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Alignment Health Silicon (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Silicon (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 Silicon (HMO C-SNP) in 2026, please refer to our full plan details page.
Alignment Health Silicon (HMO C-SNP) is a HMO C-SNP plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in Santa Clara. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Alignment Health Silicon (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 Silicon (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 Silicon (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 Silicon (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:
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Drug Coverage
The Alignment Health Silicon (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 Tier 1, Tier 2, and Tier 4 drugs, and a 31% coinsurance for Tier 3 preferred brand drugs at standard pharmacies or via standard mail. There is no copay for Tier 5 specialty tier drugs during this initial coverage phase. If you qualify for Extra Help, your Part D premium is reduced to $12.00 under this plan. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Alignment Health Silicon (HMO C-SNP) plan offers robust healthcare coverage featuring no copays for primary care visits, specialist services, routine chiropractic care, and urgent care. Many outpatient services, including therapy, dialysis, and durable medical equipment, are covered with a 20% coinsurance and no copay. Inpatient hospital stays and skilled nursing facility admissions require Medicare-defined copays and coinsurance, while emergency room visits carry a 20% coinsurance up to $75 with no copay. For routine wellness, members enjoy no deductibles for vision and hearing services, which include annual exams, a $500 eyewear allowance every two years, and up to two prescription hearing aids. Preventive and restorative dental services are covered, with Medicare-covered dental care requiring a 20% coinsurance and no copay. This plan also provides valuable extra benefits, such as a $155 monthly over-the-counter allowance and up to 60 one-way trips annually to plan-approved locations.
Inpatient Hospital See details
Alignment Health Silicon (HMO C-SNP) partially covers inpatient hospital acute and psychiatric stays, which require doctor referrals, prior authorization, and Medicare-defined copays and coinsurance. However, additional days, non-Medicare-covered stays, and upgrades for acute stays are not covered.
Outpatient Services See details
Outpatient services are covered by Alignment Health Silicon (HMO C-SNP) with a 20% coinsurance and no copay. This coverage 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
Alignment Health Silicon (HMO C-SNP) covers partial hospitalization services with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Alignment Health Silicon (HMO C-SNP), as transportation to any health-related location is not covered. Covered ground and air ambulance services require prior authorization and have a 20% coinsurance and no copay, while covered transportation is limited to 60 one-way trips per year to plan-approved locations.
Emergency Services See details
Alignment Health Silicon (HMO C-SNP) covers emergency services with a 20% coinsurance (up to $75 per visit) and no copay, while urgently needed services are covered with no copay and no coinsurance. Worldwide emergency and urgent care are partially covered with a $75 copay and no coinsurance up to a $25,000 maximum benefit, though worldwide emergency transportation is not covered.
Primary Care See details
Alignment Health Silicon (HMO C-SNP) offers partially covered primary care benefits, as podiatry services are not covered. Covered services such as occupational, physical, and psychiatric therapies require a 20% coinsurance and no copay, while primary care visits, specialist services, and routine chiropractic care have no copay and no coinsurance.
Preventive Services See details
Preventive services are partially covered by Alignment Health Silicon (HMO C-SNP) with no copay and no coinsurance for Medicare-covered zero-dollar preventive services, annual physical exams, and select additional benefits. However, several services are not covered, including health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home and bathroom safety devices, and counseling.
Hearing Services See details
Alignment Health Silicon (HMO C-SNP) partially covers hearing services with no deductible, offering one routine hearing exam and one fitting evaluation annually, plus up to two prescription hearing aids. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Alignment Health Silicon (HMO C-SNP) provides partially covered vision services with no deductibles, though eyewear upgrades are not covered. The plan includes one routine eye exam every year and a $500 combined maximum benefit every two years for contacts and eyeglasses.
Dental Services See details
Alignment Health Silicon (HMO C-SNP) offers partially covered dental services, with Medicare-covered dental care requiring a 20% coinsurance and no copay. While preventive and restorative services are 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 by Alignment Health Silicon (HMO C-SNP) with prior authorization required. Medicare Part B insulin drugs have a $35 copay and 0% to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs carry no copay and 0% to 20% coinsurance.
Dialysis Services See details
Alignment Health Silicon (HMO C-SNP) covers Dialysis Services with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive these covered services.
Medical Equipment See details
Alignment Health Silicon (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, though diabetic supplies are not covered. Prior authorization is required for these covered medical equipment benefits.
Diagnostic and Radiological Services See details
Alignment Health Silicon (HMO C-SNP) diagnostic and radiological services are partially covered, featuring no copay and a 20% coinsurance for covered lab services, diagnostic procedures, and therapeutic radiological services. Diagnostic radiological services and outpatient X-ray services are not covered under this plan.
Home Health Services See details
Home health services are covered by Alignment Health Silicon (HMO C-SNP), requiring both prior authorization and a doctor referral. Information regarding specific copays and coinsurance for these covered services is not specified in the plan details.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Alignment Health Silicon (HMO C-SNP) plan, meaning there is no coverage, copay, or coinsurance for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by Alignment Health Silicon (HMO C-SNP) with Medicare-defined copays and coinsurance, requiring prior authorization and a doctor referral. The plan allows admission with less than a three-day hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Alignment Health Silicon (HMO C-SNP), offering acupuncture up to 12 treatments per year, a $155 monthly over-the-counter allowance, meal benefits, and digital health technology support with no copays or coinsurance specified. Highly Integrated Services for Dual Eligible SNPs are not covered.
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