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Alignment Health CalPlusDuals (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health CalPlusDuals (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health CalPlusDuals (HMO D-SNP) in 2025, please refer to our full plan details page.
Alignment Health CalPlusDuals (HMO D-SNP) is a HMO D-SNP plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in Northern and Southern California. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Alignment Health CalPlusDuals (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Alignment Health CalPlusDuals (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Alignment Health CalPlusDuals (HMO D-SNP).
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 CalPlusDuals (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.20. 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 a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $8850.00 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 CalPlusDuals (HMO D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy (LIS), you will pay $0.20 for each prescription. After the deductible, you will pay the costs for your drugs, but the exact costs for each tier and pharmacy are not listed. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Alignment Health CalPlusDuals (HMO D-SNP) plan offers a wide range of benefits, including coverage for inpatient and outpatient services, along with preventive care like annual physical exams with no copay. You'll find coverage for vision, dental, and hearing services, with copays and coinsurance varying depending on the service. The plan also provides coverage for ambulance and transportation services, emergency services, and home health services with no copay, as well as services such as acupuncture, and an over-the-counter (OTC) allowance. Be aware that some services, like certain hearing aids and vision upgrades, may have limitations or require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization and a doctor referral. Additional days, non-Medicare covered stays, and upgrades for Inpatient Hospital-Acute and Additional days and non-Medicare covered stays for 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. Outpatient hospital services, observation services, individual and group outpatient substance abuse sessions, and outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the Alignment Health CalPlusDuals (HMO D-SNP) plan, but requires prior authorization and a doctor referral. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location are covered for up to 50 one-way trips per year with no copay and medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Alignment Health CalPlusDuals (HMO D-SNP) plan. Emergency and Urgently Needed Services have a 20% coinsurance, and Worldwide Emergency Services has a maximum plan benefit coverage of $50,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health CalPlusDuals (HMO D-SNP) plan covers primary care physician services, chiropractic services (with a limit of 24 visits per year), occupational therapy services with 20% coinsurance, physician specialist services with 10% coinsurance, mental health specialty services with 20% coinsurance, and physical therapy and speech-language pathology services with 20% coinsurance. Podiatry services are not covered.
Preventive Services See details
The Alignment Health CalPlusDuals (HMO D-SNP) plan covers preventive services, including annual physical exams, with no copay. Additional services like Personal Emergency Response Systems, In-Home Support Services, Support for Caregivers, and Fitness Benefits are also covered. Some services, like Health Education, are not covered.
Hearing Services See details
Hearing Services includes coverage for hearing exams, routine hearing exams (1 per year), and fitting/evaluation for hearing aids (1 per year). Prescription hearing aids are covered, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams with a doctor referral, eyewear, and upgrades. Eyewear has a combined maximum benefit of $500 every two years, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are each limited to one every two years.
Dental Services See details
The Alignment Health CalPlusDuals (HMO D-SNP) plan covers Medicare Dental Services with 20% coinsurance. Other Dental Services include oral exams (1 visit every six months), dental x-rays (1 per year), prophylaxis (cleaning) (1 visit every six months), and fluoride treatment (1 visit per year). Orthodontic services are covered up to $300 every three months. Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are also covered. Adjunctive General Services, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Alignment Health CalPlusDuals (HMO D-SNP) plan, with a copay of $35 for Medicare Part B Insulin Drugs. Coinsurance information is available, but not specified in this summary.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Therapeutic Shoes/Inserts has a 20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Alignment Health CalPlusDuals (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have no copay, with a coinsurance of at most 20%, while 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 CalPlusDuals (HMO D-SNP) plan with no copay or coinsurance, but authorization and a referral are required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. Prior authorization is required, and there is a coinsurance for the covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered days or non-Medicare-covered stays. Prior authorization and a doctor referral are required, and you will be responsible for the Medicare-defined cost share for tier 1.
Other Services See details
The Alignment Health CalPlusDuals (HMO D-SNP) plan covers acupuncture with a limit of 24 treatments per year, and requires prior authorization and a doctor referral. Over-the-counter (OTC) items are covered with a maximum benefit of $80.00 per month, and the plan also offers a meal benefit for certain chronic illnesses and medical conditions. However, services such as Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many others are not covered.
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