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Alignment Health Heart & Diabetes NCPlus (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 NCPlus (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 NCPlus (HMO-POS C-SNP) in 2026, please refer to our full plan details page.
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) is a HMO-POS C-SNP plan offered by Alignment Healthcare USA, LLC available for enrollment in 2026 to people living in Mountains and Piedmont Regions. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that Alignment Health Heart & Diabetes NCPlus (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 NCPlus (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 NCPlus (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 NCPlus (HMO-POS C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $36.20. 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 $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 $9250.00 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 Heart & Diabetes NCPlus (HMO-POS C-SNP)
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Drug Coverage
The Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) prescription drug plan has an annual deductible of $615. You will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. For other prescription categories, Tier 2 generic drugs, Tier 3 preferred brand drugs, and Tier 5 specialty drugs for a one-month supply all carry a 25% coinsurance. Tier 4 non-preferred drugs require a 32% coinsurance for standard pharmacy and mail order fills.
Additional Benefits
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) offers comprehensive medical coverage featuring no copay and no coinsurance for primary care, telehealth, preventive services, and home health care. Specialist visits require a 30% coinsurance with no copay, while outpatient hospital services, emergency care, mental health services, and durable medical equipment generally carry a 20% coinsurance and no copay. Inpatient hospital stays and skilled nursing facility services are covered under standard Medicare-defined copays and coinsurance. This plan also includes valuable supplemental benefits with no copay and no coinsurance, including up to $2,400 annually for covered dental services, a $500 eyewear allowance every two years, and routine hearing exams with up to two prescription hearing aids per year. Additionally, members can access up to 50 one-way transportation trips per year to plan-approved locations and receive up to $379 monthly for over-the-counter items.
Inpatient Hospital See details
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) covers inpatient acute and psychiatric hospital services, which are subject to Medicare-defined copays and coinsurance, as well as prior authorization and referral requirements. While unlimited additional days are covered for acute care, psychiatric care does not include additional days, and non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization and referrals are required for these services, and the deductible is waived for the first three pints of blood.
Partial Hospitalization See details
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 50 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any other health-related locations is not covered.
Emergency Services See details
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) covers emergency services with a 20% coinsurance and no copay, which is waived if you are admitted to the hospital within three days. Urgently needed services feature no copay and no coinsurance, and worldwide emergency and urgent services are covered up to $25,000 with no copay or coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) covers primary care, telehealth, and routine podiatry with no copay and no coinsurance, while routine chiropractic care is covered up to 24 visits per year with other chiropractic services excluded. Specialist visits require a 30% coinsurance and no copay, whereas therapy, mental health, psychiatric, and opioid treatment services require a 20% coinsurance and no copay.
Preventive Services See details
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) covers preventive services, including annual physicals and most screenings with no copay and no coinsurance, though kidney education has no copay and a 20% coinsurance. This benefit is partially covered because several sub-services are not covered, including health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs for chemotherapy hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, extra smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) covers routine hearing exams and fitting evaluations annually with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance for up to two devices per year, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) with no copay and no coinsurance, which includes one routine eye exam every year and up to $500 for eyewear every two years. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) offers dental services with no copay and no coinsurance up to a $2,400 annual maximum, though prior authorization is required. The benefit is partially covered, as other diagnostic, other preventive, adjunctive general, maxillofacial prosthetics, implants, and orthodontic services are not covered.
Home Infusion bundled Services See details
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and radiation, carry a coinsurance ranging from no coinsurance to 20%, while covered insulin requires a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required to access this benefit.
Medical Equipment See details
Medical equipment is covered by Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) with no copay and 20% coinsurance, subject to prior authorization and vendor limitations. This benefit partially covers diabetic equipment, as diabetic therapeutic shoes and inserts are covered but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) provides partial coverage for diagnostic and radiological services, requiring referrals and prior authorization. Covered diagnostic procedures, lab services, and therapeutic radiological services have no copay and a 20% coinsurance, while diagnostic radiological services and outpatient x-ray services are not covered.
Home Health Services See details
Home Health Services are covered by Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) with no copay and no coinsurance. Members must obtain a referral and prior authorization before receiving these services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered in practice under the Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) plan. While the plan technically features no copay, key sub-services such as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) covers Skilled Nursing Facility (SNF) services with Medicare-defined cost-sharing, which includes standard Medicare copays and coinsurance. Prior authorization, a referral, and a three-day prior inpatient hospital stay are required for admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) covers acupuncture, over-the-counter (OTC) items, and meal benefits with no copay and no coinsurance. Acupuncture is limited to 24 treatments annually, OTC items are covered up to $379 monthly, and home meal benefits are provided for qualifying chronic illnesses or medical conditions.
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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* 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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