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Alignment Health Heart & Diabetes Care (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Heart & Diabetes Care (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 Heart & Diabetes Care (HMO C-SNP) in 2026, please refer to our full plan details page.
Alignment Health Heart & Diabetes Care (HMO C-SNP) is a HMO C-SNP plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in Central and Northern California. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Alignment Health Heart & Diabetes Care (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 Heart & Diabetes Care (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 Heart & Diabetes Care (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 Heart & Diabetes Care (HMO C-SNP), 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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $1990.00 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 Heart & Diabetes Care (HMO C-SNP) plan features an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, you pay a $5 copay for Tier 1 preferred generic and Tier 5 specialty drugs, and a $30 copay for Tier 2 standard generic drugs. Tier 3 preferred brand drugs require a 50% coinsurance, while Tier 4 non-preferred drugs carry a 33% coinsurance at standard pharmacies and mail-order services. These initial coverage costs apply until your total drug costs reach $2,100. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. If you qualify for the low-income subsidy, your Part D costs can be reduced to no cost.
Additional Benefits
The Alignment Health Heart & Diabetes Care (HMO C-SNP) plan offers comprehensive medical coverage with predictable cost-sharing, featuring a $100 daily copay for inpatient acute hospital stays up to five days and no copay for days six through ninety. Outpatient hospital services require a $200 copay, while emergency care has a $120 copay and urgently needed services are available with no copay. Ground ambulance transport requires a $100 copay, and the plan also covers up to 50 one-way routine transportation trips per year to approved locations. For daily wellness, members benefit from no copay or coinsurance for preventive care, annual physicals, and preventive dental services like cleanings and exams. The plan covers annual routine eye and hearing exams, and includes a $25 monthly reimbursement for over-the-counter items with no copay. Specialized treatments like dialysis and therapeutic radiology require a 20% coinsurance, while durable medical equipment features no copay and ranges up to 20% coinsurance.
Inpatient Hospital See details
Alignment Health Heart & Diabetes Care (HMO C-SNP) partially covers inpatient hospital benefits with no coinsurance for covered services. Acute care requires a $100 copay per day for days 1 through 5 and no copay for days 6 through 90, while psychiatric care requires a $250 copay, but upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Alignment Health Heart & Diabetes Care (HMO C-SNP) covers outpatient services with no coinsurance, including outpatient hospital services for a $200 copay, ambulatory surgical center visits for a $100 copay, and outpatient substance abuse sessions for a $15 copay. Outpatient blood and observation services are also covered with no deductible, though prior authorization and a doctor referral are required for most of these benefits.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the Alignment Health Heart & Diabetes Care (HMO C-SNP) plan with a $15.00 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these services.
Ambulance and Transportation Services See details
Alignment Health Heart & Diabetes Care (HMO C-SNP) covers ambulance services with no coinsurance, requiring a $100 copay for ground transport and a $125 copay for air transport, both of which are waived if you are admitted to the hospital. Transportation benefits are partially covered, allowing up to 50 one-way trips per year to plan-approved health-related locations, though transportation to any health-related location is not covered.
Emergency Services See details
Alignment Health Heart & Diabetes Care (HMO C-SNP) covers emergency services with a $120 copay and no coinsurance, which is waived if admitted to the hospital within 48 hours, and urgently needed services with no copay and no coinsurance. Worldwide emergency services are partially covered up to a $25,000 maximum benefit, though worldwide emergency transportation is not covered.
Primary Care See details
Alignment Health Heart & Diabetes Care (HMO C-SNP) covers primary care, physical therapy, and podiatry, though chiropractic services are only partially covered since routine chiropractic care is excluded. For mental health and psychiatric specialty services, some services are covered, but individual and group sessions are not covered. Opioid treatment program services require a 20% coinsurance, while copay and coinsurance details for other covered services are not specified.
Preventive Services See details
Preventive services are covered by Alignment Health Heart & Diabetes Care (HMO C-SNP) with no copay and no coinsurance for Medicare-covered zero-dollar services, annual physicals, and kidney disease education. However, additional preventive services are only partially covered, excluding health education, safety assessments, medical nutrition therapy, medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, smoking cessation counseling, disease management, telemonitoring, remote access, home modifications, and counseling.
Hearing Services See details
Hearing services are covered by Alignment Health Heart & Diabetes Care (HMO C-SNP), including one annual routine hearing exam and one fitting/evaluation exam with no deductible, though copay and coinsurance details are not provided. While some hearing aid benefits are covered, prescription hearing aids—including inner ear, outer ear, and over the ear types—and over-the-counter hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Alignment Health Heart & Diabetes Care (HMO C-SNP), providing one routine eye exam and eyewear per year with no deductible and a $200 combined annual limit, while upgrades are not covered.
Dental Services See details
Dental services are partially covered by Alignment Health Heart & Diabetes Care (HMO C-SNP), featuring no copay or coinsurance for preventive care like exams, cleanings, x-rays, and fluoride. Covered comprehensive services require copays ranging from $15.00 to $570.00 with no coinsurance, while adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Alignment Health Heart & Diabetes Care (HMO C-SNP) covers home infusion bundled services, which require prior authorization and step therapy. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Alignment Health Heart & Diabetes Care (HMO C-SNP) plan with 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive these covered services.
Medical Equipment See details
Alignment Health Heart & Diabetes Care (HMO C-SNP) covers Durable Medical Equipment (DME) with no copay and coinsurance ranging from no coinsurance to 20% with prior authorization. However, some services are not covered, including prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Alignment Health Heart & Diabetes Care (HMO C-SNP) partially covers Diagnostic and Radiological Services, offering covered therapeutic radiological services with no copay and a 20% coinsurance. Other sub-services, including diagnostic procedures and 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 Heart & Diabetes Care (HMO C-SNP) plan, requiring prior authorization and a doctor referral. While specific copay and coinsurance amounts are not detailed, these services are covered for eligible members who meet the referral and authorization requirements.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Alignment Health Heart & Diabetes Care (HMO C-SNP) plan. In practice, none of the associated sub-services are covered, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Alignment Health Heart & Diabetes Care (HMO C-SNP) with a daily copay of $20 for days 1-20 and $100 for days 21-100, and no coinsurance. This benefit is partially covered because additional days beyond the Medicare-covered limit are not covered, and services require prior authorization and a doctor referral.
Other Services See details
Other Services are partially covered by Alignment Health Heart & Diabetes Care (HMO C-SNP), as acupuncture and highly integrated services for dual eligible SNPs are not covered. Covered benefits include digital health technology support, a limited-duration meal benefit, and a monthly $25 reimbursement for over-the-counter items with no copay or coinsurance.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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