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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 2025, 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 2025.
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 has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. For example, generic drugs have a $10 copay at standard pharmacies, and brand name drugs have a $93 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, you will also pay $0 for your Part D drugs.
Additional Benefits
The Alignment Health AllCare Preferred (HMO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays depending on the specific service. The plan also includes coverage for primary care, preventive services, hearing and vision services, dental, and home health services. Additional benefits include ambulance and transportation services, emergency services, and access to medical equipment and home infusion services. The plan also offers coverage for other services like acupuncture, over-the-counter items, and meal benefits.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric stays, with some services not usually covered by Medicare plans. For Inpatient Hospital Psychiatric, you will pay a $120 copay for days 1-10, and no copay for days 11-90. Additional days for Inpatient Hospital Psychiatric are covered for 40 days. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered by the Alignment Health AllCare Preferred (HMO) plan. Outpatient substance abuse individual and group sessions have a copay of $20.00, and outpatient blood services have a three (3) pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the Alignment Health AllCare Preferred (HMO) plan. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Alignment Health AllCare Preferred (HMO) plan. Ground and air ambulance services have a $50 copay, and there is no coinsurance. Transportation services to a plan-approved health-related location are covered for 26 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered. Emergency Services have a $75 copay and no coinsurance, while Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Transportation is not covered. Worldwide Emergency Services has a maximum plan benefit coverage of $7,500.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic, Physician Specialist, Mental Health Specialty, Podiatry, Other Health Care Professional, Psychiatric, Additional Telehealth, and Opioid Treatment Program Services require prior authorization and a doctor referral. Individual and Group sessions for Mental Health Specialty Services are not covered. Individual and Group sessions for Psychiatric Services have a $20 copay. 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. Additional benefits include Personal Emergency Response System (PERS), In-Home Support Services, Support for Caregivers of Enrollees (with a maximum benefit of $300 per year for Caregiver Training), and Fitness Benefits for Memory Fitness, all of which are covered. Glaucoma Screening, Diabetes Self-Management Training, Digital Rectal Exams, and EKG following Welcome Visit are also covered. However, Health Education, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), 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 Services includes routine hearing exams and fitting/evaluation for hearing aids, each covered for one visit per year with no deductible. Prescription Hearing Aids (all types) are covered with a copay between $195 and $1750, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. OTC Hearing Aids are not covered.
Vision Services See details
The Alignment Health AllCare Preferred (HMO) plan covers vision services, including routine eye exams with one visit per year. It also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $200 per year, and one pair of each allowed annually.
Dental Services See details
The Alignment Health AllCare Preferred (HMO) plan covers a variety of dental services, including oral exams, dental x-rays, cleaning, and fluoride treatments. Restorative services have a copay of $20-$400, endodontics have a copay of $25-$350, periodontics have a copay of $15-$550, prosthodontics (removable) have a copay of $20-$570, prosthodontics (fixed) have a copay of $40-$400, and oral and maxillofacial surgery have a copay of $25-$250; 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, including Medicare Part B Insulin Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Alignment Health AllCare Preferred (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with a coinsurance between 0% and 20% and no copay, though Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit and Diabetic Therapeutic Shoes/Inserts are covered, both with a coinsurance of 20% and no copay, while Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under the Alignment Health AllCare Preferred (HMO) plan. While there is no copay for all services, Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered. Therapeutic Radiological Services are covered with a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Alignment Health AllCare Preferred (HMO) plan with no copay or coinsurance, but additional hours of care and personal care services are not covered. Authorization and referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically 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 for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Alignment Health AllCare Preferred (HMO) plan, but require prior authorization and a doctor's referral. There is no copay for days 1-20, and a $50 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Alignment Health AllCare Preferred (HMO) plan covers acupuncture with no copay, over-the-counter items with a $40 monthly maximum benefit, meal benefits for chronic illness or medical conditions, and digital health technology support with no maximum benefit. The plan does not cover 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.
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