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Alignment Health the ONE + Rite Aid (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health the ONE + Rite Aid (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health the ONE + Rite Aid (HMO) in 2025, please refer to our full plan details page.
Alignment Health the ONE + Rite Aid (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 2025.
It's important to know that Alignment Health the ONE + Rite Aid (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 + Rite Aid (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 the ONE + Rite Aid (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:
Sign up for Alignment Health the ONE + Rite Aid (HMO)
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Drug Coverage
The Alignment Health the ONE + Rite Aid (HMO) plan has an enhanced alternative drug benefit. This plan has no deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions depending on the drug tier and the pharmacy. For example, you will pay a $1 copay for preferred generic drugs at a standard or mail-order pharmacy. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs.
Additional Benefits
The Alignment Health the ONE + Rite Aid (HMO) plan offers a range of benefits, including inpatient hospital stays with varying copays, outpatient services with copays, and ambulance services with a $75 copay. Emergency services and many primary care services have no copay, and preventive services are covered. This plan also includes coverage for hearing and vision services, offering routine exams and eyewear with specific limits. Additionally, it covers home infusion, dialysis, and medical equipment with varying coinsurance. Other benefits include acupuncture, over-the-counter items, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization and a doctor referral. For Inpatient Hospital-Acute, there is no copay for days 1-4 and 11-90, and a $100 copay for days 5-10. For Inpatient Hospital Psychiatric, this plan offers additional days, but does not cover non-Medicare stays or upgrades.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $200 copay, ambulatory surgical center services with a $100 copay, and outpatient blood services with no copay. Outpatient substance abuse services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Alignment Health the ONE + Rite Aid (HMO) plan, but requires prior authorization and a doctor's referral. The plan does not specify the cost of this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Alignment Health the ONE + Rite Aid (HMO) plan, including ground and air ambulance services, each with a $75 copay. Transportation Services to a plan-approved health-related location are covered for up to 20 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered with no copay and no coinsurance. Worldwide Urgent Coverage has a $75 copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health the ONE + Rite Aid (HMO) plan covers Primary Care Physician, Chiropractic, Occupational Therapy, Physician Specialist, Other Health Care Professional, Psychiatric, Physical Therapy and Speech-Language Pathology, Additional Telehealth, and Opioid Treatment Program Services. Chiropractic services require a referral and prior authorization and are limited to 12 visits per year. Occupational Therapy, Physical Therapy and Speech-Language Pathology services require prior authorization, and all of these services have no copay and no coinsurance. Opioid Treatment Program Services have a 20% coinsurance. Mental Health Specialty Services, Individual Sessions for Mental Health Specialty Services, and Group Sessions for Mental Health Specialty Services are not covered. Podiatry Services are not covered.
Preventive Services See details
The Alignment Health the ONE + Rite Aid (HMO) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, and additional preventive services. Additional services like health education, in-home safety assessments, medical nutrition therapy, and others are not covered.
Hearing Services See details
Hearing Services includes coverage for routine hearing exams and fitting/evaluation for hearing aids, with one visit per year for each service. Prescription Hearing Aids (all types) are covered with a copay between $195 and $1750. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
The Alignment Health the ONE + Rite Aid (HMO) plan covers vision services, including eye exams, with one routine eye exam covered every year, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $350 every two years, with one pair of contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames covered every two years.
Dental Services See details
Dental services are partially covered under the plan, with a 20% coinsurance for Medicare Dental Services. Orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Alignment Health the ONE + Rite Aid (HMO) plan and 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) with a coinsurance between 0% and 20% and no copay, but Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance and no copay. Diabetic Equipment is covered with a coinsurance, while 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 under the Alignment Health the ONE + Rite Aid (HMO) plan. All Diagnostic services are covered with no copay, but Diagnostic Procedures/Tests and Lab Services are not covered; Radiological services are covered with no copay, but some services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Alignment Health the ONE + Rite Aid (HMO), 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 not covered by the Alignment Health the ONE + Rite Aid (HMO) plan. Specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization and a doctor's referral are required.
Other Services See details
The Alignment Health the ONE + Rite Aid (HMO) plan covers acupuncture, with a limit of 12 treatments per year. It also covers over-the-counter (OTC) items, with a maximum benefit of $60.00 every month, and offers a meal benefit for chronic or medical conditions requiring the enrollee to stay at home. Digital Health Technology Support is also covered. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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