Alignment Health L.A. (HMO C-SNP)

Inpatient Hospital See details

Inpatient Hospital benefits, including acute and psychiatric care, are covered, but the specific cost-sharing details (copay and coinsurance) are not provided. Additional days, non-Medicare-covered stays, and upgrades for both acute and psychiatric care are not covered.

Outpatient Services See details

Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services also have a 20% coinsurance. Individual and group sessions for outpatient substance abuse have a coinsurance between 20% and 20%.

Partial Hospitalization See details

Partial Hospitalization is covered, but requires prior authorization and a doctor referral. You will pay 20% coinsurance for this service.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered by the Alignment Health L.A. (HMO C-SNP) plan. This includes all ambulance services with a 20% coinsurance for both ground and air ambulance services, and transportation services to plan-approved health-related locations, with a maximum of 100 one-way trips per year; however, transportation services to any health-related location are not covered.

Emergency Services See details

Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered. Emergency Services has a 20% coinsurance, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $75 copay. Worldwide Emergency Transportation is not covered.

Primary Care See details

The Alignment Health L.A. (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, other health care professional services with 20% coinsurance, psychiatric services, 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 L.A. (HMO C-SNP) plan covers preventive services, including Medicare-covered services, annual physical exams, and additional preventive services, which require prior authorization. Additionally, the plan covers Personal Emergency Response Systems, In-Home Support Services, Support for Caregivers of Enrollees (with a $300 annual benefit), and Fitness Benefits including Memory Fitness. The plan does not cover 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, or Counseling Services.

Hearing Services See details

Hearing services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids (all types), with no deductible. Routine hearing exams and fitting/evaluation for hearing aids are limited to 1 visit per year, and prescription hearing aids (all types) are limited to 2 visits per 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 L.A. (HMO C-SNP) plan covers routine eye exams, eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $500 every two years, while upgrades are not covered.

Dental Services See details

Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Other Dental Services include oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments, with one visit allowed for each service at the specified periodicity.

Orthodontic Services are covered up to a maximum of $750 every three months, while 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, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while other drugs have a coinsurance between 0% and 20%.

Dialysis Services See details

Dialysis Services are covered, but require prior authorization and a doctor referral. You will pay a 20% coinsurance for these services.

Medical Equipment See details

Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and no copay, Prosthetics/Medical Supplies with a 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance and no copay; however, Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services include coverage for diagnostic procedures and lab services, with no copay and 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 L.A. (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 covered, but specific services like Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. There is coinsurance for the covered services, but the exact amount is not specified.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered by the Alignment Health L.A. (HMO C-SNP) plan, but the specific cost sharing details are not provided in this snippet. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered. Prior authorization and a doctor's referral are required for this benefit.

Other Services See details

The Alignment Health L.A. (HMO C-SNP) plan covers acupuncture with a limit of 12 treatments per year, as well as over-the-counter items up to $165.00 per month, and a meal benefit for chronic illnesses or conditions that require the member to stay home. Digital health technology support is also covered. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services are not covered.