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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 2026, 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 SoCal and NorCal. This plan received an overall rating of 4 out of 5 stars in 2026.
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 $1499.00 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 offers an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, which lasts until total drug costs reach $2,100, you will pay a $5 copay for Tier 1 preferred generic drugs and Tier 5 specialty drugs at standard pharmacies or through standard mail. Standard generic drugs carry a $30 copay, while Tier 3 preferred brands and Tier 4 non-preferred drugs require a 40% and 33% coinsurance, respectively. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, beneficiaries who qualify for the full low-income subsidy, also known as Extra Help, will have no cost for their Part D coverage.
Additional Benefits
The Alignment Health Heart & Diabetes (HMO C-SNP) plan offers comprehensive medical coverage with affordable out-of-pocket costs, including no copay for primary care visits and a low $3 copay for specialist appointments. For hospital stays, members pay a $100 daily copay for the first three days of inpatient care and no copay for days four through ninety. Emergency room visits require a $70 copay, which is waived if admitted, while urgently needed services require no copay. The plan also features valuable everyday benefits, such as routine hearing and vision exams with no deductible, plus a $200 annual allowance for eyewear. Dental care is available with no coinsurance and copays starting at $15, while skilled nursing facility stays have no copay for the first 31 days. Additionally, members receive a $25 monthly reimbursement for over-the-counter items and a meal benefit for chronic conditions.
Inpatient Hospital See details
Alignment Health Heart & Diabetes (HMO C-SNP) partially covers inpatient hospital services, with acute care requiring a $100 daily copay for days 1 through 3 and no copay for days 4 through 90, and psychiatric care requiring a $250 copay, both with no coinsurance. Upgrades and non-Medicare-covered stays are not covered under these benefits.
Outpatient Services See details
Alignment Health Heart & Diabetes (HMO C-SNP) covers outpatient services, including outpatient hospital, observation, ambulatory surgical center, blood, and substance abuse services, typically requiring prior authorization and a doctor referral. Outpatient substance abuse sessions require a $15 copay and no coinsurance, while outpatient blood services have no deductible.
Partial Hospitalization See details
Alignment Health Heart & Diabetes (HMO C-SNP) covers partial hospitalization services with a $15.00 copay and no coinsurance. A doctor referral and prior authorization are required to receive this care.
Ambulance and Transportation Services See details
Alignment Health Heart & Diabetes (HMO C-SNP) partially covers ambulance and transportation services, requiring a $100 copay and no coinsurance for ground and air ambulance services. The plan covers up to 50 one-way medical transport trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Alignment Health Heart & Diabetes (HMO C-SNP) with a $70 copay and no coinsurance, with the copay waived if admitted to the hospital within 48 hours. Urgently needed services require no copay and no coinsurance, while worldwide emergency services are partially covered up to a $25,000 maximum, as worldwide emergency transportation is not covered.
Primary Care See details
Alignment Health Heart & Diabetes (HMO C-SNP) covers primary care, occupational therapy, and podiatry with no copay and no coinsurance, whereas specialist visits require a $3 copay and no coinsurance, and opioid treatment has 20% coinsurance and no copay. Chiropractic services are partially covered, with routine chiropractic care not covered, while mental health and psychiatric benefits cover some services, but individual and group sessions are not covered.
Preventive Services See details
Preventive services are partially covered by Alignment Health Heart & Diabetes (HMO C-SNP) with no copay and no coinsurance for covered benefits, which include annual physical exams, caregiver support, and diabetes self-management training. However, several sub-services are not covered, including health education, weight management, alternative therapies, therapeutic massage, adult day health, counseling, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, nutritional benefits, palliative care, smoking cessation sessions, disease management, telemonitoring, remote access technologies, and home safety devices.
Hearing Services See details
Hearing services are partially covered by Alignment Health Heart & Diabetes (HMO C-SNP), which provides one routine hearing exam and one fitting or evaluation for hearing aids annually with no deductible, though specific copay and coinsurance details are not specified. Prescription hearing aids and over-the-counter (OTC) hearing aids are not covered under this plan.
Vision Services See details
Vision services are covered by Alignment Health Heart & Diabetes (HMO C-SNP) with no deductible, although specific copay and coinsurance information is not specified. The plan provides one routine eye exam per year and a $200 annual maximum allowance for eyewear, including contacts, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Alignment Health Heart & Diabetes (HMO C-SNP), featuring no coinsurance for covered services and copays ranging from $15 to $570 for comprehensive care. 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 by Alignment Health Heart & Diabetes (HMO C-SNP) with prior authorization, requiring no copay and no coinsurance to 20% coinsurance for chemotherapy, radiation, and other Part B drugs. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Alignment Health Heart & Diabetes (HMO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Medical Equipment See details
Alignment Health Heart & Diabetes (HMO C-SNP) covers durable medical equipment (DME) with no copay and 0% to 20% coinsurance, though prior authorization is required. Other medical equipment benefits, including prosthetic devices, medical supplies, diabetic supplies, and therapeutic shoes or inserts, are not covered.
Diagnostic and Radiological Services See details
Alignment Health Heart & Diabetes (HMO C-SNP) diagnostic services are not covered, while its radiological services are partially covered. Covered therapeutic radiological services require no copay and a 20% coinsurance, but diagnostic radiological services, outpatient X-ray services, diagnostic procedures, and lab services are not covered.
Home Health Services See details
Home Health Services are covered under the Alignment Health Heart & Diabetes (HMO C-SNP) plan, requiring a doctor referral and prior authorization. Information regarding specific copay and coinsurance costs for these services is not specified in this benefit summary.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Alignment Health Heart & Diabetes (HMO C-SNP) plan. While the category is technically listed, none of the sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are covered in practice.
Skilled Nursing Facility (SNF) See details
Alignment Health Heart & Diabetes (HMO C-SNP) partially covers skilled nursing facility (SNF) services with no coinsurance, featuring no copay for days 1 to 31 and a $50 daily copay for days 32 to 100. Prior authorization and a doctor referral are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Alignment Health Heart & Diabetes (HMO C-SNP) partially covers other services, featuring a $25 monthly reimbursement for over-the-counter items, a meal benefit for chronic conditions, and digital health technology support with no copay or coinsurance. Acupuncture and highly integrated dual-eligible SNP services are not covered.
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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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