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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 2026, 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 2026.
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:
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Drug Coverage
The Alignment Health Platinum + Instacart (HMO-POS) plan features an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, you will pay a standard copay of $3.00 for preferred generics, $30.00 for standard generics, $75.00 for preferred brands, and $5.00 for specialty drugs at standard pharmacies or through standard mail. Non-preferred drugs require a 33% coinsurance, and these rates apply until your total combined drug costs reach $2,100.00. After your yearly out-of-pocket drug costs hit $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D prescription drugs. Furthermore, beneficiaries who qualify for the low-income subsidy program will see their Part D premium reduced to no cost.
Additional Benefits
The Alignment Health Platinum + Instacart (HMO-POS) plan offers affordable medical coverage with low out-of-pocket costs, featuring no copay and no coinsurance for inpatient hospital stays on days 1 through 3 and 8 through 90. Outpatient hospital services require an $85 copay with no coinsurance, while emergency room visits carry a $90 copay that is waived if you are admitted. Additionally, the plan covers Medicare-covered preventive services and urgently needed care with no copay and no coinsurance. For supplemental care, members receive a $2,000 annual dental benefit, a $300 eyewear allowance with no deductible, and coverage for up to two prescription hearing aids per year. The plan also covers up to 24 one-way medical transportation trips and provides a $30 monthly over-the-counter allowance with no copay. Furthermore, skilled nursing facility stays are covered with no copay or coinsurance for the first 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by Alignment Health Platinum + Instacart (HMO-POS), as upgrades and non-Medicare-covered stays are not covered. Covered acute care has no coinsurance, with no copay for days 1–3 and 8–90 and a $50 daily copay for days 4–7, while psychiatric care has no coinsurance, a $120 daily copay for days 1–10, and no copay for days 11–90.
Outpatient Services See details
Outpatient services are covered by Alignment Health Platinum + Instacart (HMO-POS) with no coinsurance, featuring an $85 copay for outpatient hospital services and a $50 copay for outpatient substance abuse sessions. Prior authorization and doctor referrals are required for most of these services, which also include covered ambulatory surgical center, observation, and outpatient blood benefits.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the Alignment Health Platinum + Instacart (HMO-POS) plan with a $55.00 copay and no coinsurance. Receiving these covered services requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Alignment Health Platinum + Instacart (HMO-POS) covers ground and air ambulance services with a $75 copay and no coinsurance. Transportation services are partially covered, providing up to 24 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
Alignment Health Platinum + Instacart (HMO-POS) partially covers emergency services, as worldwide emergency transportation is not covered. Emergency room visits require a $90 copay and no coinsurance (waived if admitted within 48 hours), urgently needed services have no copay and no coinsurance, and covered worldwide emergency and urgent services require a $50 copay and no coinsurance up to a $100,000 maximum limit.
Primary Care See details
Primary Care benefits are partially covered by Alignment Health Platinum + Instacart (HMO-POS), though podiatry, routine chiropractic care, and mental health specialty sessions are not covered. Covered psychiatric services require a $20 copay with no coinsurance, while opioid treatment program services require a 20% coinsurance with no copay.
Preventive Services See details
Preventive services are partially covered by Alignment Health Platinum + Instacart (HMO-POS), offering no copay and no coinsurance for Medicare-covered zero-dollar preventive services. While annual exams, in-home support, and caregiver training are covered, the plan does not cover health education, in-home safety assessments, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Alignment Health Platinum + Instacart (HMO-POS), which offers one annual routine exam and fitting evaluation with no deductible. The plan covers up to two prescription hearing aids (all types) per year with a copay ranging from $195.00 to $1,750.00 and no coinsurance, but OTC hearing aids and inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Vision services are partially covered by Alignment Health Platinum + Instacart (HMO-POS), featuring no deductibles, one routine eye exam per year, and a $300 annual limit for eyewear, though upgrades are not covered. Specific copay and coinsurance details for these covered services are not specified in the plan.
Dental Services See details
Dental services are partially covered by Alignment Health Platinum + Instacart (HMO-POS) up to a maximum annual benefit of $2,000. Covered services include oral exams, cleanings, x-rays, fluoride, restorative services, endodontics, periodontics, prosthodontics, and oral surgery, while adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Alignment Health Platinum + Instacart (HMO-POS) covers home infusion bundled services, which require prior authorization. Medicare Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%, while chemotherapy, radiation, and other Part B drugs have no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by the Alignment Health Platinum + Instacart (HMO-POS) plan with a $30 copay and no coinsurance. Prior authorization and a doctor referral are required to receive this covered benefit.
Medical Equipment See details
Alignment Health Platinum + Instacart (HMO-POS) covers medical equipment with no copay, though prior authorization is required. Durable medical equipment ranges from no coinsurance to 20% coinsurance, while prosthetics, medical supplies, and diabetic therapeutic shoes require 20% coinsurance. Diabetic equipment is partially covered, as diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Alignment Health Platinum + Instacart (HMO-POS) partially covers diagnostic and radiological services, offering therapeutic radiological services with a 20% coinsurance and no copay. Diagnostic procedures, lab services, diagnostic radiological services, and outpatient X-ray services are not covered.
Home Health Services See details
Home health services are covered by the Alignment Health Platinum + Instacart (HMO-POS) plan, requiring prior authorization and a doctor referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Alignment Health Platinum + Instacart (HMO-POS) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Alignment Health Platinum + Instacart (HMO-POS) partially covers Skilled Nursing Facility (SNF) care, requiring prior authorization and a doctor referral. There is no copay and no coinsurance for days 1 to 20, followed by a $50 daily copay and no coinsurance for days 21 to 100, though additional days beyond Medicare-covered services are not covered.
Other Services See details
Alignment Health Platinum + Instacart (HMO-POS) partially covers Other Services, as acupuncture and dual eligible SNPs with highly integrated services are not covered. Covered benefits include meal benefits, digital health technology support, and a $30 monthly over-the-counter reimbursement with no copay or coinsurance, while personalized health risk screenings require a $75 copay and no coinsurance.
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