A non-government entity
Alignment Health Heart & Diabetes CalPlus (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Heart & Diabetes CalPlus (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) in 2026, please refer to our full plan details page.
Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) is a HMO C-SNP plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in Northern and Southern California. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Alignment Health Heart & Diabetes CalPlus (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Alignment Health Heart & Diabetes CalPlus (HMO C-SNP).
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 Heart & Diabetes CalPlus (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $12.00. 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 a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 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 Heart & Diabetes CalPlus (HMO C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) offers an Enhanced Alternative drug benefit with a $615.00 annual prescription drug deductible. If you qualify for the low-income subsidy (Extra Help), your Part D premium is reduced to $12.00. During the initial coverage phase, standard retail and standard mail-order prescription costs are 25% coinsurance for Tiers 1, 2, and 4, 31% coinsurance for Tier 3, and no copay for Tier 5 specialty drugs. These cost-sharing rates apply until your yearly out-of-pocket drug costs reach $2,100.00. Once you reach this threshold, you enter the catastrophic coverage phase, where you will pay nothing for covered Medicare Part D prescription drugs.
Additional Benefits
The Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) plan offers comprehensive coverage with no copay for primary care visits, standard preventive services, and urgent care. For inpatient hospital stays, members pay a $275 daily copay for the first six days and no copay for days seven through 90. Most outpatient services, emergency care, specialist therapies, dialysis, and durable medical equipment require no copay but carry a 20% coinsurance. Additional benefits include annual routine hearing and vision exams with no deductible, plus a $500 eyewear allowance every two years. Members also benefit from up to 50 one-way transportation trips to plan-approved health locations and a $129 monthly reimbursement for over-the-counter items. Dental care, home health, and acupuncture are also covered, though some services require prior authorization or referrals.
Inpatient Hospital See details
Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) partially covers inpatient hospital benefits, excluding upgrades, non-Medicare-covered stays, and additional psychiatric hospital days. Covered acute hospital stays require a $275 daily copay for days 1 through 6, no copay for days 7 through 90, and no coinsurance, while psychiatric stays require Medicare-defined copays and coinsurance.
Outpatient Services See details
Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) covers outpatient services, including outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required for these covered services.
Partial Hospitalization See details
Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) covers partial hospitalization with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to access these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Alignment Health Heart & Diabetes CalPlus (HMO C-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered, providing up to 50 one-way trips per year to plan-approved health-related locations, while transportation to any health-related location is not covered.
Emergency Services See details
Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) covers emergency services with a 20% coinsurance (up to $75 per visit) and no copay, and urgently needed services with no copay and no coinsurance. Worldwide emergency and urgent services are partially covered up to a $25,000 maximum with a $75 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) offers partially covered Primary Care benefits, as podiatry services are not covered. Covered services like physical therapy, mental health, and psychiatric care require a 20% coinsurance and no copay, while primary care physician visits have no copay and no coinsurance.
Preventive Services See details
Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) covers standard preventive services, annual physicals, and kidney disease education with no copay and no coinsurance. Additional preventive benefits are only partially covered, excluding services like health education, weight management, and alternative therapies while including caregiver training and memory fitness.
Hearing Services See details
Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) covers annual routine hearing exams and fitting evaluations with no deductible. Prescription hearing aids are partially covered, with inner ear, outer ear, and over-the-ear types not covered, and over-the-counter (OTC) hearing aids are also excluded from coverage.
Vision Services See details
Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) partially covers vision services with no deductible, which includes one routine eye exam annually and a $500 combined maximum benefit for eyewear every two years. Covered eyewear options include contact lenses and eyeglasses, though eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Alignment Health Heart & Diabetes CalPlus (HMO C-SNP), though copay and coinsurance details are not specified. Most covered treatments require prior authorization, while adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) covers home infusion bundled services, which require prior authorization and may require step therapy. Covered Part B chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Medicare Part B insulin has a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) with a 20% coinsurance and no copay. Both a doctor referral and prior authorization are required to receive these covered services.
Medical Equipment See details
Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic equipment is partially covered, offering therapeutic shoes and inserts for a 20% coinsurance and no copay, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) partially covers Diagnostic and Radiological Services, offering no copay and a 20% coinsurance for covered lab services, diagnostic procedures, and therapeutic radiological services. Outpatient X-ray services and diagnostic radiological services are not covered under this plan.
Home Health Services See details
Home Health Services are covered by Alignment Health Heart & Diabetes CalPlus (HMO C-SNP), though patients will need to obtain a doctor referral and prior authorization to receive these services.
Cardiac Rehabilitation Services See details
Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) technically covers cardiac rehabilitation, meaning some services are covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Since these services are not covered, there are no associated copays or coinsurance costs for members under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Alignment Health Heart & Diabetes CalPlus (HMO C-SNP), with Medicare-defined copay and coinsurance rates applying alongside prior authorization and doctor referral requirements. While standard SNF stays are covered and do not require a prior three-day inpatient hospital stay, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) covers several additional benefits, including up to 12 acupuncture visits per year with a referral, a $129 monthly over-the-counter item reimbursement, home meal delivery for chronic conditions, and digital health technology support. These services are covered with no copay or coinsurance details specified under the plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved