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Alignment Health Heart & Diabetes Access (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Heart & Diabetes Access (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 Access (HMO C-SNP) in 2026, please refer to our full plan details page.
Alignment Health Heart & Diabetes Access (HMO C-SNP) is a HMO C-SNP plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in Los Angeles, Riverside, San Bernardino. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Alignment Health Heart & Diabetes Access (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 Access (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 Access (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 Access (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 $1.00. 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:
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Drug Coverage
The Alignment Health Heart & Diabetes Access (HMO C-SNP) plan features an Enhanced Alternative drug benefit with a $615.00 prescription drug deductible. After meeting this deductible, you will pay a 25% coinsurance for Tier 1, Tier 2, and Tier 4 drugs, and a 31% coinsurance for Tier 3 preferred brand drugs at standard pharmacies or through standard mail. Tier 5 specialty drugs are highly accessible with no copay during this initial coverage phase. If you qualify for the low-income subsidy (LIS), your cost is reduced to $12.00. Once 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 prescriptions. Please check the plan's formulary to verify coverage for your specific medications.
Additional Benefits
The Alignment Health Heart & Diabetes Access (HMO C-SNP) plan offers comprehensive medical coverage featuring no copay for primary care physician visits, urgent care, and key preventive services. For many outpatient services, emergency care, ambulance transport, and dialysis, members will pay no copay and a 20% coinsurance. Inpatient hospital stays and skilled nursing facility care are covered with standard Medicare-defined copays and coinsurance. This plan also includes valuable specialty benefits, such as routine hearing exams with up to two prescription hearing aids per year and a routine eye exam with a $500 eyewear allowance every two years. Additionally, members benefit from no copay and a 20% coinsurance on Medicare-covered dental care, alongside a $194 monthly over-the-counter reimbursement and up to 100 one-way transportation trips to plan-approved locations.
Inpatient Hospital See details
Alignment Health Heart & Diabetes Access (HMO C-SNP) covers inpatient acute and psychiatric hospital services, with cost-sharing in the form of Medicare-defined copays and coinsurance. While core inpatient stays are covered with prior authorization and a doctor referral, the plan does not cover additional days, non-Medicare-covered stays, or upgrades.
Outpatient Services See details
Outpatient services are covered by Alignment Health Heart & Diabetes Access (HMO C-SNP) with no copay and a 20% coinsurance. This benefit includes outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services, all of which require prior authorization and a doctor referral.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Alignment Health Heart & Diabetes Access (HMO C-SNP) 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 partially covered by Alignment Health Heart & Diabetes Access (HMO C-SNP), with prior authorization required for both. Ground and air ambulance services require a 20% coinsurance and no copay, while transportation services are limited to 100 one-way trips to plan-approved locations, as transportation to any health-related location is not covered.
Emergency Services See details
Alignment Health Heart & Diabetes Access (HMO C-SNP) covers emergency services with a 20% coinsurance and no copay, and urgently needed services with no copay or coinsurance. Worldwide emergency and urgent care are partially covered up to a $25,000 limit with a $75 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits are partially covered by Alignment Health Heart & Diabetes Access (HMO C-SNP), as podiatry services are not covered. Covered services such as physical, occupational, and psychiatric therapies require a 20% coinsurance and no copay, while primary care physician visits are covered with no copay or coinsurance.
Preventive Services See details
Alignment Health Heart & Diabetes Access (HMO C-SNP) covers Medicare-covered zero-dollar preventive services, annual physicals, and kidney disease education with no copays or coinsurance. Other additional preventive services are partially covered, including caregiver support and memory fitness, while sub-services such as health education, weight management, and therapeutic massage are not covered.
Hearing Services See details
Hearing services are partially covered by Alignment Health Heart & Diabetes Access (HMO C-SNP) with no deductible, including one routine exam, one fitting evaluation, and up to two prescription hearing aids of all types per year. OTC hearing aids and specific prescription hearing aid types, such as inner ear, outer ear, and over the ear, are not covered.
Vision Services See details
Vision services are partially covered by Alignment Health Heart & Diabetes Access (HMO C-SNP), featuring one annual routine eye exam with no deductible and a $500 combined eyewear allowance every two years. Covered eyewear includes contact lenses and eyeglasses, though eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Alignment Health Heart & Diabetes Access (HMO C-SNP), featuring a 20% coinsurance and no copay for Medicare-covered dental care. While preventive services and select comprehensive treatments are covered, adjunctive general services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Alignment Health Heart & Diabetes Access (HMO C-SNP) covers home infusion bundled services, subject to prior authorization, with a 0% to 20% coinsurance on covered Medicare Part B drugs. Part B insulin drugs require a $35 copay, while chemotherapy, radiation, and other Part B drugs carry no copay.
Dialysis Services See details
Alignment Health Heart & Diabetes Access (HMO C-SNP) covers dialysis services with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to access this benefit.
Medical Equipment See details
Alignment Health Heart & Diabetes Access (HMO C-SNP) partially covers medical equipment with a 20% coinsurance and no copay for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic supplies are not covered, and prior authorization is required for covered equipment.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by Alignment Health Heart & Diabetes Access (HMO C-SNP), featuring no copay and a 20% coinsurance for covered services. Covered options 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 Heart & Diabetes Access (HMO C-SNP) plan, requiring prior authorization and a doctor referral. Copay and coinsurance cost details are not specified for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Alignment Health Heart & Diabetes Access (HMO C-SNP) plan, as all sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by Alignment Health Heart & Diabetes Access (HMO C-SNP) subject to Medicare-defined copay and coinsurance rates, requiring prior authorization and a doctor referral. While the plan allows for admission with less than a three-day prior hospital stay, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Alignment Health Heart & Diabetes Access (HMO C-SNP), which provides up to 12 acupuncture treatments yearly, a $194 monthly over-the-counter reimbursement, home meal benefits, and digital health support. Highly integrated services for Dual Eligible SNPs are not covered under this plan.
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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.
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