A non-government entity
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 2026, 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 2026.
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 $12.00. 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 $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 BreathEasy (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 BreathEasy (HMO C-SNP) plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. After meeting this deductible, you will pay a 25% coinsurance for generic and non-preferred drugs, a 30% coinsurance for preferred brand drugs, and no copay for specialty tier drugs at standard pharmacies or through standard mail. This initial coverage phase continues until your total drug costs reach $2,100.00. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for covered Part D prescription drugs. For those who qualify for the low-income subsidy, the plan's premium may be reduced to $12.00. This plan provides a clear cost-sharing structure to help you manage your healthcare expenses.
Additional Benefits
The Alignment Health BreathEasy (HMO C-SNP) plan offers comprehensive coverage for essential medical services, with many benefits featuring no copay and a 20% coinsurance. Outpatient care, primary care therapies, medical equipment, and dialysis all require no copay alongside a 20% coinsurance, while preventive services are available with no copay and no coinsurance. For inpatient hospital stays and skilled nursing facility care, members are responsible for Medicare-defined copays and coinsurance. This plan also includes valuable extra benefits such as routine dental, vision, and hearing coverage with no deductibles for routine examinations. Members can take advantage of a $500 eyewear allowance every two years, up to 50 plan-approved one-way transportation trips, and a $124 monthly over-the-counter reimbursement. Note that while many services are covered, certain benefits like cardiac rehabilitation and diabetic supplies are excluded from this plan.
Inpatient Hospital See details
Alignment Health BreathEasy (HMO C-SNP) partially covers inpatient acute and psychiatric hospital stays, which require doctor referrals, prior authorization, and Medicare-defined copays and coinsurance. Upgrades, additional days, and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
Alignment Health BreathEasy (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 benefits.
Partial Hospitalization See details
Alignment Health BreathEasy (HMO C-SNP) covers partial hospitalization services with a 20% coinsurance and no copay. These covered benefits require prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by Alignment Health BreathEasy (HMO C-SNP), as transportation to any health-related location is not covered. Ground and air ambulance services require a 20% coinsurance and no copay, while plan-approved transportation is limited to 50 one-way trips per year, with prior authorization required for both benefits.
Emergency Services See details
Alignment Health BreathEasy (HMO C-SNP) covers emergency services with a 20% coinsurance and no copay, and urgently needed services with no copay and no coinsurance. Worldwide emergency services are partially covered up to a $25,000 maximum limit with a $75 copay and no coinsurance for emergency and urgent care, though worldwide emergency transportation is not covered.
Primary Care See details
Primary Care benefits are partially covered by Alignment Health BreathEasy (HMO C-SNP), as podiatry services are not covered. Most covered services—including occupational, physical, and mental health therapies—require no copay and a 20% coinsurance, alongside a doctor referral and prior authorization.
Preventive Services See details
Alignment Health BreathEasy (HMO C-SNP) covers preventive services with no copay and no coinsurance, including annual physical exams and kidney disease education. Additional preventive services are partially covered; caregiver support, fitness benefits, and personal emergency response systems are included, while sub-services like health education, therapeutic massage, weight management, and alternative therapies are not covered.
Hearing Services See details
Alignment Health BreathEasy (HMO C-SNP) hearing services are partially covered with no deductible, providing one routine exam, one fitting evaluation, and up to two prescription hearing aids of all types per year. However, OTC hearing aids as well as prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision Services are partially covered by Alignment Health BreathEasy (HMO C-SNP), which offers one routine eye exam annually and a $500 combined eyewear allowance every two years with no deductible, though eyewear upgrades are not covered.
Dental Services See details
Alignment Health BreathEasy (HMO C-SNP) offers partially covered dental services, featuring Medicare-covered dental care with a 20% coinsurance and no copay, alongside other covered services with no copays or coinsurance. 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 by Alignment Health BreathEasy (HMO C-SNP), requiring prior authorization. Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Medicare Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by Alignment Health BreathEasy (HMO C-SNP) with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to access these services.
Medical Equipment See details
Alignment Health BreathEasy (HMO C-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
Alignment Health BreathEasy (HMO C-SNP) partially covers diagnostic and radiological services, which feature no copay and a 20% coinsurance for covered services. Covered benefits include diagnostic procedures, lab services, and therapeutic radiological services, while 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, requiring prior authorization and a doctor referral before receiving care.
Cardiac Rehabilitation Services See details
Alignment Health BreathEasy (HMO C-SNP) does not cover Cardiac Rehabilitation Services, including intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Alignment Health BreathEasy (HMO C-SNP) partially covers Skilled Nursing Facility (SNF) services with Medicare-defined copays and coinsurance, requiring prior authorization and a doctor referral. While the plan allows SNF admission without a prior three-day hospital stay, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Alignment Health BreathEasy (HMO C-SNP), including up to 24 acupuncture treatments per year with prior authorization, a $124 monthly over-the-counter reimbursement, meal benefits for chronic conditions, and digital health technology support. Dual Eligible SNPs with Highly Integrated Services are not covered under this plan, and the over-the-counter benefit does not cover all drugs on the CMS list.
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