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Alignment Health Heart & Diabetes (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Heart & Diabetes (HMO-POS C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health Heart & Diabetes (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Alignment Health Heart & Diabetes (HMO-POS C-SNP) is a HMO-POS C-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 Heart & Diabetes (HMO-POS C-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 Heart & Diabetes (HMO-POS C-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 Heart & Diabetes (HMO-POS C-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 Heart & Diabetes (HMO-POS C-SNP), 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 $2900.00 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 Heart & Diabetes (HMO-POS C-SNP) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay varying copays or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have no copay at standard mail, and standard generic drugs have a $30 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, your premium for Part D drugs will be $0.
Additional Benefits
The Alignment Health Heart & Diabetes (HMO-POS C-SNP) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. Emergency, urgent, and worldwide emergency services are covered, with copays ranging from $0 to $70, and a maximum benefit for worldwide emergencies. Additionally, this plan provides coverage for primary care, preventive services, and home health services, with many services having no copay. This plan also includes coverage for hearing, vision, and dental services, with specific limitations on some benefits. Other notable benefits include ambulance and transportation services, home infusion, and medical equipment. The plan covers Dialysis Services with a coinsurance, and a monthly allowance for over-the-counter (OTC) items.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a $100 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, there is a $250 copay. Additional days for Inpatient Hospital-Acute and Psychiatric are covered, while Non-Medicare-covered stays and Upgrades are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, ambulatory surgical center services, and outpatient substance abuse services, are covered. Outpatient Hospital Services have a $200 copay, and both individual and group sessions for outpatient substance abuse have a copay between $15.00 and $15.00.
Partial Hospitalization See details
Partial Hospitalization is covered by the Alignment Health Heart & Diabetes (HMO-POS C-SNP) plan, requiring prior authorization and a doctor referral, with a $15 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a $100 copay; there is no coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 50 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 under the Alignment Health Heart & Diabetes (HMO-POS C-SNP) plan. Emergency Services have a $70 copay, and there is no coinsurance, while Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Services have a maximum plan benefit coverage of $25,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician services, Chiropractic services, Occupational Therapy Services, Physician Specialist Services, Other Health Care Professional, Podiatry Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Mental Health Specialty Services and Psychiatric Services are partially covered, with individual and group sessions not covered. Services for Occupational Therapy, Physical Therapy and Speech-Language Pathology Services have no copay and no coinsurance. Opioid Treatment Program Services have a coinsurance of 20%.
Preventive Services See details
The Alignment Health Heart & Diabetes (HMO-POS C-SNP) plan covers preventive services, including Medicare-covered services with no copay. Additional preventive services, the annual physical exam, glaucoma screening, diabetes self-management training, digital rectal exams, and EKG following Welcome Visit are covered. Support for Caregivers of Enrollees, In-Home Support Services, and Fitness Benefits are covered, while Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, 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, 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.
Hearing Services See details
Hearing services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids (all types), with no deductible. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered. Routine hearing exams and fitting/evaluation for hearing aids are unlimited, while hearing exams have a maximum benefit of $750 every six months.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Routine eye exams are limited to one per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are unlimited.
Dental Services See details
Dental services are covered, with a maximum plan benefit of $750 every six months. 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 and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are also covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Alignment Health Heart & Diabetes (HMO-POS C-SNP) plan, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. The plan also covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with a doctor referral. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered under the Alignment Health Heart & Diabetes (HMO-POS C-SNP) plan, with a 0-20% coinsurance for Durable Medical Equipment (DME), but Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit is covered with no coinsurance or copay, but Prosthetic Devices and Medical Supplies are not covered. Finally, Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay for all services. However, Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered, while Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Alignment Health Heart & Diabetes (HMO-POS C-SNP) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Alignment Health Heart & Diabetes (HMO-POS C-SNP) plan. Specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor referral. For days 1-20 and days 52-100, there is no copay, while days 21-51 have a $100 copay.
Other Services See details
The Alignment Health Heart & Diabetes (HMO-POS C-SNP) plan covers acupuncture with prior authorization, and offers unlimited treatments with no maximum plan benefit coverage amount. Over-the-counter (OTC) items are covered up to $25.00 every month, including nicotine replacement therapy and naloxone, but does not cover all drugs on the CMS OTC list. Meal benefits are covered for a chronic illness or medical condition that requires the enrollee to stay at home. Other services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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