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Alignment Health Harmony (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Harmony (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health Harmony (HMO) in 2025, please refer to our full plan details page.
Alignment Health Harmony (HMO) is a HMO plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in AL, SC, SF. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Alignment Health Harmony (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 Harmony (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 Harmony (HMO), 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 $3400.00 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 Harmony (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay varying copays or coinsurance depending on the drug tier and pharmacy used. For example, standard generic drugs have a $40 copay, while preferred brand drugs have a $100 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. This plan also offers a premium reduction if you qualify for the low-income subsidy (LIS), resulting in no cost for Part D drugs.
Additional Benefits
The Alignment Health Harmony (HMO) plan provides a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services have copays for hospital and ASC services. Primary care visits and preventive services are covered with no copay. The plan also covers hearing, vision, and dental services, with copays or maximum benefits for specific services. Other benefits include ambulance, transportation, emergency services, and home health services, with various copays or coinsurance. Additionally, the plan covers dialysis, medical equipment, and home infusion services.
Inpatient Hospital See details
Inpatient Hospital coverage with Alignment Health Harmony (HMO) includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $100 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will pay a $120 copay for days 1-10, and no copay for days 11-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional days for Inpatient Hospital Psychiatric are covered for up to 40 days, but Non-Medicare-covered Stay for Inpatient Hospital Psychiatric is not covered.
Outpatient Services See details
Outpatient services, including all outpatient hospital services, are covered with a $200 copay for outpatient hospital services and a $100 copay for Ambulatory Surgical Center (ASC) services. Outpatient substance abuse services are covered with a $40 copay for both individual and group sessions, and outpatient blood services are covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Alignment Health Harmony (HMO) plan, requiring prior authorization and a doctor referral. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including those not typically covered by Medicare, are covered by the Alignment Health Harmony (HMO) plan. Ground and air ambulance services have a $175 copay, with no coinsurance. Transportation Services to any health-related location are covered for 28 one-way trips per year.
Emergency Services See details
Emergency Services are covered by the Alignment Health Harmony (HMO) plan with a $100 copay, while Urgently Needed Services have no copay. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $20 copay, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health Harmony (HMO) plan covers primary care physician services, occupational therapy services, physician specialist services, and psychiatric services, with no copay or coinsurance for occupational therapy services and no coinsurance for physical therapy and speech-language pathology services. Individual and group psychiatric sessions have a $40 copay. The plan also covers additional telehealth benefits and opioid treatment program services with 20% coinsurance. However, routine chiropractic care, individual sessions for mental health specialty services, and podiatry services are not covered.
Preventive Services See details
Preventive services, including Medicare-covered services, an annual physical exam, and other preventive services are covered. Fitness benefits are covered, including memory fitness. However, health education, in-home safety assessment, personal emergency response system, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered. Glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit are also covered.
Hearing Services See details
Hearing services include routine hearing exams and fitting/evaluation for hearing aids, each covered for one visit per year. Prescription hearing aids are covered, with a copay between $195 and $1750 per hearing aid, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are also not covered.
Vision Services See details
The Alignment Health Harmony (HMO) plan covers vision services, including routine eye exams with no copay, and eyewear with a maximum plan benefit of $150 per year. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are also covered. However, upgrades are not covered.
Dental Services See details
The Alignment Health Harmony (HMO) plan covers a range of dental services, including oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments. Restorative services have a copay of $20-$400, endodontics have a copay of $25-$350, periodontics have a copay of $15-$550, prosthodontics (removable) have a copay of $20-$570, prosthodontics (fixed) have a copay of $40-$400, and oral and maxillofacial surgery have a copay of $25-$250. However, the plan does not cover adjunctive general services, maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%, while the other drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Alignment Health Harmony (HMO) plan, requiring prior authorization and a doctor's referral. The copay for dialysis services is $30.
Medical Equipment See details
Medical Equipment is covered by the Alignment Health Harmony (HMO) plan, including Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetic Devices and Medical Supplies with a 20% coinsurance. Diabetic Equipment is covered, but Diabetic Supplies are not covered, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Alignment Health Harmony (HMO) plan, however, Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered. Therapeutic Radiological Services are covered with a coinsurance of at most 20%, and Medicare-covered X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Alignment Health Harmony (HMO) plan with no copay and no coinsurance. 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. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Alignment Health Harmony (HMO), but require prior authorization and a doctor's referral. For days 1-20, there is no copay, but for days 21-100, there is a $100 copay; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes acupuncture, over-the-counter (OTC) items, and digital health technology support. Acupuncture is covered with no copay, and OTC items are covered up to $30 per month.
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