture with no copay, over-the-counter items with a $30 monthly maximum benefit, a meal benefit, "Other 1" services with a $75 copay, and "Other 2" services. However, 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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