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Alignment Health Select (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Select (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health Select (HMO) in 2025, please refer to our full plan details page.
Alignment Health Select (HMO) is a HMO plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in Alameda, San Diego. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Alignment Health Select (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 Select (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 Select (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
The Alignment Health Select (HMO) plan has an enhanced alternative drug benefit with no deductible. During the initial coverage phase, you'll pay a copay for your prescriptions. For example, you'll pay a $3.00 copay for preferred generic drugs at a standard or mail-order pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. If you qualify for the low-income subsidy (LIS), your Part D costs are $0.00.
Additional Benefits
The Alignment Health Select (HMO) plan offers comprehensive coverage, including inpatient hospital stays with a copay, outpatient services, and partial hospitalization. The plan covers ambulance services with a copay, and emergency services with a copay, as well as primary care physician services, hearing, vision, and dental services. The plan also offers a variety of other services, such as home health, skilled nursing, and medical equipment with varying cost-sharing amounts such as copays, coinsurance, or no cost.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $295 copay for days 1-7 and no copay for days 8-90. For Inpatient Hospital Psychiatric, you will pay a $250 copay for days 1-7 and no copay for days 8-60. Additional days for Inpatient Hospital-Acute are covered, and additional days for Inpatient Hospital Psychiatric are covered up to 40 days. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services are covered by the Alignment Health Select (HMO) plan, including outpatient hospital services with a $200 copay, ambulatory surgical center services with a $35 copay, and outpatient substance abuse services with a $25 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered with a $25 copay. Prior authorization and a doctor's referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Alignment Health Select (HMO) plan, with no coinsurance. Ground and air ambulance services have a $240 copay, which is waived if admitted to the hospital. Transportation services to a plan-approved health-related location are covered up to 24 one-way trips per year, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $90 copay and no coinsurance, while Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Services has a maximum plan benefit of $25,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health Select (HMO) plan covers Primary Care Physician Services with a $10 copay, Physician Specialist Services with a $35 copay, and Physical Therapy and Speech-Language Pathology Services with a $40 copay. Chiropractic Services are not covered for routine chiropractic care, and Podiatry Services are not covered. Mental Health Specialty Services and Psychiatric Services have a copay of $20-$35 depending on the service, and Opioid Treatment Program Services have a 20% coinsurance.
Preventive Services See details
The Alignment Health Select (HMO) plan covers preventive services, including Medicare-covered services, annual physical exams, and additional preventive services, such as memory fitness. However, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and several other services are not covered.
Hearing Services See details
Hearing Services includes hearing exams with a $10 copay, and prescription hearing aids with a copay between $195 and $1750. Routine hearing exams and fitting/evaluation for hearing aids are covered, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Alignment Health Select (HMO) plan covers vision services, including routine eye exams once per year with no copay or coinsurance, and eyewear with a combined maximum of $300 every two years. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered, with specific limitations on the number of pairs or frames allowed. Upgrades are not covered.
Dental Services See details
Dental services include oral exams with a $10 copay, dental x-rays with a $30 copay, prophylaxis (cleaning) with a $20 copay, and fluoride treatment with a $10 copay. Restorative services have a copay of $20-$400, Endodontics have a copay of $25-$350, Periodontics have a copay of $15-$550, Prosthodontics, removable have a copay of $20-$570, Prosthodontics, fixed have a copay of $40-$400, and Oral and Maxillofacial Surgery have a copay of $25-$250. Adjunctive General Services, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and 0-20% coinsurance. Other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Alignment Health Select (HMO), requiring prior authorization and a doctor's referral. The copay for dialysis services is between $30.00 and $30.00.
Medical Equipment See details
The Alignment Health Select (HMO) plan covers medical equipment, including durable medical equipment, prosthetics, and medical supplies, with a 20% coinsurance for certain services, and no copay. Diabetic equipment is covered, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Alignment Health Select (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 any of the covered services.
Home Health Services See details
Home Health Services are covered by the Alignment Health Select (HMO) plan with no copay and no coinsurance. 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 Select (HMO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Alignment Health Select (HMO) plan. For days 1-20, there is no copay, and for days 21-100, there is a $140 copay.
Other Services See details
The Alignment Health Select (HMO) plan's "Other Services" benefit covers over-the-counter (OTC) items, with a maximum benefit coverage amount of $25.00 per month, including nicotine replacement therapy and naloxone coverage, but does not cover acupuncture. Additionally, the plan offers a meal benefit for chronic illnesses or medical conditions requiring the member to stay at home. Other services like digital health technology support are also covered. However, services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing, and many others are not covered.
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