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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 2026, 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 2026.
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 $0.00. 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 a $615.00 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 $9250.00 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) Medicare prescription drug plan features an annual drug deductible of $615.00. During the initial coverage phase, you will pay a 25% coinsurance at standard pharmacies and standard mail services for Tier 1 preferred generic, Tier 2 standard generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs. There is no copay for Tier 5 specialty drugs under this plan. If you qualify for the Low-Income Subsidy, also known as Extra Help, your costs may be reduced to $0.00. Once your total out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase where you pay nothing for covered Medicare Part D prescription drugs.
Additional Benefits
The Alignment Health CalPlusDuals (HMO D-SNP) plan offers comprehensive coverage with many services requiring no copay, though coinsurance typically applies. For outpatient care, partial hospitalization, diagnostics, dialysis, and emergency services, members will pay no copay and a 20% coinsurance. Primary care visits, preventive services, and home health care are fully covered with no copay or coinsurance, while specialist visits carry a 10% coinsurance. This plan also features valuable supplemental benefits, including vision coverage with no deductible and a $500 eyewear allowance every two years, alongside hearing coverage that includes two annual hearing aids. Dental care is available with no copay and 0% to 20% coinsurance depending on the service. Additionally, members benefit from up to 50 one-way transportation trips, 24 acupuncture treatments, and an $80 monthly over-the-counter allowance at no cost.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Alignment Health CalPlusDuals (HMO D-SNP), requiring prior authorization and doctor referrals for both acute and psychiatric care. Patients are responsible for Medicare-defined copays and coinsurance, but the plan does not cover additional days, non-Medicare-covered stays, or hospital upgrades.
Outpatient Services See details
Outpatient services are covered by Alignment Health CalPlusDuals (HMO D-SNP) with no copay and a 20% coinsurance. This benefit includes outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services, all of which require prior authorization and a doctor referral.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Alignment Health CalPlusDuals (HMO D-SNP) with no copay and a 20% coinsurance. These services require a doctor referral and prior authorization.
Ambulance and Transportation Services See details
Alignment Health CalPlusDuals (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered, providing up to 50 one-way medical transport trips per year to plan-approved health-related locations, while transportation to any other health-related location is not covered.
Emergency Services See details
Alignment Health CalPlusDuals (HMO D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay. Worldwide emergency and urgent care are also covered up to a $50,000 limit, though the worldwide benefit is only partially covered as worldwide emergency transportation is not covered.
Primary Care See details
Alignment Health CalPlusDuals (HMO D-SNP) partially covers primary care services with no copays for all covered benefits, though podiatry services are not covered. There is no coinsurance for primary care physician visits, chiropractic care, and telehealth, while specialist visits carry a 10% coinsurance, and therapy, mental health, psychiatric, and opioid treatment services carry a 20% coinsurance.
Preventive Services See details
Alignment Health CalPlusDuals (HMO D-SNP) covers preventive services, including annual physical exams, kidney disease education, and Medicare-covered zero-dollar preventive services with no copay or coinsurance. Additional preventive services are partially covered, but health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy 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 are not covered.
Hearing Services See details
Hearing services are partially covered by Alignment Health CalPlusDuals (HMO D-SNP) with no deductible, although copay and coinsurance details are not specified. Covered benefits include one routine exam, one fitting evaluation, and up to two prescription hearing aids annually, but OTC hearing aids and prescription hearing aids for the inner, outer, and over the ear are not covered.
Vision Services See details
Vision services are covered by Alignment Health CalPlusDuals (HMO D-SNP) with no deductible, including one routine eye exam annually and a $500 combined maximum benefit for eyewear every two years. This eyewear coverage applies to contact lenses, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Alignment Health CalPlusDuals (HMO D-SNP), featuring a 20% coinsurance and no copay for Medicare-covered dental care, and no copay or coinsurance for other covered services. Adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered, and orthodontic services are subject to a $300 maximum benefit limit every three months.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Alignment Health CalPlusDuals (HMO D-SNP) with prior authorization, featuring 0% to 20% coinsurance and no copay for chemotherapy, radiation, and other Medicare Part B drugs. Covered Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Alignment Health CalPlusDuals (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Medical Equipment See details
Alignment Health CalPlusDuals (HMO D-SNP) partially covers medical equipment, requiring a 20% coinsurance and no copay for durable medical equipment, prosthetics, and diabetic therapeutic shoes. Diabetic supplies are not covered under this plan, and prior authorization is required for most covered services.
Diagnostic and Radiological Services See details
Alignment Health CalPlusDuals (HMO D-SNP) partially covers diagnostic and radiological services, with covered services requiring no copay and a 20% coinsurance. Covered options include diagnostic procedures, lab services, and therapeutic radiological services, while diagnostic radiological services and outpatient x-ray services are not covered.
Home Health Services See details
Home Health Services are covered by Alignment Health CalPlusDuals (HMO D-SNP) with no copay or coinsurance. Prior authorization and a doctor referral are required to access these benefits.
Cardiac Rehabilitation Services See details
Alignment Health CalPlusDuals (HMO D-SNP) does not cover Cardiac Rehabilitation Services, as all sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered. Since there is no coverage for these services, members have no copay or coinsurance responsibilities.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered under Alignment Health CalPlusDuals (HMO D-SNP) with Medicare-defined copays and coinsurance, requiring prior authorization, a doctor referral, and a prior three-day inpatient hospital stay. Additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Alignment Health CalPlusDuals (HMO D-SNP), which excludes Dual Eligible SNPs with Highly Integrated Services. Covered benefits include up to 24 acupuncture treatments per year, an $80 monthly over-the-counter allowance, and meal benefits, all offered with no copay and no coinsurance.
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