Alignment Health the ONE (HMO)

Alignment Health the ONE (HMO) is a HMO plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in LA, OC, SD, SB, SC, Riverside. This plan received an overall rating of 4 out of 5 stars in 2026.

It's important to know that Alignment Health the ONE (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 the ONE (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.

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:

Drug Coverage

The Alignment Health the ONE (HMO) plan offers an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, standard pharmacy and standard mail order drug costs include a $1.00 copay for Tier 1 preferred generics, a $40.00 copay for Tier 2 standard generics, a $100.00 copay for Tier 3 preferred brands, and a $5.00 copay for Tier 5 specialty drugs. Tier 4 non-preferred drugs require a 33% coinsurance until your total drug costs reach $2,100.00. After reaching $2,100.00 in yearly out-of-pocket drug costs, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Furthermore, individuals who qualify for the full low-income subsidy will pay nothing for their Part D coverage.

Additional Benefits

Alignment Health the ONE (HMO) offers affordable core medical coverage, featuring no copays or coinsurance for emergency services, urgent care, and preventive annual physicals. Inpatient hospital stays require no coinsurance, with no copay for most days and a $100 daily copay for days five through ten. Outpatient hospital services carry a $200 copay, while ambulatory surgical center visits require a $100 copay, both with no coinsurance. This plan also includes valuable supplemental benefits such as routine vision exams with no deductible, a $350 biennial eyewear allowance, and hearing aid coverage with no coinsurance. Additionally, members benefit from up to 20 one-way medical transport trips per year, a $60 monthly over-the-counter reimbursement, and medical equipment with no copays and up to 20% coinsurance. Medicare-covered dental care is also available with no copay and a 20% coinsurance.