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Alignment Health smartSavings (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health smartSavings (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health smartSavings (HMO) in 2025, please refer to our full plan details page.
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 2025.
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.
For Alignment Health smartSavings (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $150.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2899.00 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 smartSavings (HMO) plan has an enhanced alternative drug benefit. The plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different copays or coinsurance depending on the drug tier and pharmacy. For example, you will pay no copay for preferred generic drugs at a standard pharmacy, and a $30 copay for standard generic drugs. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Alignment Health smartSavings (HMO) plan offers a range of benefits, including coverage for inpatient hospital stays with a copay of $120 for the first five days and no copay thereafter. Outpatient services, such as outpatient hospital and ambulatory surgical center services, are covered with copays ranging from $50 to $200. The plan also includes coverage for ambulance services, emergency services, and a wide array of primary care services, such as chiropractic, mental health, and psychiatric services, with copays varying from $10 to $20. Preventive, hearing, vision, and dental services are included, with routine exams and eyewear covered under vision. Medical equipment and home health services are covered with coinsurance, while skilled nursing facility services have a copay. The plan also offers benefits for home infusion services, dialysis services, and cardiac rehabilitation services, with specific copays or coinsurance amounts.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For Inpatient Hospital-Acute, you will pay a $120 copay for days 1-5, and no copay for days 6-90; Inpatient Hospital Psychiatric has a $120 copay for days 1-10, and no copay for days 11-90, with 40 additional days covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $200 copay, Ambulatory Surgical Center (ASC) Services with a $50 copay, Outpatient Substance Abuse Services with a $35 copay for both individual and group sessions, and Outpatient Blood Services. All services require prior authorization and a doctor referral.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay, and requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $100 copay, and air ambulance services have a $200 copay, with no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered by the Alignment Health smartSavings (HMO) plan. Emergency Services have a $110 copay and no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $25,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health smartSavings (HMO) plan covers primary care physician services, occupational therapy services, physician specialist services, mental health specialty services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $10 copay, while individual and group sessions for mental health have a $10 copay. Individual and group sessions for psychiatric services have a $20 copay, and opioid treatment program services have a 20% coinsurance. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Alignment Health smartSavings (HMO) plan covers preventive services, including annual physical exams, and other preventive services such as glaucoma screenings, and diabetes self-management training. Additional services such as health education, in-home safety assessments, medical nutrition therapy, and several others are not covered.
Hearing Services See details
Alignment Health smartSavings (HMO) covers routine hearing exams and fitting/evaluation for hearing aids, each with one visit per year, but does not cover prescription or OTC hearing aids. There is no copay or coinsurance for these services.
Vision Services See details
The Alignment Health smartSavings (HMO) plan covers vision services, including routine eye exams once per year. Eyewear is covered, with benefits including eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, each with a maximum plan benefit coverage amount of $200 every year, and contact lenses with a maximum plan benefit coverage amount of $100 every year; however, upgrades are not covered.
Dental Services See details
Dental services are covered by the Alignment Health smartSavings (HMO) plan, including oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatment. Other covered services include restorative services with a copay of $20-$400, endodontics with a copay of $25-$350, periodontics with a copay of $15-$550, prosthodontics (removable) with a copay of $20-$570, prosthodontics (fixed) with a copay of $40-$400, and oral and maxillofacial surgery with a copay of $25-$250; however, adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay with coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Alignment Health smartSavings (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the Alignment Health smartSavings (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance with no copay, and requires prior authorization. Prosthetic Devices and Medical Supplies have a 20% coinsurance with no copay, and require authorization. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance with no copay. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under the Alignment Health smartSavings (HMO) plan. While there is no copay for any of the services, Diagnostic Procedures/Tests, Lab Services, 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 smartSavings (HMO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, requiring prior authorization and a doctor's referral. For days 1-20, the copay is $20 per day, and for days 21-100, the copay is $100 per day.
Other Services See details
Other Services are not covered, including acupuncture, over-the-counter items, and meal benefits. Other services such as digital health technology support are covered.
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