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Alignment Health Platinum (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Platinum (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health Platinum (HMO-POS) in 2025, please refer to our full plan details page.
Alignment Health Platinum (HMO-POS) is a HMO-POS plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in Mountains and Piedmont Regions. This plan received an overall rating of 5 out of 5 stars in 2025.
It's important to know that Alignment Health Platinum (HMO-POS) 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 Platinum (HMO-POS).
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 Platinum (HMO-POS), 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 $2999.00 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 Platinum (HMO-POS) plan has an enhanced alternative drug benefit. The plan has no deductible for prescription drugs. During the initial coverage phase, you will pay different copays depending on the drug tier and the pharmacy you use. For example, you'll pay no copay for preferred generic drugs at a standard or mail-order pharmacy. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs.
Additional Benefits
The Alignment Health Platinum (HMO-POS) plan offers a wide range of benefits. This plan covers inpatient hospital stays with copays varying by day and type of service, as well as outpatient services with copays for hospital and substance abuse services. Emergency, primary care, preventive, hearing, vision, dental, home health, and skilled nursing services are also covered. Additional benefits include ambulance and transportation services, home infusion, dialysis, and medical equipment coverage. The plan also provides coverage for diagnostic and radiological services, as well as cardiac rehabilitation. Other services include acupuncture, over-the-counter items, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay no copay for days 1-1 and days 8-90, and a $295 copay for days 2-7. For Inpatient Hospital Psychiatric, you will pay a $295 copay for days 1-6 and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered. Additional days for Inpatient Hospital Psychiatric are covered up to 40 days, while Non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services for the Alignment Health Platinum (HMO-POS) plan cover outpatient hospital services with a $200 copay, ambulatory surgical center services with a $180 copay, and outpatient substance abuse services with a $35 copay for both individual and group sessions. Outpatient blood services are also covered, with three pints waived from the deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Alignment Health Platinum (HMO-POS) plan, but requires prior authorization and a doctor's referral. The copay for this benefit is $35.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Alignment Health Platinum (HMO-POS) plan. Ground and air ambulance services have a $200 copay, and there is no coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 28 one-way trips per year, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Alignment Health Platinum (HMO-POS) plan. Emergency Services have a copay of $120 and no coinsurance, while Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $25,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health Platinum (HMO-POS) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services with a $3 copay, mental health specialty services with a $35 copay for individual and group sessions, podiatry services, other health care professional services with a $35 copay, psychiatric services with a $35 copay for individual and group sessions, physical therapy and speech-language pathology services with a $10 copay, additional telehealth benefits, and opioid treatment program services with 50% coinsurance. Chiropractic services and opioid treatment program services require prior authorization and a doctor referral.
Preventive Services See details
Preventive Services, including annual physical exams, are covered. Other services include Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Fitness Benefit (Memory Fitness) is covered. Glaucoma Screening, Diabetes Self-Management Training, Digital Rectal Exams, and EKG following Welcome Visit are covered. Barium Enemas are covered with prior authorization.
Hearing Services See details
Hearing Services include hearing exams with a maximum benefit of $750 every six months, routine hearing exams once per year, and fitting/evaluation for hearing aids once per year. Prescription hearing aids (all types) are covered, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear such as contact lenses and eyeglasses. Routine eye exams are unlimited, and there is a maximum plan benefit coverage of $750 every six months for eye exams.
Dental Services See details
The Alignment Health Platinum (HMO-POS) plan covers a variety of dental services, including oral exams, x-rays, and cleanings, with a maximum benefit of $750 every six months. Other covered services include fluoride treatments, restorative services, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Alignment Health Platinum (HMO-POS) plan and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Alignment Health Platinum (HMO-POS) plan, requiring a doctor's referral. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Alignment Health Platinum (HMO-POS) plan, but some services are not covered. There is no copay for all diagnostic and radiological services, but therapeutic radiological services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Alignment Health Platinum (HMO-POS) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. This benefit requires authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Alignment Health Platinum (HMO-POS) plan, but require prior authorization and a doctor's referral. You will pay a copay of $20 for days 1-20, and a copay of $178 for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Alignment Health Platinum (HMO-POS) plan covers acupuncture, over-the-counter (OTC) items (up to $40 monthly, including nicotine replacement therapy and naloxone), and a meal benefit for chronic or home-bound illnesses. Other services covered include personalized health risk screening with a $75 copay and a $200 maximum benefit every two years, and digital health technology support. The plan does not cover Dual Eligible SNPs with Highly Integrated Services, and several other services are also not covered.
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