Alignment Health smartSavings (HMO)

Alignment Health smartSavings (HMO) is a HMO plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in LA, OC, Riv, SB, SD. This plan received an overall rating of 4 out of 5 stars in 2026.

It's important to know that Alignment Health smartSavings (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.

Key Plan Facts

Below are a few key facts and commonly-asked questions about Alignment Health smartSavings (HMO).

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.

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:

Drug Coverage

The Alignment Health smartSavings (HMO) plan offers an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, which lasts until total drug costs reach $2,100, you will pay no copay for Tier 1 preferred generic drugs through standard pharmacies or standard mail. Tier 2 standard generic drugs carry a $30 copay, while Tier 3 preferred brand drugs require a $100 copay. For Tier 4 non-preferred drugs, you will pay a 33% coinsurance, and Tier 5 specialty drugs require a $5 copay. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D prescription drugs. This plan also offers premium reductions down to $0 for individuals who qualify for the low-income subsidy.

Additional Benefits

The Alignment Health smartSavings (HMO) plan offers affordable medical coverage featuring no copay for preventive services and annual physical exams, alongside a low $5 copay for specialist visits. For hospital stays, members pay a $120 daily copay for the first five days of acute inpatient care and no copay for days 6 through 90, while outpatient hospital services require a $200 copay. Emergency care is accessible with a $110 copay, and urgent care services are available with no copay. The plan also provides routine dental, vision, and hearing care, including preventive dental services with no copay and annual allowances of up to $100 for contact lenses and $200 for eyeglasses. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay, while skilled nursing facility stays require daily copays starting at $20 for the first 20 days. Please note that certain diagnostic services, cardiac rehabilitation, and transportation are not covered under this plan.