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Alignment Health S.D. Premium Giveback (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health S.D. Premium Giveback (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health S.D. Premium Giveback (HMO) in 2026, please refer to our full plan details page.
Alignment Health S.D. Premium Giveback (HMO) is a HMO plan offered by Alignment Healthcare USA, LLC available for enrollment in 2026 to people living in San Diego. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Alignment Health S.D. Premium Giveback (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 S.D. Premium Giveback (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 S.D. Premium Giveback (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 $185.00. 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 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 $2400.00 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 S.D. Premium Giveback (HMO) offers an Enhanced Alternative prescription drug benefit with an annual deductible of $615.00. If you qualify for Extra Help, your Part D drug costs can be reduced to $0.00. After meeting the deductible, you enter the initial coverage phase until your total drug costs reach $2,100.00. During this initial phase, standard pharmacy and mail-order options offer no copay for Tier 1 preferred generics, a $47.00 copay for Tier 2 standard generics, and a $5.00 copay for Tier 5 specialty drugs. For Tiers 3 and 4, you will pay a coinsurance of 45% and 25% respectively. Once your yearly out-of-pocket costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs.
Additional Benefits
The Alignment Health S.D. Premium Giveback (HMO) offers healthcare coverage with no copay for routine chiropractic care and a low $5 copay for specialists, physical therapy, and occupational therapy. Emergency room visits require a $150 copay, which is waived if you are admitted within 48 hours, while urgent care services are available with no copay. For inpatient hospital stays, patients pay no copay for days 1 through 5 and days 11 through 90, with a $200 daily copay required only for days 6 through 10. Routine annual hearing and vision exams are covered with no deductibles, and the plan provides a $150 eyewear allowance every two years. Preventive dental care is also covered, while major dental procedures and hearing aids are excluded from coverage. Additionally, durable medical equipment and dialysis services are covered with no copay and up to a 20% coinsurance.
Inpatient Hospital See details
Alignment Health S.D. Premium Giveback (HMO) partially covers inpatient hospital benefits with no coinsurance, though upgrades and non-Medicare-covered stays are not covered. Acute care requires a $200 daily copay for days 6–10 (with no copay for days 1–5 and 11–90), while psychiatric care requires a $120 daily copay for days 1–5 and no copay for days 6–90.
Outpatient Services See details
Outpatient services are covered by Alignment Health S.D. Premium Giveback (HMO) with no coinsurance, featuring a $200 copay for outpatient hospital services and a $100 copay for ambulatory surgical center services. Outpatient substance abuse services require a $40 copay for individual or group sessions, and outpatient blood services are covered with no deductible.
Partial Hospitalization See details
Alignment Health S.D. Premium Giveback (HMO) covers partial hospitalization benefits with a $55.00 copay and no coinsurance. Prior authorization and a doctor referral are required to access these covered services.
Ambulance and Transportation Services See details
Alignment Health S.D. Premium Giveback (HMO) covers both ground and air ambulance services with a $155 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Alignment Health S.D. Premium Giveback (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if admitted to the hospital within 48 hours, and urgently needed services with no copay or coinsurance. Worldwide emergency services are partially covered up to a $25,000 maximum, featuring a $90 copay and no coinsurance for worldwide emergency coverage, though worldwide emergency transportation is not covered.
Primary Care See details
Alignment Health S.D. Premium Giveback (HMO) partially covers primary care and associated services with no coinsurance, featuring no copay for routine chiropractic care and a $5 copay for specialists, physical therapy, and occupational therapy. While mental health, psychiatric, and opioid treatments require copays of $20 to $40, podiatry services are not covered.
Preventive Services See details
Preventive Services are covered by Alignment Health S.D. Premium Giveback (HMO) with no copay or coinsurance for Medicare-covered zero-dollar services, annual physicals, and kidney disease education. While memory fitness and an optional personal emergency response system are covered, additional preventive benefits are only partially covered, excluding health education, safety assessments, nutritional therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, massage, adult day care, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, bathroom safety, and counseling.
Hearing Services See details
Hearing services are partially covered by Alignment Health S.D. Premium Giveback (HMO), which provides one routine hearing exam and one fitting evaluation annually with no deductible. Prescription hearing aids—including inner, outer, 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 S.D. Premium Giveback (HMO), which covers one routine eye exam annually and provides a $150 combined maximum benefit for eyewear every two years with no deductibles, though eyewear upgrades are not covered. Specific copay and coinsurance information for these services is not specified in the plan details.
Dental Services See details
Alignment Health S.D. Premium Giveback (HMO) partially covers dental services, including preventive care such as oral exams, cleanings, x-rays, and fluoride treatments, though prior authorization and referrals are required. Major dental procedures like restorative services, endodontics, periodontics, and orthodontics are not covered, and specific copay or coinsurance information is not specified in the plan details.
Home Infusion bundled Services See details
Alignment Health S.D. Premium Giveback (HMO) covers Home Infusion bundled Services with prior authorization, requiring 0% to 20% coinsurance and no copay for chemotherapy, radiation, and other Part B drugs. Medicare Part B insulin drugs are covered with a $35 copay and 0% to 20% coinsurance, though the plan does not cover Part D home infusion drugs as part of a bundled service.
Dialysis Services See details
Dialysis Services are covered under the Alignment Health S.D. Premium Giveback (HMO) plan with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Medical Equipment See details
Medical Equipment is partially covered by Alignment Health S.D. Premium Giveback (HMO), offering Durable Medical Equipment with no copay and no coinsurance to 20% coinsurance. Diabetic therapeutic shoes and inserts are covered with no copay and 20% coinsurance, while prosthetic devices, medical supplies, and diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Alignment Health S.D. Premium Giveback (HMO) partially covers diagnostic and radiological services, though diagnostic procedures, lab services, diagnostic radiological services, and outpatient X-ray services are not covered. Therapeutic radiological services are covered with a 20% coinsurance and no copay, and require prior authorization and a doctor referral.
Home Health Services See details
Home Health Services are covered under the Alignment Health S.D. Premium Giveback (HMO) plan, requiring both prior authorization and a doctor referral. Specific copay and coinsurance details for these services are not specified in the plan benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Alignment Health S.D. Premium Giveback (HMO) plan, which excludes coverage for cardiac, intensive cardiac, pulmonary, and SET for PAD services. Consequently, there is no copay or coinsurance coverage for these rehabilitation services.
Skilled Nursing Facility (SNF) See details
Alignment Health S.D. Premium Giveback (HMO) partially covers Skilled Nursing Facility (SNF) services, requiring a $20 daily copay for days 1 to 20, a $100 daily copay for days 21 to 100, and no coinsurance. Prior authorization and a doctor referral are required, and additional days beyond Medicare-covered SNF services are not covered.
Other Services See details
Alignment Health S.D. Premium Giveback (HMO) provides partial coverage for Other Services, including digital health technology support and up to 24 acupuncture treatments per year with prior authorization and a doctor referral. Over-the-counter (OTC) items, meal benefits, and dual-eligible SNPs with highly integrated services are not covered under this plan.
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