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 2025, 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 2025.
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 $29.70. 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 $590.00 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 $7350.00 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) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs based on the tier and pharmacy you use. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, your Part D premium will be $29.70.
Additional Benefits
The Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) plan offers a range of benefits, including inpatient hospital stays with a copay for the first few days, and outpatient services with 20% coinsurance. You'll also find coverage for primary care, preventive services, and some vision, hearing, and dental services. The plan provides coverage for ambulance services with 20% coinsurance, and emergency services with 20% coinsurance. Additionally, the plan offers coverage for medical equipment, home health, and skilled nursing facility services, all with specific requirements for authorization and referral.
Inpatient Hospital See details
Inpatient Hospital services are covered, including acute and psychiatric care, but the plan does not cover non-Medicare-covered stays or upgrades for acute care, nor does it cover additional days or non-Medicare-covered stays for psychiatric care. For acute care, you will pay a $275 copay for days 1-6, and no copay for days 7-90; for psychiatric care, you will pay the Medicare-defined cost share.
Outpatient Services See details
Outpatient services are covered by the Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) plan. Outpatient Hospital Services and Observation Services have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor referral. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a 20% coinsurance for both ground and air ambulance services. Transportation services to any health-related location are not covered, but transportation services to a plan-approved health-related location are covered for up to 50 one-way trips per year.
Emergency Services See details
Emergency Services are covered with a 20% coinsurance, and no copay. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $75 copay, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) plan covers primary care physician services, chiropractic services (with a limit of 12 visits per year), occupational therapy services with 20% coinsurance, physician specialist services, mental health specialty services with 20% coinsurance, other health care professional services with 20% coinsurance, psychiatric services with 20% coinsurance, physical therapy and speech-language pathology services with 20% coinsurance, additional telehealth benefits, and opioid treatment program services with 20% coinsurance. Podiatry Services are not covered.
Preventive Services See details
The Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) plan covers preventive services, including an annual physical exam, additional preventive services (with prior authorization), and kidney disease education services. This plan also covers Personal Emergency Response Systems, In-Home Support Services, Support for Caregivers of Enrollees (with a maximum benefit of $300 per year), and Fitness Benefits. However, Health Education, In-Home Safety Assessments, Medical Nutrition Therapy, Post-discharge In-Home Medication Reconciliation, Re-admission 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 exams, fitting/evaluation for hearing aids, and prescription hearing aids (all types) are covered with no deductible. Routine hearing exams and fitting/evaluation for hearing aids are covered for 1 visit every year. Prescription hearing aids (all types) are covered for 2 visits every year. Prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids, are not covered.
Vision Services See details
The Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) plan covers vision services including routine eye exams with one visit per year, and eyewear with a combined maximum of $500 every two years. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered, with a limit of one pair or set every two years. Upgrades are not covered.
Dental Services See details
The Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) plan covers a variety of dental services, including 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 of $20-$400, endodontics has a copay of $25-$350, periodontics has a copay of $15-$550, prosthodontics (removable) has a copay of $20-$570, prosthodontics (fixed) has a copay of $40-$400, and oral and maxillofacial surgery has a copay of $25-$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 and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) plan. This benefit requires prior authorization and a doctor's referral, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered by the Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) plan, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 20% coinsurance, while Diabetic Supplies are not covered. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, and Medical Supplies have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) plan. Diagnostic Procedures/Tests and Lab Services have no copay and a coinsurance of at most 20%, while Therapeutic Radiological Services have no copay and a coinsurance of at most 20%; however, Diagnostic Radiological Services and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) plan with no copay and no coinsurance, but require authorization and referral. 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 Heart & Diabetes CalPlus (HMO C-SNP) 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 Heart & Diabetes CalPlus (HMO C-SNP) plan, but require prior authorization and a doctor's referral. The plan does not cover additional days beyond Medicare-covered SNF stays, nor does it cover non-Medicare-covered SNF stays.
Other Services See details
The Alignment Health Heart & Diabetes CalPlus (HMO C-SNP) plan covers acupuncture, with a limit of 12 treatments per year, and over-the-counter (OTC) items, with a maximum benefit of $135 per month. The plan also covers a meal benefit for chronic illnesses or medical conditions that require the enrollee to stay at home. Many additional services are not covered.
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