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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 2025, 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 NorCal and SoCal. This plan received an overall rating of 4 out of 5 stars in 2025.
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 $990.00 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:
Sign up for Alignment Health Heart & Diabetes Care (HMO C-SNP)
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Drug Coverage
The Alignment Health Heart & Diabetes Care (HMO C-SNP) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay for your medications, which varies depending on the drug tier and the pharmacy you use. For example, standard generic drugs have a $30 copay, while preferred brand drugs have a $75 copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. If you qualify for the low-income subsidy (LIS), your Part D costs will be $0.
Additional Benefits
The Alignment Health Heart & Diabetes Care (HMO C-SNP) plan offers a range of benefits, including inpatient and outpatient services, with specific copays for some services like substance abuse and partial hospitalization. The plan covers ambulance and transportation services, with copays for ground and air ambulance, and offers up to 50 one-way trips per year for health-related transportation. Emergency and urgent care services have copays, and worldwide emergency services are covered up to $25,000. Additional benefits include primary care, preventive, hearing, vision, and dental services. Vision services include routine eye exams with no copay and eyewear coverage up to $200 per year. Dental services cover various procedures with varying copays. The plan also provides home infusion, dialysis, medical equipment, and home health services. The plan covers acupuncture and offers an OTC benefit, but some services like cardiac rehabilitation and certain home health services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. Inpatient Hospital Psychiatric has a $250 copay for a Medicare-covered stay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Individual and group sessions for Outpatient Substance Abuse have a copay of $15.00, and Outpatient Blood Services includes an enhanced benefit with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Alignment Health Heart & Diabetes Care (HMO C-SNP) plan, with a $15 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a $100 copay, and air ambulance services have a $125 copay, with no coinsurance. Transportation services to plan-approved health-related locations are covered for up to 50 one-way trips per year, and transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered, with a $70 copay and no coinsurance. Urgently Needed Services are covered with no copay and no coinsurance. Worldwide Emergency Services are covered, with a maximum plan benefit of $25,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health Heart & Diabetes Care (HMO C-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Mental health specialty services are partially covered; individual and group sessions are not covered.
Preventive Services See details
Preventive Services are covered, including services not usually covered by Medicare plans. Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services include routine hearing exams and fitting/evaluation for hearing aids, each covered once per year. Prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
The Alignment Health Heart & Diabetes Care (HMO C-SNP) plan covers vision services, including routine eye exams with no copay, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum of $200 per year. The plan also covers upgrades.
Dental Services See details
Dental Services include coverage for Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Fluoride Treatment, Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery. Oral exams, prophylaxis, and fluoride treatments are limited to one visit every six months, and dental x-rays are limited to one visit every three years. Restorative services have a copay of $20-$400, endodontics has a copay of $25-$350, periodontics has a copay of $15-$550, removable prosthodontics has a copay of $20-$570, fixed prosthodontics has a copay of $40-$400, and oral and maxillofacial surgery has a copay of $25-$250. Adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization, 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.
Dialysis Services See details
Dialysis Services are covered under the Alignment Health Heart & Diabetes Care (HMO C-SNP) plan, but require prior authorization and a doctor's referral. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, but DME for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit has no copay or coinsurance, but the plan does not cover Prosthetic Devices or Medical Supplies. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under the Alignment Health Heart & Diabetes Care (HMO C-SNP) plan. While there is no copay for any services, Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered. Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Alignment Health Heart & Diabetes Care (HMO C-SNP) plan with no copay and no coinsurance, but require authorization and referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically 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, but require prior authorization and a doctor's referral. There is no copay for days 1-31, and a $50 copay for days 32-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Alignment Health Heart & Diabetes Care (HMO C-SNP) plan covers acupuncture with no copay, and also covers Over-the-Counter (OTC) items with a $25 monthly benefit, including nicotine replacement therapy and Naloxone, but not all drugs on the CMS OTC list. The plan also offers a meal benefit and Digital Health Technology Support. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and several other services are not covered.
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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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