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Alignment Health Premium (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Premium (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 Premium (HMO-POS) in 2025, please refer to our full plan details page.
Alignment Health Premium (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 Premium (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 Premium (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 Premium (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $8.00. 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 $2950.00 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 Premium (HMO-POS) plan has an "Enhanced Alternative" drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays depending on the drug tier and pharmacy. For example, you'll pay no copay for preferred generic drugs at standard pharmacies, and a $45 copay for standard generic drugs at standard pharmacies. 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 Premium (HMO-POS) plan offers comprehensive coverage, including inpatient hospital stays with a $0 copay for most days, outpatient services, and emergency services with a $100 copay. The plan also covers primary care, preventive, hearing, vision, and dental services, with varying copays and coinsurance amounts depending on the service. Additional benefits include ambulance and transportation services, home health services with no copay, and coverage for home infusion services, dialysis, and medical equipment. There is also coverage for acupuncture, over-the-counter items up to $30 per month, and a meal benefit. However, services like cardiac rehabilitation and certain types of hearing aids are not covered.
Inpatient Hospital See details
The Alignment Health Premium (HMO-POS) plan covers inpatient hospital stays, including services not usually covered by Medicare, with a $0 copay for days 1-2, a $120 copay for days 3-7, and a $0 copay for days 8-90. Additional days for inpatient hospital are covered, while non-Medicare-covered stays and upgrades are not covered. Inpatient psychiatric care is also covered, with a $120 copay for days 1-10 and no copay for days 11-90, and additional days are covered up to 40 days per benefit period.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered by the Alignment Health Premium (HMO-POS) plan. Individual and group sessions for outpatient substance abuse have a copay of $50.
Partial Hospitalization See details
Partial Hospitalization is covered, requiring 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 Premium (HMO-POS) plan. Ground and Air Ambulance Services have a $200 copay, and there is no coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 34 one-way trips per year via medical transport, while transportation to any other 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 Premium (HMO-POS) plan. Emergency Services has a $100 copay, and Worldwide Emergency Services has a maximum plan benefit coverage amount of $50,000. 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, podiatry services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services are covered. Physician specialist services have a $15 copay, while individual and group sessions for mental health and psychiatric services have a $5-$20 copay. Routine foot care has a $5 copay. Opioid treatment program services have a 20% coinsurance.
Preventive Services See details
The Alignment Health Premium (HMO-POS) plan covers preventive services, including an annual physical exam and additional services not usually covered by Medicare plans. Additionally, the plan covers in-home support services, support for caregivers (up to $300 per year), and a fitness benefit that includes memory fitness. However, health education, in-home safety assessments, and several other services are not covered.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered. Routine hearing exams and fitting/evaluation for hearing aids are limited to one visit every year. Prescription hearing aids are partially covered, with a copay between $195 and $1750 for prescription hearing aids of all types, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
The Alignment Health Premium (HMO-POS) plan covers vision services including routine eye exams, eyewear, contact lenses, eyeglass lenses, and eyeglass frames. Routine eye exams are limited to one visit per year, and eyewear has a combined maximum benefit of $200 per year; upgrades are not covered.
Dental Services See details
The Alignment Health Premium (HMO-POS) plan covers a variety of dental services with a $2,500 annual maximum. Oral exams are covered for one visit every six months, dental x-rays are covered for one visit every three years, prophylaxis (cleaning) is covered for one visit every six months, and fluoride treatments are covered for one visit every six months. The plan also covers restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, 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, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay. For all other Home Infusion bundled Services drugs, there is a coinsurance between 0% and 20%, depending on the specific drug.
Dialysis Services See details
Dialysis Services are covered by the Alignment Health Premium (HMO-POS) plan, requiring a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 0-20% coinsurance and no copay, Prosthetics/Medical Supplies with a 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, 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%, and there is no copay for any of these services.
Home Health Services See details
Home Health Services are covered by the Alignment Health Premium (HMO-POS) plan with no copay and no coinsurance, but prior authorization and a referral are required. 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 Premium (HMO-POS) plan. Services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Alignment Health Premium (HMO-POS) plan, with a $20 copay for days 1-20 and a $100 copay for days 21-100; however, additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization and a doctor referral are required.
Other Services See details
The Alignment Health Premium (HMO-POS) plan covers acupuncture, over-the-counter (OTC) items up to $30 per month, and a meal benefit for certain conditions. Personalized Health Risk Screenings have a $75 copay and are covered up to $200 every two years, and digital health technology support is also covered. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services, are not covered.
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