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Alignment Health Heart & Diabetes (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 (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 (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Alignment Health Heart & Diabetes (HMO-POS C-SNP) is a HMO-POS C-SNP 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 Heart & Diabetes (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 (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 (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 (HMO-POS 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2400.00 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 Heart & Diabetes (HMO-POS C-SNP) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying copays or coinsurance depending on the drug tier and pharmacy. For example, you'll pay no copay for preferred generic drugs at standard mail pharmacies, but a $45 copay for standard generic drugs at standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, you may still be responsible for costs for excluded drugs covered under any enhanced benefit. If you qualify for the low-income subsidy, the plan's premium may be reduced.
Additional Benefits
The Alignment Health Heart & Diabetes (HMO-POS C-SNP) plan offers a range of benefits, including inpatient hospital care with a copay, outpatient services, and partial hospitalization. Emergency and urgent care services have copays, and ambulance services are covered with a copay. The plan also covers primary care, preventive services, and home health services with no copays, along with hearing, vision, and dental services with annual limits. Additional benefits include home infusion, dialysis, and medical equipment coverage, with varying cost-sharing. Other services such as acupuncture, over-the-counter items, and meal benefits are also included. Note that some services require prior authorization or doctor referrals, and specific services may have copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $120 copay for days 1-5, and no copay for days 6-90, and for Inpatient Hospital Psychiatric, you will pay a $250 copay.
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 of $15.
Partial Hospitalization See details
Partial Hospitalization is covered by the Alignment Health Heart & Diabetes (HMO-POS C-SNP) plan, and requires prior authorization and a doctor referral. There is a $15 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and Air Ambulance Services have a $200 copay, waived if admitted to the hospital, with no coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 50 one-way trips per year, with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Alignment Health Heart & Diabetes (HMO-POS C-SNP) plan. Emergency Services have a $70 copay and no coinsurance, while Urgently Needed Services have no copay or coinsurance. Worldwide Emergency Services have a maximum plan benefit coverage of $25,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health Heart & Diabetes (HMO-POS C-SNP) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Physician Specialist Services have a $15 copay, and Opioid Treatment Program Services have a 20% coinsurance. Individual and group sessions for Mental Health Specialty Services and Psychiatric Services are not covered.
Preventive Services See details
The Alignment Health Heart & Diabetes (HMO-POS C-SNP) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, and additional preventive services requiring prior authorization and a doctor's referral. This plan also covers Personal Emergency Response System, In-Home Support Services, Support for Caregivers of Enrollees (with a $300 maximum benefit), and Fitness Benefits. The plan does not cover Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, 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, Home and Bathroom Safety Devices and Modifications, or Counseling Services.
Hearing Services See details
Hearing services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids (all types), and are covered. Routine hearing exams and fitting/evaluation for hearing aids are covered once per year, and prescription hearing aids (all types) are covered with a copay between $195 and $1750 for 2 visits per year. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered, nor are OTC hearing aids.
Vision Services See details
The Alignment Health Heart & Diabetes (HMO-POS C-SNP) plan covers vision services, including routine eye exams with one visit per year, and eyewear with a combined maximum benefit of $200 per year. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered, with one pair or set available each year. Upgrades are not covered.
Dental Services See details
Dental services are covered with a maximum plan benefit of $2,000 per year. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered, with limitations on the number of visits and periodicity. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered, while adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay with coinsurance between 0-20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered with a doctor referral, and the coinsurance is 20%.
Medical Equipment See details
Medical Equipment is covered, but Durable Medical Equipment (DME) has a coinsurance of 0-20% and requires authorization, while DME for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit is covered with no coinsurance or copay, but Prosthetic Devices and Medical Supplies are not covered. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Alignment Health Heart & Diabetes (HMO-POS C-SNP) plan, but some services are not covered including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services. Therapeutic Radiological Services have a coinsurance of at most 20%, while all other covered services have no copay.
Home Health Services See details
Home Health Services are covered by the Alignment Health Heart & Diabetes (HMO-POS C-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires prior authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Alignment Health Heart & Diabetes (HMO-POS C-SNP) plan with prior authorization and a doctor's referral. For days 1-31, there is no copay, and for days 32-100, there is a $50 copay.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, meal benefits, and digital health technology support. Acupuncture requires prior authorization, and OTC items are covered up to $40 every month, including nicotine replacement therapy and Naloxone.
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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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