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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 2025, 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 2025.
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 $15.50. 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
The Alignment Health the ONE + Walgreens (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and pharmacy. For example, standard generic drugs have a $45 copay and 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's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Alignment Health the ONE + Walgreens (HMO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays. You will have no copay for many services, like routine eye exams and home health services. The plan also covers vision, dental, and hearing services, with copays and coverage limits for specific services. This plan includes coverage for ambulance services and transportation to health-related locations, as well as emergency and worldwide emergency services. You may also receive additional benefits like over-the-counter items, and a meal benefit for chronic illnesses. Some services require prior authorization, and some services are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with prior authorization and a doctor referral required. For Inpatient Hospital-Acute, there is no copay for days 1 and 3, a $50 copay for days 4-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, there is a $120 copay for days 1-10, and no copay for days 11-90. Additional days for Inpatient Hospital Psychiatric are covered for up to 40 days.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have an $85 copay, while individual and group substance abuse sessions have a copay between $50 and $50.
Partial Hospitalization See details
Partial Hospitalization is covered under the plan, but requires prior authorization and a doctor's referral. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Alignment Health the ONE + Walgreens (HMO), including ground and air ambulance services with a $75 copay. The plan also covers 24 one-way trips per year to a plan-approved health-related location via medical transport, but does not cover transportation to any health-related location.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Alignment Health the ONE + Walgreens (HMO) plan. Emergency Services have a $50 copay with no coinsurance, and the copay is waived if admitted to the hospital within 48 hours. Worldwide Emergency Services has a maximum benefit coverage of $50,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health the ONE + Walgreens (HMO) plan covers primary care physician services, occupational therapy, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits and opioid treatment program services. Chiropractic services and psychiatric services require prior authorization and a doctor's referral. Individual and group sessions for mental health specialty services are not covered. Individual and group sessions for psychiatric services have a $20 copay. Opioid treatment program services have a 20% coinsurance.
Preventive Services See details
The Alignment Health the ONE + Walgreens (HMO) plan covers preventive services, including annual physical exams and other preventive services that require prior authorization. The plan also covers Personal Emergency Response Systems, In-Home Support Services, Support for Caregivers of Enrollees (with a $300 annual maximum), and Fitness Benefits including memory fitness. Kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas (prior authorization required), digital rectal exams, and EKGs after a welcome visit are also covered. However, health education, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, 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.
Hearing Services See details
Hearing Services include routine hearing exams and fitting/evaluation for hearing aids, with one visit allowed per year for each. Prescription hearing aids are covered, with a copay between $195 and $1750, and two visits allowed per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services include coverage for routine eye exams, eyeglasses, and contact lenses. This plan covers one routine eye exam per year, with no copay or coinsurance, and also covers one pair of contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames per year. Eyewear has a combined maximum benefit of $300.00 per year, and upgrades are not covered.
Dental Services See details
Dental services with the Alignment Health the ONE + Walgreens (HMO) plan include oral exams for a $10 copay, dental x-rays for a $30 copay, prophylaxis (cleaning) for a $20 copay, and fluoride treatment for a $10 copay. Restorative services have a copay between $20 and $400, endodontics have a copay between $25 and $350, periodontics have a copay between $15 and $550, prosthodontics (removable) have a copay between $20 and $570, prosthodontics (fixed) have a copay between $40 and $400, and oral and maxillofacial surgery has a copay between $25 and $250; however, adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Alignment Health the ONE + Walgreens (HMO) plan. A doctor referral and prior authorization are required, and the plan has a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment (DME) with no copay and a 0-20% coinsurance, and prosthetic devices and medical supplies with no copay and a 20% coinsurance. Durable medical equipment for use outside the home and diabetic supplies are not covered, while 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 + Walgreens (HMO) plan, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered. Therapeutic Radiological Services have a coinsurance of at most 20%, and there is no copay for these services.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires prior authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Alignment Health the ONE + Walgreens (HMO) plan, but require prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $50. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include over-the-counter items with a $25 monthly maximum, and a meal benefit for chronic illnesses or medical conditions that require the enrollee to remain at home. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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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