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Alignment Health Platinum (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Platinum (HMO). 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) in 2026, please refer to our full plan details page.
Alignment Health Platinum (HMO) is a HMO 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 2026.
It's important to know that Alignment Health Platinum (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 Platinum (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 Platinum (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.
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 $3900.00 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) plan features no drug deductible, allowing your prescription drug coverage to begin immediately. Under this plan, you will enjoy no copay for Tier 1 preferred generic and Tier 2 generic drugs filled at standard pharmacies or through standard mail order. For Tier 6 select care drugs, there is a low $5 copay for a one-month supply and no copay for a three-month supply. For Tier 3 preferred brand medications, standard pharmacy and mail-order fills cost a flat $45 copay for a one-month supply. Higher-tier prescriptions require coinsurance, featuring a 40% coinsurance for Tier 4 non-preferred drugs and a 33% coinsurance for a one-month supply of Tier 5 specialty drugs. These structured pricing tiers help you easily manage and predict your out-of-pocket medication expenses.
Additional Benefits
The Alignment Health Platinum (HMO) plan offers robust coverage for everyday medical needs, featuring no copays or coinsurance for primary care visits, annual physicals, routine hearing exams, and home health services. Vision care is also covered with no copay or deductible, including a routine eye exam and up to $300 annually for eyewear. Additionally, specialist visits require a low $15 copay, while dental benefits include no copay for Medicare-covered services up to a $2,000 maximum and low $10 to $30 copays for preventive dental care. For emergency and acute care, the plan features a $120 copay for emergency room visits and a $200 copay for ambulance and outpatient hospital services. Inpatient hospital stays require a $200 copay for days one and two, a $295 copay for days three through seven, and no copay for subsequent days. Other specialized services like durable medical equipment, dialysis, and therapeutic radiology require no copay but are subject to a 20% coinsurance.
Inpatient Hospital See details
Alignment Health Platinum (HMO) provides inpatient hospital care with no coinsurance, though the benefit is partially covered because upgrades and non-Medicare-covered stays are not covered. For acute hospital stays, there is a $200 copay for days 1-2, a $295 copay for days 3-7, and no copay for days 8 and beyond, while psychiatric stays require a $295 copay for days 1-6 and no copay for days 7-90.
Outpatient Services See details
Alignment Health Platinum (HMO) covers outpatient services with no coinsurance, including a $200 copay for outpatient hospital services, a $180 copay for ambulatory surgical center services, and a $35 copay for outpatient substance abuse sessions. Outpatient blood services are covered with no copay and no coinsurance, though prior authorization and referrals are required for most of these services.
Partial Hospitalization See details
Partial hospitalization is covered by Alignment Health Platinum (HMO) with a $35.00 copay and no coinsurance. This benefit requires both a referral and prior authorization.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Alignment Health Platinum (HMO) plan, with Medicare-covered ground and air ambulance services requiring prior authorization and a $200 copay with no coinsurance. Transportation services are partially covered, offering up to 28 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Alignment Health Platinum (HMO) covers emergency services with a $120 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services and worldwide emergency care are covered with no copay or coinsurance, though worldwide coverage is limited to a $25,000 maximum and excludes emergency transportation.
Primary Care See details
Alignment Health Platinum (HMO) covers primary care, telehealth, and routine podiatry with no copay and no coinsurance, while chiropractic care is partially covered with no copay or coinsurance for up to 24 routine visits. Specialist visits require a $15 copay, physical therapy requires a $10 copay, and occupational, mental health, and psychiatric therapies require a $35 copay, all with no coinsurance. Opioid treatment services are covered with no copay and 50% coinsurance.
Preventive Services See details
Alignment Health Platinum (HMO) covers preventive services, such as annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered, including memory fitness, but health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
Alignment Health Platinum (HMO) covers routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $195 to $1,750, though OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
Alignment Health Platinum (HMO) covers vision services with no copay, no coinsurance, and no deductible, including one routine eye exam and up to $300 annually for eyewear like contacts or eyeglasses. This benefit is partially covered, as other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental Services are partially covered by Alignment Health Platinum (HMO), offering no copay and no coinsurance for Medicare-covered dental, restorative, endodontic, periodontic, prosthodontic, and oral surgery services, subject to prior authorization and a $2,000 annual maximum. Preventive care requires no coinsurance but has copays of $10 for exams and fluoride, $20 for cleanings, and $30 for x-rays. Other diagnostic, other preventive, adjunctive general, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Alignment Health Platinum (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance ranging from no coinsurance to 20%, while Medicare Part B insulin drugs require a $35.00 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Alignment Health Platinum (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a referral are required to access this benefit.
Medical Equipment See details
Medical equipment is partially covered by Alignment Health Platinum (HMO), featuring no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, though diabetic supplies are not covered. Prior authorization is required for these benefits, and certain items are limited to preferred vendors or specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Alignment Health Platinum (HMO), requiring both referrals and prior authorization. Covered diagnostic services have no copay and no coinsurance, though lab services and diagnostic procedures are not covered; therapeutic radiological services require a 20% coinsurance and no copay, while outpatient X-rays and diagnostic radiological services are not covered.
Home Health Services See details
Home Health Services are covered by Alignment Health Platinum (HMO) with no copay and no coinsurance, though prior authorization and a referral are required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Alignment Health Platinum (HMO) with a $10 copay and no coinsurance, though prior authorization and referrals are required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy for symptomatic peripheral artery disease services are not covered.
Skilled Nursing Facility (SNF) See details
Alignment Health Platinum (HMO) covers up to 100 days of Skilled Nursing Facility (SNF) services with no coinsurance, featuring a $20 daily copay for days 1 through 20 and a $178 daily copay for days 21 through 100. Prior authorization and referrals are required, but a prior three-day inpatient hospital stay is not necessary for admission.
Other Services See details
Alignment Health Platinum (HMO) covers other services including acupuncture, over-the-counter items, meals, and digital health technology support with no copay and no coinsurance. Personalized health risk screenings are also covered with a $75 copay and no coinsurance, up to a maximum benefit of $200 every two years.
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