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Alignment Health AllCare Preferred (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health AllCare Preferred (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health AllCare Preferred (HMO) in 2026, please refer to our full plan details page.
Alignment Health AllCare Preferred (HMO) is a HMO plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in Stanislaus. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Alignment Health AllCare Preferred (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 AllCare Preferred (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 AllCare Preferred (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 $1999.00 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 AllCare Preferred (HMO) plan features an Enhanced Alternative drug benefit with no prescription drug deductible. For a 30-day supply at standard pharmacies or through standard mail, you will pay a $10 copay for preferred generics, a $40 copay for standard generics, and a $93 copay for preferred brand drugs. Non-preferred drugs require a 33% coinsurance, while specialty tier drugs have a $5 copay. These initial coverage rates apply until your total yearly drug costs reach $2,100.00. After reaching this limit, you enter the catastrophic coverage phase where you will pay nothing for covered Medicare Part D prescription drugs.
Additional Benefits
The Alignment Health AllCare Preferred (HMO) plan offers comprehensive coverage for essential medical services, typically featuring low out-of-pocket costs and no coinsurance on many key benefits. Outpatient hospital visits require a $100 copay, emergency services have a $75 copay, and urgent care is available with no copay. For inpatient psychiatric care, members pay a $120 copay for days 1 through 10, and no copay for days 11 through 90. This plan also includes key supplemental benefits, such as routine hearing and preventive dental care with no copays, plus a $200 annual eyewear allowance. Members can access up to 26 one-way transportation trips to approved locations and a $40 monthly over-the-counter reimbursement. However, some services like cardiac rehabilitation and diagnostic laboratory tests are not covered under this plan.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by Alignment Health AllCare Preferred (HMO), as upgrades and non-Medicare-covered stays are not covered. Psychiatric stays require a $120 copay for days 1 through 10, no copay for days 11 through 90, and no coinsurance, while prior authorization and doctor referrals are required for all inpatient services.
Outpatient Services See details
Alignment Health AllCare Preferred (HMO) covers outpatient services with no coinsurance, featuring a $100 copay for outpatient hospital and ambulatory surgical center services, and a $20 copay for outpatient substance abuse sessions. Outpatient blood services are covered with no deductible, no copay, and no coinsurance, though prior authorization and a doctor referral are required for most services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Alignment Health AllCare Preferred (HMO), requiring both prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Alignment Health AllCare Preferred (HMO), featuring a $50 copay and no coinsurance for ground and air ambulance services. Transportation is partially covered, offering up to 26 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Alignment Health AllCare Preferred (HMO) covers emergency services with a $75 copay and no coinsurance, and urgently needed services with no copay and no coinsurance. Worldwide emergency services are partially covered up to a $7,500 maximum limit, which excludes worldwide emergency transportation.
Primary Care See details
Primary care benefits are covered by Alignment Health AllCare Preferred (HMO), though some services are covered but individual and group sessions for mental health specialty services are not covered. Covered psychiatric services require a $20 copay with no coinsurance, while opioid treatment program services require 20% coinsurance with no copay.
Preventive Services See details
Preventive services are partially covered by Alignment Health AllCare Preferred (HMO) with no copay and no coinsurance for covered benefits like annual physical exams, glaucoma screenings, and diabetes self-management. Uncovered services under this plan include health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, tobacco cessation counseling, disease management, telemonitoring, remote access technologies, home safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Alignment Health AllCare Preferred (HMO), which excludes OTC hearing aids and prescription hearing aids for the inner ear, outer ear, and over the ear. Covered routine hearing exams and fitting evaluations have no copay, coinsurance, or deductible, while covered prescription hearing aids (all types) require a copay of $195 to $1,750 and no coinsurance.
Vision Services See details
Vision Services are partially covered by Alignment Health AllCare Preferred (HMO), which features no deductible for eye exams or eyewear but does not cover eyewear upgrades. The plan covers one routine eye exam and provides a $200 annual allowance for eyeglasses or contact lenses, though specific copay and coinsurance information is not specified.
Dental Services See details
Alignment Health AllCare Preferred (HMO) partially covers dental services, offering preventive care like exams and cleanings with no copays or coinsurance. Covered comprehensive treatments require copays ranging from $15 to $570 and no coinsurance, while adjunctive general services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Alignment Health AllCare Preferred (HMO) and require prior authorization, with no copay and a coinsurance ranging from no coinsurance to 20% for chemotherapy, radiation, and other Part B drugs. Medicare Part B insulin drugs are covered with a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Alignment Health AllCare Preferred (HMO) plan with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to access this benefit.
Medical Equipment See details
Alignment Health AllCare Preferred (HMO) covers medical equipment with no copays, featuring no coinsurance to 20% coinsurance for Durable Medical Equipment (DME) and a 20% coinsurance for prosthetics, medical supplies, and diabetic shoes. Diabetic equipment is partially covered, as diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Alignment Health AllCare Preferred (HMO) offers partial coverage for diagnostic and radiological services, though diagnostic services (including lab services and diagnostic procedures) are not covered in practice. Therapeutic radiological services are covered with no copay and a 20% coinsurance, while diagnostic radiological and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by the Alignment Health AllCare Preferred (HMO) plan, requiring prior authorization and a doctor referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Alignment Health AllCare Preferred (HMO) plan, with no coverage provided for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Alignment Health AllCare Preferred (HMO) covers Skilled Nursing Facility (SNF) services with no copay for days 1 to 20, a $50 daily copay for days 21 to 100, and no coinsurance. Prior authorization and a doctor referral are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Alignment Health AllCare Preferred (HMO), including unlimited acupuncture, a $40 monthly over-the-counter reimbursement, digital health technology support, and home meal benefits with no copay or coinsurance details specified. Highly integrated dual-eligible SNP services and certain CMS-listed over-the-counter drugs are not covered.
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