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Alignment Health BreathEasy (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health BreathEasy (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 BreathEasy (HMO C-SNP) in 2025, please refer to our full plan details page.
Alignment Health BreathEasy (HMO C-SNP) is a HMO C-SNP plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in NorCal and SoCal. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Alignment Health BreathEasy (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 BreathEasy (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 BreathEasy (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 BreathEasy (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.10. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $5.00. 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 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 $8850.00 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 BreathEasy (HMO C-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs. The plan does not specify the cost sharing for each tier, but you will enter the next coverage phase when your total drug costs reach $2,000. Once your yearly out-of-pocket drug costs reach $2,000, you will pay nothing for your Medicare Part D covered drugs. If you qualify for the low-income subsidy, your Part D premium will be $18.10.
Additional Benefits
The Alignment Health BreathEasy (HMO C-SNP) plan offers a wide range of benefits, including coverage for inpatient and outpatient services, with varying coinsurance amounts. It also provides coverage for vision, hearing, and dental services, with specific limits on exams, eyewear, and hearing aids. Additionally, the plan includes benefits such as ambulance services, home health, and medical equipment, as well as coverage for over-the-counter items and meal benefits.
Inpatient Hospital See details
The Alignment Health BreathEasy (HMO C-SNP) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but the cost sharing details for copay and coinsurance are not specified. Additional days, non-Medicare covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. For Outpatient Hospital Services, Observation Services, and Outpatient Blood Services, you pay 20% coinsurance, while for Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services, coinsurance details are available in the plan documents.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor's referral. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Alignment Health BreathEasy (HMO C-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location are covered for up to 50 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered, with a 20% coinsurance. Urgently Needed Services are covered with no copay and no coinsurance. Worldwide Emergency Services are covered, with a $75 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health BreathEasy (HMO C-SNP) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic, Occupational Therapy, Mental Health, Psychiatric Services, and Opioid Treatment Program Services require prior authorization and a referral. For Occupational Therapy, Mental Health, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services, there is a 20% coinsurance. Physical Therapy and Speech-Language Pathology Services have a 20% coinsurance.
Preventive Services See details
The Alignment Health BreathEasy (HMO C-SNP) plan covers preventive services, including an annual physical exam, with no copay. This plan also covers the Personal Emergency Response System (PERS), In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Digital Rectal Exams, and EKG following Welcome Visit. Health Education, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), 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 Benefit, Home-Based Palliative Care, 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, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids are covered for one visit per year, and prescription hearing aids (all types) are covered for two visits per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Alignment Health BreathEasy (HMO C-SNP) plan covers vision services, including routine eye exams with one visit per year and eyewear with a combined maximum benefit of $500 every two years. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered, with the plan offering 1 pair or set every two years for each. Upgrades are not covered.
Dental Services See details
The Alignment Health BreathEasy (HMO C-SNP) plan covers dental services including Medicare Dental Services with 20% coinsurance. Other dental services include oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatment, all of which have visit limitations. Orthodontic Services are covered up to a maximum of $500 every three months. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are also covered. Adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Alignment Health BreathEasy (HMO C-SNP) plan, but require prior authorization and a doctor's referral. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits for the Alignment Health BreathEasy (HMO C-SNP) plan include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Prosthetic Devices have a 20% coinsurance. Medical Supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Alignment Health BreathEasy (HMO C-SNP) plan, including Diagnostic Procedures/Tests and Lab Services with a coinsurance of at most 20%, and Therapeutic Radiological Services with a coinsurance of at most 20%. 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 BreathEasy (HMO C-SNP) plan 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 not covered by the Alignment Health BreathEasy (HMO C-SNP) plan. Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but prior authorization and a doctor referral are required. The plan does not provide Skilled Nursing Facility Services as a supplemental benefit under Part C. Additional days beyond Medicare-covered for Skilled Nursing Facility (SNF) and Non-Medicare-covered stays for Skilled Nursing Facility (SNF) are not covered.
Other Services See details
The Alignment Health BreathEasy (HMO C-SNP) plan covers acupuncture with a limit of 24 treatments per year. The plan also covers over-the-counter (OTC) items with a maximum benefit coverage amount of $135.00 per month, and meal benefits for chronic illnesses or medical conditions requiring the enrollee to stay home for a period of time. Digital Health Technology Support is also covered. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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