A non-government entity
Alignment Health Platinum + Instacart (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Platinum + Instacart (HMO-POS). 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-POS) in 2025, please refer to our full plan details page.
Alignment Health Platinum + Instacart (HMO-POS) is a HMO-POS plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in San Diego, Marin, San Francisco. 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-POS) 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-POS).
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-POS), 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 $998.00 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 Platinum + Instacart (HMO-POS)
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 Platinum + Instacart (HMO-POS) plan has an enhanced alternative drug benefit. The plan has no deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions, with the amount depending on the drug tier and pharmacy. For example, you will pay a $3 copay for preferred generic drugs at a standard pharmacy, and a $75 copay for preferred brand drugs at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Alignment Health Platinum + Instacart (HMO-POS) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays depending on the specific service. This plan also covers emergency services, ambulance services, and a variety of primary care and preventive services. Dental, vision, and hearing services are covered, with copays and annual maximums for certain services. Additional benefits include home health services, skilled nursing facility care, and home infusion. The plan also provides coverage for medical equipment, diagnostic services, and dialysis services. Other notable benefits include coverage for acupuncture, over-the-counter items, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both requiring prior authorization and a doctor referral. For Inpatient Hospital-Acute, there is no copay for days 1-3 and 8-90, and a $50 copay for days 4-7. For Inpatient Hospital Psychiatric, there is a $120 copay for days 1-10 and no copay for days 11-90. Additional days are covered for Inpatient Hospital-Acute, and 40 additional days are covered for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a $85 copay, while individual and group sessions for outpatient substance abuse have a copay between $50 and $50.
Partial Hospitalization See details
Partial Hospitalization is covered by the Alignment Health Platinum + Instacart (HMO-POS) plan, requiring prior authorization and a doctor's referral. This benefit has a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Alignment Health Platinum + Instacart (HMO-POS) plan. Ground and air ambulance services have a $75 copay, and there is no coinsurance. Transportation services to a plan-approved health-related location are covered for 24 one-way trips per year.
Emergency Services See details
Emergency Services are covered with a $90 copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $50 copay and no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health Platinum + Instacart (HMO-POS) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Individual and group sessions for psychiatric services have a $20 copay, while opioid treatment program services have a 20% coinsurance. Occupational therapy and physical therapy services have no copay or coinsurance.
Preventive Services See details
The Alignment Health Platinum + Instacart (HMO-POS) plan covers various preventive services, including Medicare-covered services, annual physical exams, and additional preventive services, though some services like health education, in-home safety assessments, and others are not covered. The plan also covers Personal Emergency Response Systems, In-Home Support Services, Support for Caregivers of Enrollees (with a maximum benefit of $300 per year), and Fitness Benefits. Additionally, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas (with prior authorization), Digital Rectal Exams, and EKGs following Welcome Visits are covered.
Hearing Services See details
Hearing services include routine hearing exams and fitting/evaluation for hearing aids, each covered once per year. Prescription hearing aids (all types) are covered with a copay between $195 and $1750. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The Alignment Health Platinum + Instacart (HMO-POS) plan covers vision services including routine eye exams with no copay, and eyewear including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum of $300 per year. Upgrades are not covered.
Dental Services See details
The Alignment Health Platinum + Instacart (HMO-POS) plan covers dental services, including oral exams for a $10 copay, dental x-rays for a $30 copay, prophylaxis (cleaning) for a $20 copay, and fluoride treatment for a $10 copay. This plan also covers restorative services with a copay ranging from $20 to $400, endodontics with a copay of $25 to $350, periodontics with a copay of $15 to $550, prosthodontics (removable) with a copay of $20 to $570, prosthodontics (fixed) with a copay of $40 to $400, and oral and maxillofacial surgery with a copay of $25 to $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, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with a doctor referral and prior authorization. You will pay a copay of $30.00.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, and Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered items. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered, with no copay for all services, 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%.
Home Health Services See details
Home Health Services are covered by the Alignment Health Platinum + Instacart (HMO-POS) 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 the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, with prior authorization and a doctor referral required. For days 1-20, there is no copay, and for days 21-100, the copay is $50. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Alignment Health Platinum + Instacart (HMO-POS) plan covers acupuncture with no copay, and also covers over-the-counter (OTC) items with a maximum of $30.00 per month, including nicotine replacement therapy and Naloxone, and a meal benefit for chronic illness or a medical condition requiring the enrollee to stay at home. Other services include personalized health risk screening with a $75.00 copay and a maximum benefit of $200.00 every two years, and digital health technology support. 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.
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