A non-government entity
Alignment Health Sutter Advantage +More (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Sutter Advantage +More (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health Sutter Advantage +More (HMO) in 2026, please refer to our full plan details page.
Alignment Health Sutter Advantage +More (HMO) is a HMO plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in Santa Cruz County. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Alignment Health Sutter Advantage +More (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 Sutter Advantage +More (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 Sutter Advantage +More (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $59.00. 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 $4900.00 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 Sutter Advantage +More (HMO)
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 Sutter Advantage +More (HMO) plan offers an Enhanced Alternative drug benefit with no prescription drug deductible. The standard Part D premium is $59.00, which is reduced to $47.00 for individuals qualifying for the low-income subsidy. Under standard retail and mail-order options, you will pay a $5.00 copay for Tier 1 preferred generics and Tier 5 specialty drugs, a $40.00 copay for Tier 2 standard generics, 32% coinsurance for Tier 3 preferred brands, and 33% coinsurance for Tier 4 non-preferred drugs. These cost-sharing rates apply during the initial coverage phase until your total drug costs reach $2,100.00. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs.
Additional Benefits
The Alignment Health Sutter Advantage +More (HMO) plan offers affordable medical coverage with a low $5 copay for primary care visits, a $25 copay for specialists, and no copay for preventive services. For emergency situations, urgent care requires no copay, while emergency room visits carry a $120 copay. Inpatient hospital stays are covered with a $275 daily copay for the first five days and no copay for subsequent days. This plan also includes essential everyday benefits, featuring no copay for preventive dental care and routine hearing exams, alongside a $100 eyewear allowance every two years. Members also benefit from a $15 monthly reimbursement allowance for over-the-counter items. However, it is important to note that certain services, such as routine transportation and cardiac rehabilitation, are not covered under this plan.
Inpatient Hospital See details
Alignment Health Sutter Advantage +More (HMO) partially covers inpatient hospital benefits, as upgrades and non-Medicare-covered stays for acute and psychiatric care are not covered. Acute stays require a $275 copay for days 1 to 5 and no copay for days 6 to 90, while psychiatric stays require a $120 copay for days 1 to 10 and no copay for days 11 to 90, with no coinsurance for either service.
Outpatient Services See details
Alignment Health Sutter Advantage +More (HMO) covers outpatient services with no coinsurance, requiring a $325 copay for outpatient hospital services and a $100 copay for ambulatory surgical center services. Outpatient substance abuse sessions have a $40 copay, and outpatient blood services are covered with no deductible.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Alignment Health Sutter Advantage +More (HMO) with a $55 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these services.
Ambulance and Transportation Services See details
Alignment Health Sutter Advantage +More (HMO) partially covers Ambulance and Transportation Services, offering ground and air ambulance services for a $250 copay and no coinsurance, which is waived if you are admitted to the hospital. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by Alignment Health Sutter Advantage +More (HMO) with a $120 copay and no coinsurance, while urgently needed services require no copay and no coinsurance. Worldwide emergency and urgent care are also covered up to a $7,500 maximum limit, although worldwide emergency transportation is not covered.
Primary Care See details
Alignment Health Sutter Advantage +More (HMO) offers primary care physician visits for a $5 copay and specialist visits for a $25 copay, both with no coinsurance. This benefit is partially covered, as routine chiropractic care, podiatry services, and mental health specialty services are not covered. Psychiatric services require a $40 copay and no coinsurance, while opioid treatment has a 20% coinsurance and no copay.
Preventive Services See details
Preventive services are partially covered by Alignment Health Sutter Advantage +More (HMO), offering Medicare-covered zero-dollar preventive services and annual physical exams with no copay and no coinsurance. While memory fitness and kidney disease education are covered, other supplemental benefits such as health education, weight management, and in-home support are not covered.
Hearing Services See details
Hearing services are partially covered by Alignment Health Sutter Advantage +More (HMO), which covers one annual routine hearing exam and one fitting evaluation with no deductible. While prescription hearing aids are listed as covered, no actual prescription models (including inner ear, outer ear, or over-the-ear) or over-the-counter hearing aids are covered in practice.
Vision Services See details
Alignment Health Sutter Advantage +More (HMO) partially covers vision services with no deductibles, though copay and coinsurance information is not specified. The plan includes one routine eye exam every year and a $100 combined eyewear allowance every two years, but eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Alignment Health Sutter Advantage +More (HMO), with no copay or coinsurance for preventive care such as exams, cleanings, fluoride, and x-rays. Covered comprehensive services require copays ranging from $15 to $570 with no coinsurance, while adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Alignment Health Sutter Advantage +More (HMO) covers Home Infusion bundled Services with prior authorization required. Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Alignment Health Sutter Advantage +More (HMO) with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to receive these benefits.
Medical Equipment See details
Alignment Health Sutter Advantage +More (HMO) covers medical equipment with no copays, though diabetic equipment is only partially covered because diabetic supplies are not covered. Covered services require prior authorization, with durable medical equipment carrying no coinsurance to 20% coinsurance, and prosthetic devices, medical supplies, and diabetic shoes requiring 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Alignment Health Sutter Advantage +More (HMO), as diagnostic procedures and tests and lab services are not covered. Covered benefits include diagnostic radiological services for a $150 copay and no coinsurance, therapeutic radiological services for a 20% coinsurance and no copay, and outpatient X-rays for a $15 copay and no coinsurance.
Home Health Services See details
Home Health Services are covered under the Alignment Health Sutter Advantage +More (HMO) plan, requiring both a doctor referral and prior authorization.
Cardiac Rehabilitation Services See details
Alignment Health Sutter Advantage +More (HMO) does not cover Cardiac Rehabilitation Services, meaning there is no copay or coinsurance as cardiac, intensive cardiac, pulmonary, and SET for PAD services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Alignment Health Sutter Advantage +More (HMO) partially covers Skilled Nursing Facility (SNF) services, requiring a doctor referral and prior authorization. Covered days 1 to 20 require a $10 daily copay, days 21 to 62 require a $160 daily copay, and days 63 to 100 have no copay, with no coinsurance required for any of these stays; however, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Alignment Health Sutter Advantage +More (HMO) partially covers Other Services with no copay or coinsurance, providing digital health technology support and a $15 monthly reimbursement allowance for over-the-counter items. Acupuncture, meal benefits, and Dual Eligible SNPs with Highly Integrated 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