A non-government entity
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 2025, 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 2025.
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 $790.00 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 (HMO C-SNP)
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 Heart & Diabetes (HMO C-SNP) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and pharmacy. For example, you will have no copay for preferred generic drugs at a standard or mail pharmacy. For standard generic drugs, the copay is $30.00, and for preferred brand drugs, it is $100.00. Non-preferred drugs have a 33% coinsurance. The specialty tier has a $5.00 copay. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Alignment Health Heart & Diabetes (HMO C-SNP) plan offers a range of benefits with varying cost-sharing. Many primary care and preventive services, including vision and hearing exams, have no copay. Dental services are covered with copays ranging from $10 to $570 depending on the service. The plan covers inpatient and outpatient services, as well as ambulance, emergency, and transportation services with copays ranging from $0 to $125. Home health services, skilled nursing facilities, and dialysis services are covered with no copay or a coinsurance, while other services like over-the-counter items and a meal benefit are also available.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute, with additional days, and Inpatient Hospital Psychiatric, with additional days, all of which require prior authorization and a doctor's referral. Inpatient Hospital Psychiatric has a copay of $250 for a Medicare-covered stay; however, Inpatient Hospital-Acute does not list the cost sharing. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services, are covered. Individual and group sessions for outpatient substance abuse have a copay of $15, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Alignment Health Heart & Diabetes (HMO C-SNP) plan, with a $15 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a copay of $100 and $125, respectively. Transportation services to a plan-approved health-related location are covered for up to 50 one-way trips per year, while transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Alignment Health Heart & Diabetes (HMO C-SNP) plan. Emergency Services have a $20 copay and no coinsurance, while Urgently Needed Services have no copay or coinsurance. Worldwide Emergency Services have a maximum plan benefit coverage of $25,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health Heart & Diabetes (HMO C-SNP) plan's primary care benefit covers physician services, occupational therapy, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services, with no copay and no coinsurance for occupational therapy and physical therapy/speech-language pathology. Chiropractic services, and mental health and psychiatric individual and group sessions are partially covered, as are podiatry services, with a maximum of 12 visits per year. Opioid treatment program services have a 20% coinsurance.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and other preventive services, are covered with no copay. Additional services like Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, 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 Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered, with one visit allowed per year for each service. Prescription hearing aids and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
The Alignment Health Heart & Diabetes (HMO C-SNP) plan covers vision services, including eye exams and eyewear, with no deductible. Routine eye exams are covered once per year. Eyewear has a combined maximum plan benefit coverage of $200 per year and includes contact lenses (1 pair per year), eyeglasses (lenses and frames, 1 pair per year), eyeglass lenses (1 pair per year), eyeglass frames (1 frame per year), and upgrades.
Dental Services See details
The Alignment Health Heart & Diabetes (HMO C-SNP) plan covers a variety of dental services including 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. Restorative services have a copay of $20-$400, endodontics has a copay of $25-$350, periodontics has a copay of $15-$550, prosthodontics (removable) has a copay of $20-$570, prosthodontics (fixed) has a copay of $40-$400, and oral and maxillofacial surgery has a copay of $25-$250, while 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 the Alignment Health Heart & Diabetes (HMO C-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay and coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Alignment Health Heart & Diabetes (HMO C-SNP) plan. You are responsible for a 20% coinsurance, and prior authorization and a doctor referral are required.
Medical Equipment See details
Medical Equipment is covered by Alignment Health Heart & Diabetes (HMO C-SNP), with Durable Medical Equipment (DME) subject to a 0-20% coinsurance and requiring prior authorization, but Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit has no copay or coinsurance, but Prosthetic Devices and Medical Supplies are not covered. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Alignment Health Heart & Diabetes (HMO C-SNP) plan, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered. There is no copay for the covered services.
Home Health Services See details
Home Health Services are covered by the Alignment Health Heart & Diabetes (HMO C-SNP) plan with no copay and no coinsurance, but require authorization and a referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but not covered in practice, as Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor's referral. You will have no copay for days 1-31, and a $50 copay for days 32-100. Additional days beyond Medicare-covered, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Alignment Health Heart & Diabetes (HMO C-SNP) plan covers Over-the-Counter (OTC) items with a maximum benefit of $25.00 each month, and also covers a meal benefit. Acupuncture, 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.
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