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Alignment Health smartHMO (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health smartHMO (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 smartHMO (HMO-POS) in 2026, please refer to our full plan details page.
Alignment Health smartHMO (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. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Alignment Health smartHMO (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 smartHMO (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 smartHMO (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. Additionally, this plan comes with a Part B Premium reduction of $122.90. You must continue to pay paying your reduced 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 $6450.00 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 smartHMO (HMO-POS) prescription drug plan features an annual drug deductible of $615. Beneficiaries pay no copay for Tier 1 preferred generic and Tier 2 generic drugs for one, two, or three-month supplies at standard pharmacies and standard mail order. Additionally, Tier 6 select care drugs have no copay for a three-month supply, with a $5 copay for one month and a $10 copay for two months. For higher-tier medications, Tier 3 preferred brand drugs require a $45 copay for a one-month supply, $90 for two months, and $135 for three months. Tier 4 non-preferred drugs carry a 32% coinsurance for all supply lengths, while Tier 5 specialty drugs require a 25% coinsurance for a one-month supply. These cost-sharing rates apply to both standard retail pharmacies and standard mail-order services.
Additional Benefits
The Alignment Health smartHMO (HMO-POS) plan offers primary care, telehealth, physical therapy, and annual preventive services with no copay and no coinsurance. For specialized medical needs, members pay a $35 copay for specialist visits, a $200 copay for outpatient hospital services, and a $120 copay for emergency room visits. Inpatient hospital stays require a $375 daily copay for the first six days of acute care, while skilled nursing facility stays require a $10 daily copay for the first 20 days. Routine dental exams, cleanings, annual eye exams, and routine hearing tests are covered with no copay, though comprehensive dental and hearing aids are excluded. Home health services and home infusions are also provided with no copay, while medical equipment and dialysis services require a 20% coinsurance with no copay. Additionally, diagnostic services feature no copays, though therapeutic radiological services require a 20% coinsurance.
Inpatient Hospital See details
Alignment Health smartHMO (HMO-POS) offers partially covered inpatient hospital benefits with no coinsurance, featuring a $375 daily copay for days 1-6 of acute stays and a $120 daily copay for days 1-10 of psychiatric stays, followed by no copay for remaining covered days. Non-Medicare-covered stays and acute room upgrades are not covered, and both prior authorization and referrals are required.
Outpatient Services See details
Alignment Health smartHMO (HMO-POS) covers outpatient services with no coinsurance, including outpatient hospital services for a $200 copay and ambulatory surgical center services for a $50 copay. Outpatient substance abuse sessions require a $35 copay with no coinsurance, while outpatient blood services are provided with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Alignment Health smartHMO (HMO-POS) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Alignment Health smartHMO (HMO-POS) covers Medicare-covered ground and air ambulance services with a $200 copay and no coinsurance, which is waived if you are admitted to the hospital. Prior authorization is required for ambulance services, and transportation services to health-related locations are not covered.
Emergency Services See details
Alignment Health smartHMO (HMO-POS) covers emergency services with a $120 copay and no coinsurance, which is waived if admitted to the hospital within 48 hours, and urgently needed services with a $20 copay and no coinsurance. Worldwide emergency and urgent care are partially covered with no copay and no coinsurance up to a $25,000 maximum benefit limit, although worldwide emergency transportation is not covered.
Primary Care See details
Alignment Health smartHMO (HMO-POS) provides primary care physician visits, telehealth, and physical, occupational, and speech therapies with no copay and no coinsurance. Specialist visits require a $35 copay, mental health sessions have a $10 copay, psychiatric services have a $20 copay (all with no coinsurance), and opioid treatment has a 20% coinsurance with no copay, while chiropractic and podiatry services are not covered.
Preventive Services See details
Alignment Health smartHMO (HMO-POS) covers preventive services, including annual physical exams, kidney disease education, and diabetes self-management training, with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance, but do not cover health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home modifications, and counseling.
Hearing Services See details
Alignment Health smartHMO (HMO-POS) covers one routine hearing exam and one fitting/evaluation visit per year with no copay and no coinsurance. While some prescription hearing aid services are covered, prescription hearing aids (including all types, inner ear, outer ear, and over the ear) and OTC hearing aids are not covered in practice.
Vision Services See details
Alignment Health smartHMO (HMO-POS) offers partial coverage for vision services with no copay, no coinsurance, and no deductible, which includes one routine eye exam annually and up to $100 every two years for eyewear. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Alignment Health smartHMO (HMO-POS) partially covers dental services with no copay and no coinsurance for covered benefits like oral exams, cleanings, fluoride, and X-rays, which require prior authorization. Comprehensive services, including restorative, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics, as well as other diagnostic and preventive dental services, are not covered.
Home Infusion bundled Services See details
Alignment Health smartHMO (HMO-POS) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Related Medicare Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Alignment Health smartHMO (HMO-POS) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these services.
Medical Equipment See details
Alignment Health smartHMO (HMO-POS) covers medical equipment and prosthetics with no copay and a 20% coinsurance, subject to prior authorization. This benefit is partially covered because diabetic therapeutic shoes and inserts are covered under these same terms, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Alignment Health smartHMO (HMO-POS) with no copays, though prior authorization and referrals are required. While diagnostic services have no coinsurance and therapeutic radiological services require a 20% coinsurance, diagnostic procedures, lab services, diagnostic radiological services, and outpatient X-rays are not covered.
Home Health Services See details
Alignment Health smartHMO (HMO-POS) covers home health services with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Alignment Health smartHMO (HMO-POS) plan, as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Alignment Health smartHMO (HMO-POS) covers skilled nursing facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $100 daily copay for days 21 to 100. Prior authorization and referrals are required, a prior three-day hospital stay is not, and additional days beyond the standard 100 days are not covered.
Other Services See details
Alignment Health smartHMO (HMO-POS) partially covers other services, providing digital health technology support with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan.
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