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Alignment Health smartHMO (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health smartHMO (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health smartHMO (HMO) in 2026, please refer to our full plan details page.
Alignment Health smartHMO (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 smartHMO (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 smartHMO (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 smartHMO (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. Additionally, this plan comes with a Part B Premium reduction of $135.00. You must continue to pay paying your reduced 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 $2499.00 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 smartHMO (HMO) prescription drug plan features an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 2 generic medications filled at standard pharmacies or through mail order for up to a three-month supply. For Tier 6 select care drugs, you will pay a $5 copay for a one-month supply, a $10 copay for a two-month supply, and no copay for a three-month supply. Higher-tier medications under this plan require copayments or coinsurance, such as Tier 3 preferred brand drugs which cost a $45 copay for a one-month supply. Tier 4 non-preferred drugs require a 32% coinsurance, and Tier 5 specialty drugs carry a 25% coinsurance for a one-month supply. These clear cost-sharing tiers help you understand your out-of-pocket expenses for both standard retail pharmacies and mail-order services.
Additional Benefits
The Alignment Health smartHMO (HMO) offers affordable medical coverage with many essential services featuring no copay and no coinsurance. You will pay no copay and no coinsurance for primary care doctor visits, telehealth, preventive care, and home health services. Specialist visits require a low $5 copay, emergency room visits have a $90 copay, and inpatient hospital stays require a $125 daily copay for days 1 through 6 with no copay thereafter. Routine hearing and vision exams are covered with no copay, and the plan includes a $100 eyewear allowance every two years. While preventive dental services have no coinsurance, they do require small copays, such as $10 for oral exams and $20 for cleanings. For specialized medical needs, skilled nursing facility stays require daily copays, while medical equipment and dialysis services carry a 20% coinsurance with no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Alignment Health smartHMO (HMO) with no coinsurance, as upgrades and non-Medicare-covered stays are not covered. Covered acute stays require a $125 daily copay for days 1 to 6 with no copay thereafter, while psychiatric stays require a $120 daily copay for days 1 to 10 and no copay for days 11 to 90.
Outpatient Services See details
Alignment Health smartHMO (HMO) covers outpatient hospital services with a $200 copay and no coinsurance, and ambulatory surgical center services with a $50 copay and no coinsurance. Outpatient substance abuse sessions require a $35 copay and no coinsurance, while outpatient blood services are available with no copay and no coinsurance.
Partial Hospitalization See details
Alignment Health smartHMO (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Alignment Health smartHMO (HMO) covers ambulance services with no coinsurance, requiring a $100 copay for ground transport and a $200 copay for air transport, both of which are waived if you are admitted to the hospital. Some transportation services are covered, but transportation to plan-approved or health-related locations is not covered.
Emergency Services See details
Alignment Health smartHMO (HMO) emergency services are covered with a $90 copay and no coinsurance, which is waived if admitted within 48 hours, while urgently needed services require a $15 copay and no coinsurance. Worldwide emergency and urgent care are partially covered with no copay or coinsurance up to a $25,000 maximum, excluding worldwide emergency transportation.
Primary Care See details
Alignment Health smartHMO (HMO) covers primary care, telehealth, occupational therapy, physical therapy, and speech-language pathology with no copay and no coinsurance. Specialist visits require a $5 copay and no coinsurance, mental health sessions cost a $10 copay and no coinsurance, psychiatric sessions cost a $20 copay and no coinsurance, and opioid treatment has no copay with 20% coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services under the Alignment Health smartHMO (HMO) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and screenings. Additional preventive services are partially covered with no copay or coinsurance, providing coverage for a personal emergency response system and memory fitness, while excluding services like health education, in-home safety assessments, and nutritional therapy.
Hearing Services See details
Hearing services are partially covered by Alignment Health smartHMO (HMO), which offers one routine hearing exam and one fitting evaluation annually with no copay and no coinsurance. However, prescription hearing aids and OTC hearing aids are not covered under this plan.
Vision Services See details
Alignment Health smartHMO (HMO) features partially covered vision services with no copay, no coinsurance, and no deductible for covered care. This benefit includes one routine eye exam per year and a $100 allowance every two years for contacts or eyeglasses, while other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Alignment Health smartHMO (HMO), featuring no copay and no coinsurance for general Medicare-covered dental services. While there is no coinsurance for preventive care, copays apply for oral exams ($10), cleanings ($20), fluoride ($10), and x-rays ($30), whereas other diagnostic, other preventive, orthodontic, adjunctive general, maxillofacial prosthetics, and implant services are not covered.
Home Infusion bundled Services See details
Alignment Health smartHMO (HMO) 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—carry a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Alignment Health smartHMO (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Both prior authorization and a referral are required for these services.
Medical Equipment See details
Alignment Health smartHMO (HMO) covers medical equipment with no copay and 20% coinsurance, though prior authorization is required. This benefit is partially covered because durable medical equipment, prosthetics, and diabetic therapeutic shoes are covered, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Alignment Health smartHMO (HMO) with no copays, though diagnostic procedures, lab services, diagnostic radiological services, and outpatient x-ray services are not covered. Covered diagnostic services require no coinsurance, while covered therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Alignment Health smartHMO (HMO) plan with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under the Alignment Health smartHMO (HMO) plan technically feature no copay and no coinsurance, but are not covered in practice. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Alignment Health smartHMO (HMO) covers Skilled Nursing Facility (SNF) services for up to 100 days with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $100 daily copay for days 21 through 100. Prior authorization and referrals are required, a prior three-day hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Alignment Health smartHMO (HMO) partially covers other services, offering digital health technology support with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan.
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