Alignment Health ValorCare (HMO)

Alignment Health ValorCare (HMO) is a HMO plan offered by Alignment Healthcare USA, LLC available for enrollment in 2026 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 ValorCare (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 ValorCare (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 ValorCare (HMO) plan features an enhanced alternative drug benefit with no prescription drug deductible. During the initial coverage phase, which lasts until total drug costs reach $2,100, beneficiaries pay no copay for Tier 1 preferred generic drugs through standard pharmacy and standard mail services. For other tiers, standard costs include a $30 copay for Tier 2 standard generics, a $100 copay for Tier 3 preferred brands, a 33% coinsurance for Tier 4 non-preferred drugs, and a $5 copay for Tier 5 specialty drugs. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D prescriptions. Additionally, beneficiaries who qualify for the low-income subsidy, or Extra Help, will have their Part D premium reduced to $0. Please consult the plan's formulary to confirm coverage for your specific prescription drugs.

Additional Benefits

The Alignment Health ValorCare (HMO) plan offers comprehensive medical coverage with clear cost-sharing structures, including no copay for primary care visits, routine chiropractic care, and annual preventive services. For inpatient hospital stays, members pay a $400 daily copay for days one through five and no copay for days six through 90. Emergency room visits require a $120 copay, while urgent care services feature no copay, ensuring affordable access to immediate medical attention. Specialist visits and mental health services require a $40 copay, while routine hearing and vision exams are covered with no copay or deductibles. The plan also features a $300 annual eyewear allowance, up to $2,000 in yearly dental coverage, and a $20 monthly reimbursement for select over-the-counter items. Additionally, diagnostic services require no copays, though durable medical equipment and dialysis services generally carry a 20% coinsurance.