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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 2025, 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. The overall rating for this plan is not yet available for 2025.
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 $18.30. 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 $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 $8350.00 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 has a defined standard for drug coverage. The plan has a deductible of $590.00. If you qualify for the low-income subsidy, you will pay $18.30 for your Part D premium. After your deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) plan offers a range of benefits with varying cost-sharing. This plan includes coverage for inpatient and outpatient services, with coinsurance typically set at 20%. Emergency services have a coinsurance, with a maximum per visit amount. Additional benefits include coverage for transportation, hearing, vision, and dental services. Hearing services include routine exams and hearing aids, while vision services include routine eye exams and eyewear. Dental services have a maximum annual benefit. The plan also covers home health and home infusion services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, though specific cost-sharing details are not provided. Additional days for Inpatient Hospital-Acute are covered with no limits, while additional days for Inpatient Hospital Psychiatric are covered up to 40 days per benefit period; Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, Ambulatory Surgical Center (ASC) services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital and observation services have a 20% coinsurance, while outpatient substance abuse services, including individual and group sessions, have a coinsurance between 20% and 20%. Outpatient blood services also have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor's referral. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and there is no copay. Transportation services to plan-approved health-related locations are covered for up to 50 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered. Emergency Services has a 20% coinsurance, and a maximum per visit amount of $75, with no copay. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $75 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Individual and group sessions for mental health and psychiatric services have a 20% coinsurance. Occupational Therapy Services, and Opioid Treatment Program Services also have a 20% coinsurance. Physical Therapy and Speech-Language Pathology Services have a 20% coinsurance. Other Health Care Professional services have a 20% coinsurance. Routine Chiropractic Care is limited to 12 visits per year. Podiatry Services are not covered.
Preventive Services See details
The Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) plan covers preventive services, including Medicare-covered services, annual physical exams, and other preventive services. The plan does not cover 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.
Hearing Services See details
Hearing services include routine hearing exams and fitting/evaluation for hearing aids, each covered once per year, and prescription hearing aids (all types), covered twice per year. Prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered.
Vision Services See details
The Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) plan covers vision services, including routine eye exams with no copay, and eyewear with a combined maximum benefit of $500 every two years. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered, with limitations on the number of pairs/items allowed every two years. Upgrades are not covered.
Dental Services See details
Dental services are covered with a maximum plan benefit of $4,000 per year. Oral exams are limited to one visit every six months, Dental X-Rays are limited to one every three years, and Prophylaxis (Cleaning) is limited to one visit every six months. Fluoride treatments are limited to one per year, while Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are unlimited. 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% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) plan, but a doctor's referral is required. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetic Devices and Medical Supplies with a 20% coinsurance, but Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests and Lab Services with a coinsurance of at most 20%, and Therapeutic Radiological Services with a coinsurance of at most 20%, but Diagnostic Radiological Services and Outpatient X-Ray Services are not covered. There is no copay for any of these services.
Home Health Services See details
Home Health Services are covered by the Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) plan with no copay and no coinsurance, but require prior authorization and a referral. However, 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 Heart & Diabetes Plus (HMO-POS C-SNP) plan. Prior authorization and a doctor's referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) plan, but details on the copay and coinsurance are not provided. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Alignment Health Heart & Diabetes Plus (HMO-POS C-SNP) plan covers acupuncture with a limit of 12 treatments per year, but requires prior authorization. Over-the-counter (OTC) items are covered with a maximum benefit of $200.00 per month, including nicotine replacement therapy and naloxone, but does not cover all drugs on the CMS OTC list. The plan also covers a meal benefit for chronic illness or medical conditions requiring the enrollee to remain at home. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and others are not covered.
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