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Alignment Health Platinum Select (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Platinum Select (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 Select (HMO) in 2026, please refer to our full plan details page.
Alignment Health Platinum Select (HMO) is a HMO 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 Platinum Select (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 Select (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 Select (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 a $225.00 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 $5900.00 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 Platinum Select (HMO) plan features an annual drug deductible of $225. For prescription savings, the plan offers no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs filled at standard pharmacies or through standard mail order. Tier 3 (Preferred Brand) drugs require a $45 copay for a one-month supply, $90 for a two-month supply, and $135 for a three-month supply. For higher-tier medications, Tier 4 (Non-Preferred Drugs) carry a 40% coinsurance, while Tier 5 (Specialty Tier) drugs require a 25% coinsurance for a one-month supply. Tier 6 (Select Care Drugs) are highly affordable, requiring a $5 copay for one month, a $10 copay for two months, and no copay for a three-month supply. This drug plan structure helps beneficiaries easily manage standard pharmacy and mail-order prescription costs.
Additional Benefits
The Alignment Health Platinum Select (HMO) plan offers robust medical coverage with no copay for primary care, telehealth visits, and preventive services. For specialized medical needs, specialist visits require a $20 copay, while inpatient hospital stays feature a $200 daily copay for the first two days and a $350 daily copay for days three through seven with no coinsurance. Emergency care carries a $120 copay, which is waived if you are admitted, while urgently needed services require no copay. This plan also includes valuable supplemental benefits, such as dental care with no copay up to a $2,000 annual limit and vision coverage with no copay alongside a $300 annual eyewear allowance. Routine hearing exams are available with no copay, while prescription hearing aids require copays ranging from $195 to $1,750. Additionally, members can take advantage of no copay for up to 28 one-way transportation trips per year and a $40 monthly allowance for over-the-counter items.
Inpatient Hospital See details
Alignment Health Platinum Select (HMO) covers inpatient hospital services with no coinsurance, requiring a $200 daily copay for days 1-2 and $350 daily for days 3-7 of acute stays, and a $295 daily copay for days 1-6 of psychiatric stays. There is no copay for subsequent days, but upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Alignment Health Platinum Select (HMO) covers outpatient services with no coinsurance, featuring a $275 copay for outpatient hospital services, a $100 copay for ambulatory surgical center services, and a $35 copay for outpatient substance abuse sessions. Outpatient blood services are also covered with no copay and no coinsurance, although prior authorization and referrals are required for most of these services.
Partial Hospitalization See details
Partial hospitalization services are covered by Alignment Health Platinum Select (HMO) with a $35.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Alignment Health Platinum Select (HMO) covers ground and air ambulance services with a $200 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 28 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Alignment Health Platinum Select (HMO) covers emergency services with a $120 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have no copay or coinsurance, and worldwide emergency and urgent services are partially covered up to $25,000 with no copay or coinsurance, excluding worldwide emergency transportation.
Primary Care See details
Alignment Health Platinum Select (HMO) covers primary care, telehealth, and routine podiatry services with no copay and no coinsurance, while chiropractic care is partially covered with no copay or coinsurance, excluding other chiropractic services. Specialist visits require a $20 copay, physical and speech therapy require a $10 copay, and occupational therapy, mental health, and psychiatric services require a $35 copay, all with no coinsurance, while opioid treatment has no copay and 50% coinsurance.
Preventive Services See details
Alignment Health Platinum Select (HMO) offers partially covered preventive services with no copay and no coinsurance for covered services, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management training. While a memory fitness program is covered, several supplemental services are not covered, such as health education, in-home safety assessments, personal emergency response systems, and nutritional or dietary benefits.
Hearing Services See details
Alignment Health Platinum Select (HMO) partially covers hearing services, offering one routine hearing exam and one fitting evaluation annually with no copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and a copay ranging from $195 to $1,750, though OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Alignment Health Platinum Select (HMO) covers vision services with no copay and no coinsurance, providing one routine eye exam and up to $300 annually for eyewear like contacts or eyeglasses. This benefit is partially covered, as other eye exam services and upgrades are not covered.
Dental Services See details
Alignment Health Platinum Select (HMO) partially covers dental services with no copay and no coinsurance up to a $2,000 annual maximum, though prior authorization is required for most services. Covered treatments include oral exams, cleanings, x-rays, fluoride, restorative services, endodontics, periodontics, prosthodontics, and oral surgery, while implants, orthodontics, maxillofacial prosthetics, adjunctive general services, and other diagnostic or preventive dental services are not covered.
Home Infusion bundled Services See details
Alignment Health Platinum Select (HMO) covers home infusion bundled services with no copay and no coinsurance, although prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Alignment Health Platinum Select (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive this care.
Medical Equipment See details
Alignment Health Platinum Select (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered under this plan, offering diabetic therapeutic shoes and inserts with no copay and 20% coinsurance, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Alignment Health Platinum Select (HMO) partially covers diagnostic and radiological services with no copay, featuring no coinsurance for covered diagnostic services and a 20% coinsurance for therapeutic radiological services. However, diagnostic procedures and tests, lab services, diagnostic radiological services, and outpatient x-ray services are not covered.
Home Health Services See details
Home Health Services are covered by Alignment Health Platinum Select (HMO) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Alignment Health Platinum Select (HMO) with no coinsurance and a $10 copay, requiring prior authorization and a referral. While some services are covered, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Alignment Health Platinum Select (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $178 daily copay for days 21 through 100. Prior authorization and referrals are required for this benefit, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Alignment Health Platinum Select (HMO) covers supplemental services such as acupuncture, meal benefits, and digital health technology support with no copay and no coinsurance. Over-the-counter (OTC) items are also covered with no copay or coinsurance up to $40 monthly, while personalized health risk screenings are available with a $75 copay and no coinsurance.
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