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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 2025, 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, Washoe. This plan received an overall rating of 5 out of 5 stars in 2025.
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)
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Drug Coverage
The Alignment Health Platinum + Instacart (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy type. For example, you'll have no copay for preferred generic drugs at a standard pharmacy, and a $40 copay for standard generic drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. This plan offers enhanced alternative drug coverage, and your premium may be reduced if you qualify for the low-income subsidy (LIS).
Additional Benefits
The Alignment Health Platinum + Instacart (HMO) plan offers comprehensive coverage, including inpatient and outpatient services, with varying copays and coinsurance. Emergency services have a $50 copay, while many preventive services are covered with no cost. The plan also includes dental, vision, and hearing benefits, providing up to $3,000 per year for dental services and covering routine eye exams and hearing aids.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization and a doctor's referral; Inpatient Hospital Psychiatric has a copay of $120 for days 1-10, and no copay for days 11-90. Additional days for Inpatient Hospital-Acute are covered, and additional days for Inpatient Hospital Psychiatric are covered up to 40 days. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Individual and group sessions for outpatient substance abuse have a copay of $25.00 per session.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay, but prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $50 copay. Transportation Services to a plan-approved health-related location are covered for up to 24 one-way trips per year, while transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services are covered by the Alignment Health Platinum + Instacart (HMO) plan, with a $50 copay and no coinsurance. Urgently Needed Services have no copay or coinsurance, and Worldwide Emergency Services are covered up to $25,000 with no copay or coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health Platinum + Instacart (HMO) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Mental Health Specialty Services is partially covered, but Individual and Group Sessions for Mental Health are not covered. Individual and Group Sessions for Psychiatric Services have a $5 copay, and Opioid Treatment Program Services have a 20% coinsurance.
Preventive Services See details
The Alignment Health Platinum + Instacart (HMO) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, additional preventive services, kidney disease education services, and other preventive services. The plan also covers personal emergency response systems, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, and fitness benefits. Health education, in-home safety assessments, 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 benefits, home-based palliative care, 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, with no deductible or coinsurance. Routine hearing exams and fitting/evaluation for hearing aids are each covered for one visit per year, while prescription hearing aids (all types) are covered for two visits per year with a copay between $195 and $1750. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams once per year, and eyewear with a combined maximum benefit of $300 per year, and also covers contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Upgrades are not covered.
Dental Services See details
The Alignment Health Platinum + Instacart (HMO) plan covers a maximum of $3,000 per year for dental services, including oral exams (1 visit every six months), dental x-rays (1 every three years), prophylaxis (cleaning) (1 visit every six months), fluoride treatment (1 visit every six months), restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Alignment Health Platinum + Instacart (HMO) plan, requiring a doctor's referral. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), is covered with a coinsurance between 0% and 20%. Prosthetic devices and medical supplies are covered with 20% coinsurance, while diabetic therapeutic shoes/inserts are covered with a 20% coinsurance. Durable Medical Equipment for use outside the home and diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by the Alignment Health Platinum + Instacart (HMO) plan. There is no copay for any services, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered. Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Alignment Health Platinum + Instacart (HMO) plan with no copay or coinsurance, but prior authorization and a referral are required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the sub-services are covered. Prior authorization and a doctor referral are required for Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered stays are not covered. Prior authorization and a doctor referral are required.
Other Services See details
Under "Other Services", Acupuncture is covered with prior authorization, and there is no copay or coinsurance. Over-the-Counter (OTC) Items are covered up to $25.00 every month, including nicotine replacement therapy and naloxone coverage. Personalized Health Risk Screenings under "Other 1" require prior authorization and a doctor referral, with a $75 copay and a maximum benefit of $200.00 every two years. Digital Health Technology Support under "Other 2" is covered. Some other services are not covered.
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