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Alignment Health Heart & Diabetes Plus (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 Plus (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 Plus (HMO-POS C-SNP) in 2026, please refer to our full plan details page.
Alignment Health Heart & Diabetes Plus (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. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Alignment Health Heart & Diabetes Plus (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 Plus (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 Plus (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 Plus (HMO-POS C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. 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 $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 $8450.00 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 Plus (HMO-POS C-SNP)
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Drug Coverage
The Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. This no-copay benefit applies to one-month, two-month, and three-month supplies, helping you save on essential everyday medications. For other medication tiers, your costs are determined by coinsurance at standard pharmacies and standard mail order. You will pay a 25% coinsurance for Tier 2 generics, Tier 3 preferred brands, and Tier 5 specialty drugs, with the specialty tier coinsurance applying to a one-month supply. Tier 4 non-preferred drugs require a 31% coinsurance for one-month, two-month, and three-month supplies.
Additional Benefits
The Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) plan offers comprehensive coverage with no copays for primary care visits, preventive services, and home health care. For outpatient services, emergency care, ambulance transport, and dialysis, members can expect no copay and a standard twenty percent coinsurance. Inpatient hospital stays and skilled nursing facility care are subject to Medicare-defined copays and coinsurance. Ancillary benefits include dental care with no copay or coinsurance up to a thirty-six hundred dollar annual limit, alongside no-copay routine hearing and vision exams. Additionally, the plan features a five hundred dollar eyewear allowance every two years, up to fifty free one-way transportation trips, and a one hundred ninety-seven dollar monthly over-the-counter reimbursement. Part B insulin is also covered with a thirty-five dollar copay and up to twenty percent coinsurance.
Inpatient Hospital See details
Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) covers inpatient hospital services, including acute and psychiatric care, which are subject to Medicare-defined copays and coinsurance, as well as prior authorization and referral requirements. This partially covered benefit includes unlimited additional days for acute care and 40 additional psychiatric days, but does not cover upgrades or non-Medicare-covered stays.
Outpatient Services See details
Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) covers outpatient services with no copays, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Most of these covered services require prior authorization and a referral, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. Transportation services are partially covered, providing up to 50 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) covers emergency services with a 20% coinsurance and no copay, and urgently needed services with no copay or coinsurance. Worldwide emergency and urgent services are partially covered with a $75 copay and no coinsurance up to a $25,000 maximum limit, though worldwide emergency transportation is not covered.
Primary Care See details
Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) provides partially covered primary care benefits with no copays for all covered services, though podiatry and other chiropractic services are not covered. While primary care, specialist, routine chiropractic (up to 12 visits yearly), and telehealth services have no coinsurance, services such as therapy, mental health, psychiatric, and opioid treatments require a 20% coinsurance.
Preventive Services See details
Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) covers preventive services, annual physical exams, and kidney disease education with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance (prior authorization required), but health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety devices, and counseling are not covered.
Hearing Services See details
Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) covers hearing services with no copay and no coinsurance, including one routine exam and one fitting evaluation per year. Prescription hearing aids are partially covered with no copay or coinsurance for up to two devices yearly, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP), featuring no copay, no coinsurance, and no deductible for covered services. The plan covers one routine eye exam per year and provides a $500 combined maximum limit for eyewear every two years, while other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) provides partially covered dental services with no copay and no coinsurance, up to a maximum annual benefit of $3,600. While many preventive and comprehensive services are covered, some services are not covered including other diagnostic dental, other preventive dental, adjunctive general, maxillofacial prosthetics, implants, and orthodontics.
Home Infusion bundled Services See details
Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) covers home infusion bundled services with no copay, subject to prior authorization and step therapy. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required for these covered services.
Medical Equipment See details
Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered with no copay and a 20% coinsurance for therapeutic shoes and inserts, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) partially covers diagnostic and radiological services with no copay and a 20% coinsurance for covered lab services, diagnostic procedures, and therapeutic radiological services. Outpatient X-ray services and diagnostic radiological services are not covered, and prior authorization and referrals are required for all covered services.
Home Health Services See details
Home health services are covered by Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered with no copay under the Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) plan, requiring prior authorization and a referral. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by the Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) plan, as additional days beyond the standard Medicare-covered limit are not covered. Covered stays require prior authorization and a referral with Medicare-defined copayments and coinsurance, but do not require a prior three-day inpatient hospital stay.
Other Services See details
Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) covers other services with no copay and no coinsurance, including up to 12 acupuncture treatments annually, a $197 monthly over-the-counter reimbursement, home meal benefits for chronic conditions, and digital health technology support. Dual Eligible SNP services and certain other additional benefits are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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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