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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 2025, 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 2025.
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 $29.70. 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 Silicon (HMO C-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs in each tier until your total drug costs reach $2000. If you qualify for the low-income subsidy, your monthly Part D premium will be $29.70. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for your Part D covered drugs.
Additional Benefits
The Alignment Health Silicon (HMO C-SNP) plan offers a range of benefits with varying cost-sharing. Many services, such as primary care, preventive services, and home health services, have no copay. Other services, like outpatient services, emergency services, and dental services, typically have a 20% coinsurance. This plan includes additional benefits like hearing and vision coverage, with specific allowances for exams and eyewear. It also covers transportation, over-the-counter items, and offers acupuncture treatments. However, some services like cardiac rehabilitation, and certain types of dental and vision services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but the plan does not cover additional days or non-Medicare-covered stays for either. The cost sharing details are not specified in the provided information.
Outpatient Services See details
Outpatient Services include coverage for 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. Outpatient substance abuse services have a minimum 20% coinsurance and a maximum 20% coinsurance for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Alignment Health Silicon (HMO C-SNP) plan, but requires prior authorization and a doctor referral. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a 20% coinsurance for both ground and air ambulance services. Transportation services to a plan-approved health-related location are covered for up to 60 one-way trips per year. 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 under the Alignment Health Silicon (HMO C-SNP) plan. Emergency Services have a 20% coinsurance and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $75 copay.
Primary Care See details
The Alignment Health Silicon (HMO C-SNP) plan covers primary care services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Occupational therapy, mental health specialty services, other health care professional services, psychiatric services, and opioid treatment program services have a 20% coinsurance, while physical therapy and speech-language pathology services have a 20% coinsurance. Chiropractic services require prior authorization and a doctor referral, with up to 12 routine chiropractic visits per year. Individual and group sessions for mental health and psychiatric services have a 20% coinsurance.
Preventive Services See details
Preventive Services are covered, including Medicare-covered zero dollar services, annual physical exams, and additional preventive services. The plan also covers Personal Emergency Response Systems (PERS), In-Home Support Services, Support for Caregivers of Enrollees with a $300 annual maximum, and Fitness Benefits. Other services like Health Education, Medical Nutrition Therapy, 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, with no deductible. Routine hearing exams and fitting/evaluation for hearing aids are covered for 1 visit per year, and prescription hearing aids (all types) are covered for 2 visits per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for routine eye exams with one visit allowed every year, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $500 every two years, and you are allowed one pair of contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames every two years.
Dental Services See details
Dental Services coverage includes 20% coinsurance for Medicare dental services. Other services include oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments, with specific limits on visits and periodicity, and restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered. Orthodontic services have a maximum plan benefit of $750 every three months, while 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, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered with prior authorization and a doctor referral. You will pay 20% coinsurance.
Medical Equipment See details
The Alignment Health Silicon (HMO C-SNP) plan covers durable medical equipment with a 20% coinsurance and no copay, but does not cover durable medical equipment for use outside the home. Prosthetics/Medical Supplies have a 20% coinsurance, and diabetic equipment is covered, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for all diagnostic services with no copay, but coinsurance may apply; Diagnostic Procedures/Tests and Lab Services are covered with a maximum 20% coinsurance. Radiological Services are covered with no copay, but coinsurance may apply; however, Diagnostic and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Alignment Health Silicon (HMO C-SNP) plan. Specifically, 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 additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered. Prior authorization and a doctor referral are required.
Other Services See details
The Alignment Health Silicon (HMO C-SNP) plan covers acupuncture with a limit of 12 treatments per year, and it also covers over-the-counter items up to $165.00 per month. The plan's "Other Services" benefit does not cover: Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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