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Alignment Health Heart & Diabetes Choice (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Heart & Diabetes Choice (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 Choice (HMO C-SNP) in 2026, please refer to our full plan details page.
Alignment Health Heart & Diabetes Choice (HMO C-SNP) is a HMO C-SNP plan offered by Alignment Healthcare USA, LLC available for enrollment in 2026 to people living in NorCal and SoCal. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Alignment Health Heart & Diabetes Choice (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 Choice (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 Choice (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 Choice (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.70. 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 a $615.00 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 $9250.00 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 Choice (HMO C-SNP)
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Drug Coverage
The Alignment Health Heart & Diabetes Choice (HMO C-SNP) plan features an enhanced alternative drug benefit with a $615.00 prescription drug deductible. After meeting this deductible, you will enter the initial coverage phase until total drug costs reach $2,100.00. During this phase, you will pay a 25% coinsurance for Tier 1 preferred generics, Tier 2 standard generics, and Tier 4 non-preferred drugs, or a 30% coinsurance for Tier 3 preferred brands at standard pharmacies and standard mail services. There is no copay for Tier 5 specialty drugs at standard pharmacies or standard mail. Once your yearly out-of-pocket costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. If you qualify for the low-income subsidy, your premium may be reduced, and you will pay $0.70.
Additional Benefits
The Alignment Health Heart & Diabetes Choice (HMO C-SNP) plan offers comprehensive coverage for essential medical needs, focusing on predictable copayments and no-copay options for key services. Inpatient hospital stays require a $225 daily copay for the first six days and no copay thereafter, while emergency visits have an $85 copay, and urgent care services require no copay. Outpatient hospital visits carry a $200 copay, and skilled nursing facility stays are covered with no copay for the first 20 days. For everyday wellness, the plan features no copay for routine preventive care, annual physicals, and routine hearing and vision exams. Additional benefits include a $400 eyewear allowance every two years, up to 50 one-way transportation trips, and a $100 monthly over-the-counter allowance. Specialized needs like dialysis, home infusion, and durable medical equipment generally require a 20% coinsurance with no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Alignment Health Heart & Diabetes Choice (HMO C-SNP), excluding upgrades and non-Medicare-covered stays. Acute care requires a $225 daily copay for days 1-6 and no copay or coinsurance for days 7-90, while psychiatric care requires a $120 daily copay for days 1-10 and no copay or coinsurance for days 11-90.
Outpatient Services See details
Alignment Health Heart & Diabetes Choice (HMO C-SNP) covers outpatient services with no coinsurance, including outpatient hospital visits for a $200 copay and ambulatory surgical center services for a $100 copay. Outpatient substance abuse sessions require a $40 copay, and outpatient blood services are covered with no deductible.
Partial Hospitalization See details
Partial hospitalization benefits are covered by the Alignment Health Heart & Diabetes Choice (HMO C-SNP) with a $55.00 copay and no coinsurance. Receiving these covered services requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Alignment Health Heart & Diabetes Choice (HMO C-SNP) covers ground and air ambulance services with a $175 copay and no coinsurance, with the copay waived if you are admitted to the hospital. Transportation services are partially covered, offering up to 50 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Alignment Health Heart & Diabetes Choice (HMO C-SNP) with an $85 copay and no coinsurance, while urgently needed services require no copay and no coinsurance. Worldwide emergency services are partially covered up to a $12,000 maximum benefit, though worldwide emergency transportation is not covered.
Primary Care See details
Alignment Health Heart & Diabetes Choice (HMO C-SNP) covers primary care, specialist, therapy, and chiropractic services, but podiatry is not covered and mental health specialty services exclude individual and group sessions. Covered psychiatric services require a $40 copay, while opioid treatment services require a 20% coinsurance.
Preventive Services See details
Preventive services are partially covered by Alignment Health Heart & Diabetes Choice (HMO C-SNP) with no copay and no coinsurance for Medicare-covered zero-dollar preventive care, annual physical exams, and kidney disease education. While additional benefits like caregiver support and fitness programs are covered, various services—including health education, weight management, alternative therapies, and therapeutic massage—are not covered.
Hearing Services See details
Hearing services are partially covered by Alignment Health Heart & Diabetes Choice (HMO C-SNP) with no deductible, covering one routine hearing exam and one fitting evaluation annually. OTC hearing aids and specific prescription hearing aid types—including inner ear, outer ear, and over the ear—are not covered, and specific copay or coinsurance details are not provided.
Vision Services See details
Vision Services are partially covered by Alignment Health Heart & Diabetes Choice (HMO C-SNP), as eyewear upgrades are not covered. The plan features no deductible for one annual routine eye exam and provides a $400 maximum allowance every two years for contacts and eyeglasses, though specific copay and coinsurance information is not specified.
Dental Services See details
Dental services are partially covered by Alignment Health Heart & Diabetes Choice (HMO C-SNP), though adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered. Covered benefits include oral exams, cleanings, and restorative services, with orthodontic services capped at a maximum plan benefit of $300 every three months.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Alignment Health Heart & Diabetes Choice (HMO C-SNP) with prior authorization, requiring 0% to 20% coinsurance and no copay for chemotherapy, radiation, and other Medicare Part B drugs. Covered Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Alignment Health Heart & Diabetes Choice (HMO C-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to access these covered services.
Medical Equipment See details
Alignment Health Heart & Diabetes Choice (HMO C-SNP) partially covers medical equipment with a 20% coinsurance and no copay for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic supplies are not covered under this plan, and prior authorization is required for most covered equipment.
Diagnostic and Radiological Services See details
Alignment Health Heart & Diabetes Choice (HMO C-SNP) partially covers diagnostic and radiological services, requiring a doctor referral and prior authorization for care. While diagnostic procedures, lab services, diagnostic radiological services, and outpatient X-ray services are not covered, therapeutic radiological services are covered with no copay and a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Alignment Health Heart & Diabetes Choice (HMO C-SNP) plan. To access these benefits, members are required to obtain a doctor referral and prior authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Alignment Health Heart & Diabetes Choice (HMO C-SNP) plan, as none of the individual sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Alignment Health Heart & Diabetes Choice (HMO C-SNP), featuring no copay for days 1 to 20 and a $50 daily copay for days 21 to 100, with no coinsurance. Prior authorization and a doctor referral are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Alignment Health Heart & Diabetes Choice (HMO C-SNP) partially covers other services, including up to 12 acupuncture treatments per year, a $100 monthly over-the-counter allowance, limited meal benefits, and digital health technology support. Highly integrated Dual Eligible SNP services are not covered under this benefit, and specific copay or coinsurance details are not specified for the covered services.
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