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Alignment Health NC Duals (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health NC Duals (HMO-POS D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health NC Duals (HMO-POS D-SNP) in 2026, please refer to our full plan details page.
Alignment Health NC Duals (HMO-POS D-SNP) is a HMO-POS D-SNP 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 NC Duals (HMO-POS D-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 NC Duals (HMO-POS D-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 NC Duals (HMO-POS D-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 NC Duals (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $36.20. 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:
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Drug Coverage
The Alignment Health NC Duals (HMO-POS D-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. This zero-dollar coverage applies to one-month, two-month, and three-month supplies, making essential medications highly affordable. For other formulary tiers, you will pay a 25% coinsurance for your prescriptions. This 25% cost-sharing rate applies to Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs for up to a three-month supply. Tier 5 specialty drugs also require a 25% coinsurance, which is limited to a one-month supply at standard pharmacies and standard mail order.
Additional Benefits
The Alignment Health NC Duals (HMO-POS D-SNP) plan offers robust healthcare coverage with many essential services featuring no copayments. Inpatient hospital and skilled nursing stays follow Medicare-defined cost-sharing, while primary care, home health, and routine preventative services are covered with no copay and no coinsurance. For outpatient care, diagnostic tests, dialysis, and emergency services, members typically pay no copay and a 20% coinsurance. This plan also provides valuable supplemental benefits to support daily wellness, including dental care up to a $2,400 annual maximum and vision care with a $400 annual eyewear allowance, both with no copay or coinsurance. Additionally, members can take advantage of a $310 monthly over-the-counter allowance, up to 50 one-way transportation trips per year, and comprehensive hearing benefits with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by Alignment Health NC Duals (HMO-POS D-SNP) subject to Medicare-defined cost sharing, with prior authorization and referrals required for both acute and psychiatric stays. Additional hospital days, upgrades, and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
Alignment Health NC Duals (HMO-POS D-SNP) covers outpatient services, including outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization and referrals are required for these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Alignment Health NC Duals (HMO-POS D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization and a referral are required to access these covered services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Alignment Health NC Duals (HMO-POS D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 50 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Alignment Health NC Duals (HMO-POS D-SNP) with a 20% coinsurance up to $75 per visit (waived if admitted to the hospital within 3 days) and no copay, while urgently needed services have no copay or coinsurance. Worldwide emergency and urgent care are partially covered up to a $25,000 maximum with no copay or coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Alignment Health NC Duals (HMO-POS D-SNP) covers primary care, podiatry, and telehealth with no copay and no coinsurance, while chiropractic care is partially covered with no copay or coinsurance for routine visits (up to 24 per year) but other chiropractic services are not covered. Specialist visits, mental health, psychiatric services, physical, occupational, and speech therapies, and opioid treatment are covered with no copay and coinsurance ranging from 20% to 30%.
Preventive Services See details
Alignment Health NC Duals (HMO-POS D-SNP) partially covers preventive services, offering annual physicals and screenings with no copay and no coinsurance, while kidney disease education requires a 20% coinsurance and no copay. Additional covered benefits like caregiver training, memory fitness, and remote access technologies also have no copay and no coinsurance. However, health education, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, telemonitoring, and home safety modifications are not covered.
Hearing Services See details
Alignment Health NC Duals (HMO-POS D-SNP) provides hearing services with no copay and no coinsurance, including one routine hearing exam and one fitting evaluation annually. Hearing aids are partially covered with no copay or coinsurance for up to two prescription devices per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Alignment Health NC Duals (HMO-POS D-SNP) with no copay, no coinsurance, and no deductible for covered care. Eligible benefits include one routine eye exam per year and a $400 annual maximum allowance for eyewear, such as glasses or contact lenses, though upgrades and other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by Alignment Health NC Duals (HMO-POS D-SNP) with no copay and no coinsurance up to a $2,400 annual maximum. Covered benefits require prior authorization, while other diagnostic, other preventive, adjunctive general, maxillofacial prosthetics, implant, and orthodontic services are not covered.
Home Infusion bundled Services See details
Alignment Health NC Duals (HMO-POS D-SNP) covers Home Infusion bundled Services with no copay, although prior authorization and step therapy are required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, require between no coinsurance and 20% coinsurance, with insulin also carrying a $35 copay.
Dialysis Services See details
Dialysis services are covered under the Alignment Health NC Duals (HMO-POS D-SNP) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required to access these benefits.
Medical Equipment See details
Alignment Health NC Duals (HMO-POS D-SNP) partially covers medical equipment with no copay and a 20% coinsurance, though prior authorization is required. While durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts are covered, diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Alignment Health NC Duals (HMO-POS D-SNP) covers diagnostic procedures, lab services, and therapeutic radiological services with no copay and a 20% coinsurance, subject to prior authorization and referral requirements. However, diagnostic radiological services and outpatient X-ray services are not covered under this benefit.
Home Health Services See details
Home Health Services are covered by Alignment Health NC Duals (HMO-POS D-SNP) with no copay and no coinsurance. Both prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Alignment Health NC Duals (HMO-POS D-SNP) with no copay and a 20% coinsurance, though referrals and prior authorization are required. While some services are covered, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy for symptomatic peripheral artery disease are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Alignment Health NC Duals (HMO-POS D-SNP) subject to Medicare-defined copays and coinsurance. Prior authorization, a referral, and a three-day prior inpatient hospital stay are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Alignment Health NC Duals (HMO-POS D-SNP) offers partial coverage for other services with no copay and no coinsurance, which includes up to 24 acupuncture treatments yearly, a $310 monthly over-the-counter reimbursement allowance, and health-related meals. Other unspecified services and highly integrated dual-eligible services are not covered.
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