Alignment Health smartHMO (HMO)

Alignment Health smartHMO (HMO) is a HMO plan offered by Alignment Health Plan available for the 2026 plan year to people living in Sacramento, Placer, Yolo. This plan received an overall rating of 4 out of 5 stars in 2026.

It's important to know that Alignment Health smartHMO (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 smartHMO (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 smartHMO (HMO) plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. During the initial coverage phase, members pay no copay for Tier 1 preferred generic drugs at standard pharmacies and through standard mail. For other drug tiers, standard pharmacy and standard mail costs range from a $47.00 copay for Tier 2 standard generics and a $100.00 copay for Tier 3 preferred brands, to a 25% coinsurance for Tier 4 non-preferred drugs and a $5.00 copay for Tier 5 specialty drugs. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs. Additionally, those who qualify for the low-income subsidy (LIS) can receive a reduced Part D premium of $0.00.

Additional Benefits

The Alignment Health smartHMO (HMO) plan provides affordable coverage for your core medical needs, featuring no copays or coinsurance for annual physicals and preventive care, and a low $5 copay for specialists. If you require hospital care, inpatient acute stays charge a $200 copay for days 1 through 5, while outpatient hospital services require a $200 copay with no coinsurance. Emergency room visits require a $120 copay, and ground ambulance rides have a $100 copay, with copays waived if you are admitted to the hospital. For additional healthcare needs, the plan covers routine annual eye and hearing exams, a $100 eyewear allowance every two years, and dental care with copays ranging from $15 to $570. Specialized services like dialysis and durable medical equipment require a 20% coinsurance with no copay, while home infusion has no copay and up to 20% coinsurance. However, be aware that this plan does not cover cardiac rehabilitation, over-the-counter items, diabetic supplies, or diagnostic lab services.

Plan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpring^SM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.