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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 2025, 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 2025.
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 $24.60. 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 $590.00 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 $8350.00 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) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy, the monthly premium for Part D is $24.60. In the initial coverage phase, you will pay the costs for your drugs until your total drug costs reach $2,000. After that, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Alignment Health NC Duals (HMO-POS D-SNP) plan offers a wide range of benefits with varying cost-sharing. Many services, including primary care, preventive services, and home health services, have no copay, while many services have a 20% coinsurance. The plan also includes coverage for hearing, vision, and dental services, with maximum plan benefit amounts for some services. This plan covers both inpatient and outpatient services, including emergency, ambulance, and transportation services. Additional benefits include coverage for home infusion, dialysis, medical equipment, and diagnostic services, as well as other services like acupuncture, over-the-counter items, and meal benefits. Note that some services require prior authorization and/or a referral.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the Alignment Health NC Duals (HMO-POS D-SNP) plan. However, additional days, non-Medicare-covered stays, and upgrades for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services have a 20% coinsurance. Outpatient substance abuse services have a coinsurance of at least 20%.
Partial Hospitalization See details
Partial hospitalization is covered by the plan, but requires prior authorization and a doctor referral. You will pay a 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including ground and air ambulance, are covered by this plan. Ground and air ambulance services have a 20% coinsurance, and there is no copay. Transportation services to a plan-approved health-related location are covered for up to 50 one-way trips each year via medical transport, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered, with a 20% coinsurance. Urgently Needed Services are covered with no copay and no coinsurance. Worldwide Emergency Services are covered, with a maximum plan benefit of $25,000, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health NC Duals (HMO-POS D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Occupational therapy, other health care professional services, individual and group sessions for mental health specialty services, individual and group sessions for psychiatric services, and opioid treatment program services have a 20% coinsurance. Physical therapy and speech-language pathology services have a 20% coinsurance.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, Annual Physical Exams, and Additional Preventive Services, with some services requiring prior authorization. Kidney Disease Education Services have a coinsurance of 20%, and Other Preventive Services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas (requiring prior authorization), Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, all of which are covered; however, prescription hearing aids - inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids. Hearing exams have a maximum plan benefit of $1500 every six months, and routine hearing exams and fitting/evaluation for hearing aids are limited to one visit per year.
Vision Services See details
Vision services include eye exams, eyewear, and upgrades. Eye exams and eyewear have a maximum plan benefit coverage of $1500 every six months, and the plan covers routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames.
Dental Services See details
Dental services are covered, with 20% coinsurance for Medicare Dental Services. Other Dental Services have a maximum plan benefit coverage of $1500 every six months, and the following services are covered: Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), Oral and Maxillofacial Surgery, and Orthodontics. Orthodontic services are also covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B insulin drugs with a $35 copay and 0-20% coinsurance, and other Medicare Part B drugs with 0-20% coinsurance. Medicare Part B chemotherapy/radiation drugs are also covered with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered with a doctor referral, and the coinsurance is 20%.
Medical Equipment See details
Medical Equipment is covered by Alignment Health NC Duals (HMO-POS D-SNP), with Durable Medical Equipment (DME) subject to 20% coinsurance, and Prosthetics/Medical Supplies subject to coinsurance for Medicare-covered devices and supplies. Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance, while Diabetic Supplies are not covered, and Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Therapeutic Radiological Services have a coinsurance of at most 20%. Diagnostic Radiological Services and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Alignment Health NC Duals (HMO-POS D-SNP) plan with no copay and no coinsurance, but require prior authorization and a referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the specific services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, or Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Alignment Health NC Duals (HMO-POS D-SNP) plan, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. The plan requires prior authorization and a doctor's referral, and the cost sharing details are not provided in this snippet.
Other Services See details
Other Services includes coverage for acupuncture, over-the-counter (OTC) items, and meal benefits. Acupuncture requires prior authorization. The plan offers up to $330 per month for OTC items, including nicotine replacement therapy and Naloxone, but does not cover all drugs on the CMS OTC list. Meal benefits are provided for chronic illnesses or conditions that require the enrollee to stay home. The plan does not cover dual eligible SNPs with highly integrated services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services.
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