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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 2025, 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. The overall rating for this plan is not yet available for 2025.
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 $164.90. 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 $590.00 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) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, you'll pay no copay for preferred generic drugs at a standard pharmacy, and a $45 copay for standard generic drugs. For non-preferred drugs, you will pay 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Alignment Health smartHMO (HMO-POS) plan offers a range of benefits with varying cost-sharing. For inpatient hospital stays, you'll pay a copay for the first few days, with no copay for the rest of the stay. Outpatient services have copays, and emergency services have a $120 copay. This plan includes coverage for primary care and specialist visits with copays, along with preventive, hearing, vision, and dental services. You'll also find coverage for home health, skilled nursing, and dialysis services with copays or coinsurance. However, some services like cardiac rehabilitation and certain other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $375 copay for days 1-3, and no copay for days 4-90. For Inpatient Hospital Psychiatric, you will pay a $120 copay for days 1-10, and no copay for days 11-90.
Outpatient Services See details
Outpatient services include all outpatient hospital services with a $200 copay, ambulatory surgical center (ASC) services with a $50 copay, and outpatient substance abuse services with a $35 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Alignment Health smartHMO (HMO-POS) plan, but requires prior authorization and a doctor's referral. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Alignment Health smartHMO (HMO-POS) plan. Ground and Air Ambulance Services have a $200 copay, with no coinsurance, and the copay is waived if admitted to the hospital, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services has a $120 copay, and Urgently Needed Services has a $20 copay; both have no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $25,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health smartHMO (HMO-POS) plan covers primary care, physician specialist services with a $20 copay, and mental health specialty services with a $10 copay for individual and group sessions. Chiropractic services are covered with a $10 copay, while routine chiropractic care is not covered. Occupational therapy and physical therapy services are covered with no copay or coinsurance.
Preventive Services See details
The Alignment Health smartHMO (HMO-POS) plan covers preventive services, including Medicare-covered services, annual physical exams, and other preventive services, but health education, in-home safety assessments, 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 benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered. The plan also covers personal emergency response systems, fitness benefits, kidney disease education services, glaucoma screenings, diabetes self-management training, digital rectal exams, and EKGs following a welcome visit.
Hearing Services See details
The Alignment Health smartHMO (HMO-POS) plan covers routine hearing exams and fitting/evaluation for hearing aids, each limited to one visit per year, with no deductible or coinsurance. Prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
The Alignment Health smartHMO (HMO-POS) plan covers vision services including routine eye exams with no copay, and eyewear including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, with a combined maximum of $100 every two years, but upgrades are not covered. You are allowed one routine eye exam every year, and one pair of contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames every two years.
Dental Services See details
Dental Services include oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments. Oral exams, prophylaxis, and fluoride treatments are limited to one visit every six months, while dental x-rays are limited to one every three years; all other dental services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay, with a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Alignment Health smartHMO (HMO-POS) plan, with a doctor referral required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and no copay, and Prosthetics/Medical Supplies with a 20% coinsurance and no copay. Durable Medical Equipment for use outside the home, and Diabetic Supplies are not covered. Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Alignment Health smartHMO (HMO-POS) plan, however, 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 other services have no copay.
Home Health Services See details
Home Health Services are covered by the Alignment Health smartHMO (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Alignment Health smartHMO (HMO-POS) plan. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
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 $10, and for days 21-100, the copay is $100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services are not covered by the Alignment Health smartHMO (HMO-POS) plan, including acupuncture, over-the-counter items, and meal benefits. Additional services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are also not covered.
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