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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 2026, 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, SM. This plan received an overall rating of 4 out of 5 stars in 2026.
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
Alignment Health Harmony (HMO) offers an Enhanced Alternative drug benefit with no prescription drug deductible. For a 30-day supply at standard pharmacies or standard mail, you will pay a $3 copay for Tier 1 preferred generics, a $40 copay for Tier 2 standard generics, and a $100 copay for Tier 3 preferred brands. Tier 4 non-preferred drugs require a 33% coinsurance, while Tier 5 specialty tier drugs carry a $5 copay. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Beneficiaries who qualify for the low-income subsidy (LIS) can also reduce their Part D premium to $0.
Additional Benefits
The Alignment Health Harmony (HMO) plan offers comprehensive coverage for essential medical services with predictable out-of-pocket costs, including no coinsurance for inpatient hospital stays which require a daily copay of $100 for the first five days. Outpatient hospital services feature a $200 copay, while emergency room visits carry a $100 copay and urgent care services require no copay. Primary care visits and routine preventive services are also available to members with no copays or coinsurance. For specialized care, this plan provides dental, vision, and hearing benefits, including no copays for preventive dental cleanings, a $150 annual eyewear allowance, and routine hearing exams with no copay. Prescription hearing aids are covered with copays ranging from $195 to $1,750, and comprehensive dental treatments carry copays between $15 and $570. Additionally, members can take advantage of a $30 monthly over-the-counter allowance, 28 one-way transportation trips to plan-approved locations, and unlimited acupuncture services.
Inpatient Hospital See details
Alignment Health Harmony (HMO) partially covers inpatient hospital services with no coinsurance, requiring a daily copay of $100 for days 1 through 5 of an acute stay and $120 for days 1 through 10 of a psychiatric stay, followed by no copay for remaining days. While additional days are covered, upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Alignment Health Harmony (HMO) covers outpatient services with no coinsurance, featuring a $200 copay for outpatient hospital services, a $100 copay for ambulatory surgical center services, and a $40 copay for outpatient substance abuse sessions. Outpatient blood services are covered with no deductible, and most outpatient services require prior authorization and a doctor referral.
Partial Hospitalization See details
Alignment Health Harmony (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. This benefit requires both prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Alignment Health Harmony (HMO), though transportation is partially covered as trips to any health-related location are not covered. Ground and air ambulance services require a $175 copay and no coinsurance, which is waived if you are admitted to the hospital, while covered transportation is limited to 28 one-way trips per year to plan-approved locations.
Emergency Services See details
Alignment Health Harmony (HMO) covers emergency services with a $100 copay and no coinsurance, and urgently needed services with no copay and no coinsurance. Worldwide emergency services are partially covered up to a $100,000 maximum, with a $20 copay and no coinsurance for worldwide emergency and urgent coverage, while worldwide emergency transportation is not covered.
Primary Care See details
Primary Care benefits under Alignment Health Harmony (HMO) cover physician visits, telehealth, and therapies, though podiatry is not covered and routine chiropractic is excluded. Some mental health specialty services are covered but individual and group sessions are not, with psychiatric services requiring a $40 copay and opioid treatment carrying a 20% coinsurance.
Preventive Services See details
Preventive services are covered by Alignment Health Harmony (HMO) with no copays or coinsurance for Medicare-covered zero-dollar services, annual physical exams, kidney disease education, and glaucoma screenings. While additional supplemental benefits like health education, weight management, and nutritional therapy are not covered, the plan does offer a memory fitness benefit.
Hearing Services See details
Hearing services are partially covered by Alignment Health Harmony (HMO), which includes annual routine hearing exams and fitting evaluations with no deductible, no copay, and no coinsurance. While prescription hearing aids (all types) are covered up to two per year with a copay ranging from $195 to $1,750 and no coinsurance, OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Alignment Health Harmony (HMO) partially covers vision services, providing coverage with no deductible for one routine eye exam and a combined eyewear allowance of $150 annually for contacts or eyeglasses. While basic exams and eyewear are covered, upgrades are not covered under this plan.
Dental Services See details
Dental services are partially covered under Alignment Health Harmony (HMO), with preventive care such as exams and cleanings available with no copay or coinsurance. Comprehensive treatments like restorative care, endodontics, periodontics, prosthodontics, and oral surgery require copays ranging from $15 to $570 and no coinsurance, while adjunctive general services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Alignment Health Harmony (HMO) covers home infusion bundled services with prior authorization, offering chemotherapy, radiation, and other Part B drugs with no copay and no coinsurance to 20% coinsurance. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Alignment Health Harmony (HMO) with a $30 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these services.
Medical Equipment See details
Alignment Health Harmony (HMO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic therapeutic shoes, with a 20% coinsurance and no copay. This benefit is partially covered because diabetic supplies are not covered under the plan.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Alignment Health Harmony (HMO), where some diagnostic services are covered with no copay, but diagnostic procedures, tests, and lab services are not covered. Radiological services are partially covered with no copay, featuring therapeutic radiological services with a 20% coinsurance, while diagnostic radiological and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by Alignment Health Harmony (HMO), requiring prior authorization and a doctor referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Alignment Health Harmony (HMO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Alignment Health Harmony (HMO), offering coverage with no coinsurance, no copay for days 1 to 20, and a $100 daily copay for days 21 to 100. Prior authorization and a doctor referral are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Alignment Health Harmony (HMO), which offers unlimited acupuncture with prior authorization, digital health technology support, and a $30 monthly allowance for over-the-counter items, while meal benefits and dual eligible SNP services are not covered.
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