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Alignment Health Platinum + Instacart (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Platinum + Instacart (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 + Instacart (HMO) in 2026, please refer to our full plan details page.
Alignment Health Platinum + Instacart (HMO) is a HMO plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in Clark. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that Alignment Health Platinum + Instacart (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 + Instacart (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 + Instacart (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 $1499.00 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:
Sign up for Alignment Health Platinum + Instacart (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Alignment Health Platinum + Instacart (HMO) Medicare plan features a $0 prescription drug deductible, meaning your coverage begins immediately. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay for one, two, or three-month supplies filled at standard pharmacies or through standard mail order. This makes managing common maintenance prescriptions highly affordable. For Tier 3 preferred brand drugs, standard copays are $40 for a one-month supply, $80 for a two-month supply, and $120 for a three-month supply. Tier 4 non-preferred drugs require a 32% coinsurance, while Tier 5 specialty drugs carry a 33% coinsurance for a one-month supply. Tier 6 select care drugs cost $5 for a one-month supply, $10 for a two-month supply, and have no copay for a three-month supply.
Additional Benefits
The Alignment Health Platinum + Instacart (HMO) plan offers robust medical coverage with no copays or coinsurance for acute inpatient hospital stays, outpatient hospital services, primary care, and specialist visits. Emergency room visits and ambulance services require a low $50 copay, which is waived if you are admitted, while urgent care and worldwide emergency services have no copay. Additionally, members benefit from no copays or coinsurance for home health care, skilled nursing facility stays, and up to 24 one-way medical transportation trips per year. For specialty care, the plan features no copays or coinsurance for routine dental services up to a $3,000 annual limit, routine eye exams with a $300 annual eyewear allowance, and routine hearing exams. Prescription hearing aids are available with copays ranging from $195 to $1,750, while dialysis and durable medical equipment carry a coinsurance of up to 20% with no copay. Many of these benefits, including diagnostic services and medical equipment, require prior authorization or referrals to ensure covered care.
Inpatient Hospital See details
Alignment Health Platinum + Instacart (HMO) inpatient hospital benefits are partially covered, as upgrades and non-Medicare-covered stays are excluded. Acute inpatient hospital stays require no copay and no coinsurance, while psychiatric stays have no coinsurance and a $120 daily copay for days 1 through 10, with no copay for other covered days.
Outpatient Services See details
Outpatient services are covered by Alignment Health Platinum + Instacart (HMO) with no copay and no coinsurance for outpatient hospital, observation, ambulatory surgical center, and blood services. Outpatient substance abuse individual and group sessions are covered with a $25 copay and no coinsurance, with prior authorization and referrals required for services.
Partial Hospitalization See details
Alignment Health Platinum + Instacart (HMO) covers partial hospitalization services with a $55 copay and no coinsurance. Both prior authorization and a referral are required to receive this covered benefit.
Ambulance and Transportation Services See details
Alignment Health Platinum + Instacart (HMO) covers ground and air ambulance services with a $50 copay and no coinsurance, which is waived if you are admitted to the hospital. Transportation services are partially covered, offering up to 24 one-way medical transport trips per year to plan-approved locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Alignment Health Platinum + Instacart (HMO) covers emergency services with a $50 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 48 hours. Urgently needed services and worldwide emergency and urgent care are covered with no copay and no coinsurance, up to a $25,000 maximum limit, though worldwide emergency transportation is not covered.
Primary Care See details
Alignment Health Platinum + Instacart (HMO) provides primary care, specialist, telehealth, and therapy services with no copay and no coinsurance, though psychiatric sessions require a $5 copay with no coinsurance and opioid treatment has a 20% coinsurance with no copay. Chiropractic services are partially covered with no copay or coinsurance, excluding other chiropractic services, while some mental health specialty services are covered but individual and group sessions are not covered.
Preventive Services See details
Alignment Health Platinum + Instacart (HMO) provides partially covered preventive services with no copay and no coinsurance for covered care, which includes annual physical exams, kidney disease education, and glaucoma screenings. However, several additional preventive sub-services are not covered, including health education, weight management programs, nutritional/dietary benefits, in-home safety assessments, and home safety devices.
Hearing Services See details
Alignment Health Platinum + Instacart (HMO) covers annual 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 for up to two devices per year, but inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Alignment Health Platinum + Instacart (HMO), offering one routine eye exam per year and up to $300 annually for eyewear with no copay and no coinsurance. Other eye exam services and eyewear upgrades are not covered under this plan.
Dental Services See details
Dental services under the Alignment Health Platinum + Instacart (HMO) are partially covered with no copay and no coinsurance up to a $3,000 annual maximum, though prior authorization is required. While exams, cleanings, x-rays, and restorative care are covered, other diagnostic, other preventive, adjunctive general, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Alignment Health Platinum + Instacart (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Medicare Part B drugs for these services, including chemotherapy, insulin, and other drugs, are subject to a coinsurance ranging from no coinsurance to 20%, with insulin also carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the Alignment Health Platinum + Instacart (HMO) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive this benefit.
Medical Equipment See details
Alignment Health Platinum + Instacart (HMO) partially covers medical equipment with no copays, but prior authorization is required. Durable medical equipment ranges from no coinsurance to 20% coinsurance, and prosthetic devices, medical supplies, and diabetic therapeutic shoes carry a 20% coinsurance, though diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Alignment Health Platinum + Instacart (HMO) partially covers diagnostic and radiological services with no copays, though prior authorization and referrals are required. Covered diagnostic services have no coinsurance, but lab services and diagnostic procedures/tests are not covered. Covered radiological services feature no coinsurance except for therapeutic radiological services which require a 20% coinsurance, while diagnostic radiological and outpatient X-ray services are not covered.
Home Health Services See details
Home health services are covered by the Alignment Health Platinum + Instacart (HMO) plan with no copay and no coinsurance. Please note that both a referral and prior authorization are required to receive this care.
Cardiac Rehabilitation Services See details
Alignment Health Platinum + Instacart (HMO) covers Cardiac Rehabilitation Services with no copay and no coinsurance; however, some services are covered, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Alignment Health Platinum + Instacart (HMO) with no copay and no coinsurance, though prior authorization and referrals are required. While admission does not require a prior three-day inpatient hospital stay, additional days beyond Medicare-covered days are not covered.
Other Services See details
Other Services are partially covered by Alignment Health Platinum + Instacart (HMO), with meal benefits not covered. Acupuncture, over-the-counter items, and digital health technology support are offered with no copay and no coinsurance, while personalized health risk screenings are covered with a $75 copay and no coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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