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Alignment Health the ONE + Walgreens (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health the ONE + Walgreens (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 + Walgreens (HMO) in 2026, please refer to our full plan details page.
Alignment Health the ONE + Walgreens (HMO) is a HMO plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in Fresno, Madera, Merced. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Alignment Health the ONE + Walgreens (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 + Walgreens (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 + Walgreens (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. Additionally, this plan comes with a Part B Premium reduction of $1.50. You must continue to pay paying your reduced 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 $999.00 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 the ONE + Walgreens (HMO) offers an Enhanced Alternative prescription drug plan with no prescription drug deductible. During the initial coverage phase, standard pharmacy and mail-order copays are $3 for preferred generics, $45 for standard generics, and $100 for preferred brands. Non-preferred drugs require a 33% coinsurance, while specialty tier drugs are available for a $5 copay. After your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase where you pay nothing for covered Medicare Part D drugs. Additionally, individuals who qualify for the low-income subsidy, or Extra Help, will also pay nothing for their Part D drug costs.
Additional Benefits
The Alignment Health the ONE + Walgreens (HMO) plan offers robust coverage for core medical services with affordable out-of-pocket costs, featuring no copay for inpatient hospital stays during days 1 to 3 and 8 to 90. Outpatient hospital visits require a $150 copay, while emergency care has a $50 copay that is waived upon hospital admission. Additionally, there is no copay for urgently needed services or Medicare-covered preventive care. For extra wellness benefits, the plan includes dental cleanings and routine vision exams with no copay, plus a $300 annual allowance for eyewear. Prescription hearing aids are covered with copays ranging from $195 to $1,750, and members benefit from a $25 monthly allowance for over-the-counter items. To help you get to your appointments, the plan also covers 24 one-way transportation trips to approved locations per year.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by Alignment Health the ONE + Walgreens (HMO) with no coinsurance, as non-Medicare-covered stays and acute hospital upgrades are not covered. Covered acute stays require no copay for days 1 to 3 and 8 to 90 (with a $50 daily copay for days 4 to 7), while psychiatric stays require a $120 daily copay for days 1 to 10 and no copay for days 11 to 90.
Outpatient Services See details
Outpatient services are covered by Alignment Health the ONE + Walgreens (HMO) with no coinsurance. Copays for these services include $150 for outpatient hospital visits, $100 for ambulatory surgical center services, and $50 for outpatient substance abuse sessions, while outpatient blood services are covered with no copay or deductible.
Partial Hospitalization See details
Alignment Health the ONE + Walgreens (HMO) covers partial hospitalization benefits with a $55 copay and no coinsurance. These covered services require a doctor referral and prior authorization.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Alignment Health the ONE + Walgreens (HMO), as transportation to any health-related location is not covered. Medicare-covered ground and air ambulance services require a $75 copay and no coinsurance, which is waived if you are admitted to the hospital, while covered transportation is limited to 24 one-way trips per year to plan-approved locations.
Emergency Services See details
Alignment Health the ONE + Walgreens (HMO) covers emergency services with a $50 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 48 hours. Urgently needed services are covered with no copay and no coinsurance, while worldwide emergency services are partially covered up to $50,000, excluding worldwide emergency transportation.
Primary Care See details
Primary Care benefits are offered by Alignment Health the ONE + Walgreens (HMO), including psychiatric services with a $20 copay and no coinsurance, and opioid treatment with 20% coinsurance and no copay. Podiatry is not covered, chiropractic care is partially covered excluding routine care, and while some mental health specialty services are covered, individual and group sessions are not.
Preventive Services See details
Preventive Services are partially covered by Alignment Health the ONE + Walgreens (HMO) with no copay and no coinsurance for Medicare-covered zero-dollar preventive services. Covered benefits include annual physicals, caregiver support, and select screenings, while health education, in-home safety assessments, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, smoking cessation, disease management, telemonitoring, remote access, bathroom safety, and counseling are not covered.
Hearing Services See details
Alignment Health the ONE + Walgreens (HMO) partially covers hearing services, providing one routine exam and one fitting evaluation annually with no deductible. Prescription hearing aids are covered up to two per year with a copay ranging from $195 to $1,750 and no coinsurance, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Alignment Health the ONE + Walgreens (HMO), which offers one routine eye exam per year and a $300 annual combined maximum for eyewear with no deductibles, though upgrades are not covered.
Dental Services See details
Dental services are partially covered by Alignment Health the ONE + Walgreens (HMO), offering services like oral exams, cleanings, x-rays, and fluoride treatments with no copay or coinsurance. Covered comprehensive services, such as restorative care, endodontics, periodontics, prosthodontics, and oral surgery, require copays ranging from $15 to $570 with no coinsurance, while adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Alignment Health the ONE + Walgreens (HMO) covers Home Infusion bundled Services with prior authorization, requiring a $35 copay and no coinsurance to 20% coinsurance for Medicare Part B insulin drugs. Other covered Part B chemotherapy, radiation, and miscellaneous drugs feature no copay and require no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Alignment Health the ONE + Walgreens (HMO) with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to receive these services.
Medical Equipment See details
Alignment Health the ONE + Walgreens (HMO) covers medical equipment with no copay, featuring 0% to 20% coinsurance for durable medical equipment and 20% coinsurance for prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic equipment is partially covered, as diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Alignment Health the ONE + Walgreens (HMO) does not cover diagnostic services, as both lab services and diagnostic procedures are excluded. Radiological services are partially covered, featuring therapeutic radiological services with a 20% coinsurance and no copay, while diagnostic radiological and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered under the Alignment Health the ONE + Walgreens (HMO) plan, requiring a doctor referral and prior authorization before services can be received.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Alignment Health the ONE + Walgreens (HMO) plan, including cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Alignment Health the ONE + Walgreens (HMO), with no coverage for additional days beyond the Medicare-covered limit. There is no coinsurance, and you will pay no copay for days 1 to 20 followed by a $50 daily copay for days 21 to 100, though prior authorization and a doctor referral are required.
Other Services See details
Other Services are partially covered by Alignment Health the ONE + Walgreens (HMO), including a $25 monthly reimbursement allowance for over-the-counter items, meal benefits for chronic illnesses, and digital health technology support with no copay or coinsurance specified. Acupuncture and highly integrated SNP services are not covered.
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