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Alignment Health the ONE + Walgreens (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health the ONE + Walgreens (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health the ONE + Walgreens (HMO-POS) in 2025, please refer to our full plan details page.
Alignment Health the ONE + Walgreens (HMO-POS) is a HMO-POS plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in El Paso & Hudspeth. The overall rating for this plan is not yet available for 2025.
It's important to know that Alignment Health the ONE + Walgreens (HMO-POS) 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 the ONE + Walgreens (HMO-POS).
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 the ONE + Walgreens (HMO-POS), 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 $2950.00 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 the ONE + Walgreens (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different copays depending on the drug tier and pharmacy. For example, you will pay no copay for preferred generic drugs at a standard pharmacy and a $45 copay for standard generic drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Alignment Health the ONE + Walgreens (HMO-POS) plan offers a variety of benefits, including coverage for inpatient and outpatient services. This plan also covers services like primary care, preventive services, hearing, vision, and dental, with varying copays and coinsurance amounts depending on the service. Additional benefits include ambulance and transportation services, emergency services, and home health services with no copay. The plan provides coverage for medical equipment and home infusion services, as well as cardiac rehabilitation, skilled nursing facility, and other services like acupuncture and over-the-counter items. Some services require prior authorization and doctor referrals, and some services have exclusions.
Inpatient Hospital See details
Inpatient Hospital services, including those not usually covered by Medicare, are covered. For Inpatient Hospital-Acute, there is no copay for days 1-2 and days 8-90, and a $120 copay for days 3-7. For Inpatient Hospital Psychiatric, there is a $120 copay for days 1-10, and no copay for days 11-90.
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 between $50 and $50.
Partial Hospitalization See details
Partial Hospitalization is covered under the Alignment Health the ONE + Walgreens (HMO-POS) plan. This benefit requires prior authorization and a doctor referral, and has a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services with a $200 copay. Transportation services to a plan-approved health-related location are covered for 34 one-way trips per year, with medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered. Emergency Services have a $100 copay, while Urgently Needed Services have no copay. Worldwide Emergency Services have a maximum plan benefit coverage of $50,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care services include coverage for Physician, Chiropractic, Occupational Therapy, Physician Specialist, Mental Health, Podiatry, Other Health Care Professional, Psychiatric, Physical Therapy, Speech-Language Pathology, Additional Telehealth, and Opioid Treatment Program Services. Physician Specialist services have a $15 copay, while Individual and Group Sessions for Mental Health and Psychiatric Services have a $5 and $20 copay, respectively. Routine Foot Care has a $5 copay, and Opioid Treatment Program Services have a 20% coinsurance.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, annual physical exams, additional preventive services, kidney disease education services, and other preventive services. Some services are not covered, including Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, Home-Based Palliative Care, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services.
Hearing Services See details
Hearing Services include routine hearing exams and fitting/evaluation for hearing aids, with one visit covered per year for each service. Prescription hearing aids are covered, with a copay between $195 and $1750 for two visits per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with no deductible or coinsurance, and are limited to one visit every year. Eyewear is covered with a combined maximum of $200 every year, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, each limited to one per year. Upgrades are not covered.
Dental Services See details
The Alignment Health the ONE + Walgreens (HMO-POS) plan covers a range of dental services, including oral exams (1 visit every 6 months), dental x-rays (1 every three years), prophylaxis (cleaning) (1 visit every 6 months), and fluoride treatment (1 visit every 6 months). This plan also covers restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no limit, and a maximum benefit of $2,500 per year. However, adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and a coinsurance between 0% and 20%, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Alignment Health the ONE + Walgreens (HMO-POS) plan, with a doctor referral required. There is a 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered, with no copay. Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, but Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, 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%, and all other services have no copay.
Home Health Services See details
Home Health Services are covered by Alignment Health the ONE + Walgreens (HMO-POS) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the sub-services, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are covered. Prior authorization and a doctor referral are required for coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor referral. For days 1-20, the copay is $20 per day, and for days 21-100, the copay is $100 per day; however, additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture, over-the-counter (OTC) items, meal benefits, and other services. Acupuncture is covered with no copay, and OTC items are covered up to $30 per month. Other services include personalized health risk screening with a $75 copay. The plan does not cover dual eligible SNPs with highly integrated services, or the following services: Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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