A non-government entity
Alignment Health Heart & Diabetes Care (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Heart & Diabetes Care (HMO 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 Care (HMO C-SNP) in 2026, please refer to our full plan details page.
Alignment Health Heart & Diabetes Care (HMO C-SNP) is a HMO 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 Care (HMO 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 Care (HMO 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 Care (HMO 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 Care (HMO C-SNP), 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 $250.00 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 $3400.00 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 Care (HMO C-SNP)
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 Heart & Diabetes Care (HMO C-SNP) Medicare plan features a $250 annual prescription drug deductible. Beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 2 generic drugs filled at standard pharmacies or via standard mail order. Tier 6 select care drugs are also highly accessible, with a $5 copay for a one-month supply and no copay for a three-month supply. For higher-tier medications, Tier 3 preferred brand drugs carry a $30 copay for a one-month supply, with a discounted $75 copay for a three-month mail-order supply. Tier 4 non-preferred drugs require a 40% coinsurance, while Tier 5 specialty drugs require a 25% coinsurance for a one-month supply. This plan offers a clear cost-sharing structure to help you manage your monthly healthcare expenses.
Additional Benefits
The Alignment Health Heart & Diabetes Care (HMO C-SNP) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care, telehealth, and routine preventive services. For specialized medical needs, specialist visits require a $15 copay, while inpatient hospital stays require a $375 daily copay for days one through six with no coinsurance. Emergency care is available with a $120 copay, which is waived if you are admitted, while urgently needed services require no copay or coinsurance. In addition to core medical care, the plan provides robust dental benefits up to a $2,000 annual maximum and a $300 annual eyewear allowance, both with no copay or coinsurance. Members also receive no-copay routine hearing exams, up to 50 one-way transportation trips to approved health locations, and a $25 monthly allowance for over-the-counter items. Other valuable services like home health care, cardiac rehabilitation, and up to 24 acupuncture visits per year are also covered with no copay or coinsurance.
Inpatient Hospital See details
Alignment Health Heart & Diabetes Care (HMO C-SNP) covers inpatient hospital services with no coinsurance, requiring a $375 daily copay for days 1 to 6 of acute stays (no copay for days 7 to 90) and a $250 copay for psychiatric stays. This benefit is partially covered, as upgrades and non-Medicare-covered stays are not covered, and prior authorization and referrals are required.
Outpatient Services See details
Alignment Health Heart & Diabetes Care (HMO C-SNP) covers outpatient hospital services with a $350 copay and ambulatory surgical center services with a $250 copay, both with no coinsurance. Outpatient substance abuse sessions require a $15 copay and no coinsurance, while outpatient blood services are available with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Alignment Health Heart & Diabetes Care (HMO C-SNP) with a $50.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Alignment Health Heart & Diabetes Care (HMO C-SNP), featuring a $150 copay and no coinsurance for ground and air ambulance services, with the copay waived if you are admitted to the hospital. Transportation services are partially covered with no copay or coinsurance for up to 50 one-way trips per year to plan-approved health-related locations, though transportation to any other health-related locations is not covered.
Emergency Services See details
Alignment Health Heart & Diabetes Care (HMO C-SNP) covers emergency services with a $120 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 48 hours. Urgently needed services are covered with no copay or coinsurance, while worldwide emergency and urgent care are partially covered up to a $25,000 limit with no copay or coinsurance, excluding worldwide emergency transportation.
Primary Care See details
Alignment Health Heart & Diabetes Care (HMO C-SNP) offers primary care, telehealth, and therapy services with no copay and no coinsurance, while specialist visits, routine podiatry, and routine chiropractic care require a $15 copay and no coinsurance. Opioid treatment is covered with no copay and a 20% coinsurance, but mental health specialty and psychiatric services are not covered.
Preventive Services See details
Preventive services are partially covered by Alignment Health Heart & Diabetes Care (HMO C-SNP) with no copay and no coinsurance for covered benefits like annual physicals, kidney disease education, and select supplemental support. However, several additional preventive services are not covered, including health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Alignment Health Heart & Diabetes Care (HMO C-SNP) 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 aids per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Alignment Health Heart & Diabetes Care (HMO C-SNP) partially covers vision services with no copay and no coinsurance, which includes one routine eye exam and up to $300 annually for eyewear. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Alignment Health Heart & Diabetes Care (HMO C-SNP) provides partially covered dental services with no copay and no coinsurance up to a maximum annual benefit of $2,000. While preventive, restorative, and surgical services are covered (prior authorization required), other diagnostic, other preventive, adjunctive general, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Alignment Health Heart & Diabetes Care (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Alignment Health Heart & Diabetes Care (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Alignment Health Heart & Diabetes Care (HMO C-SNP) covers durable medical equipment with no copay and 0% to 20% coinsurance, subject to prior authorization and preferred vendor limitations. While prosthetics, medical supplies, and diabetic equipment are technically covered with no copay and no coinsurance, some services are covered but prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Alignment Health Heart & Diabetes Care (HMO C-SNP) with no copays, featuring no coinsurance for covered diagnostic services and a 20% coinsurance for therapeutic radiological services. Diagnostic procedures, lab services, diagnostic radiological services, and outpatient x-ray services are not covered.
Home Health Services See details
Alignment Health Heart & Diabetes Care (HMO C-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Alignment Health Heart & Diabetes Care (HMO C-SNP) provides coverage for Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization and a referral are required. 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 Heart & Diabetes Care (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 4, a $20 daily copay for days 5 through 20, and a $178 daily copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Alignment Health Heart & Diabetes Care (HMO C-SNP) covers several additional services with no copay and no coinsurance, including up to 24 acupuncture treatments yearly, digital health technology support, and meal benefits for qualifying chronic conditions. Members also receive a $25 monthly reimbursement for over-the-counter (OTC) items, which includes coverage for nicotine replacement therapy and naloxone.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved