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Alignment Health Total Dual+ (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Total Dual+ (HMO-POS D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health Total Dual+ (HMO-POS D-SNP) in 2026, please refer to our full plan details page.
Alignment Health Total Dual+ (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by Alignment Healthcare USA, LLC available for enrollment in 2026 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 Total Dual+ (HMO-POS D-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 Total Dual+ (HMO-POS D-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 Total Dual+ (HMO-POS D-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 Total Dual+ (HMO-POS D-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 $9250.00 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 Total Dual+ (HMO-POS D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 6 select care drugs, you will pay no copay for one, two, or three-month supplies at standard pharmacies and standard mail order. This ensures affordable access to many common and essential medications. For Tier 2 generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs, you will pay a 25% coinsurance for standard pharmacy or standard mail order fills. Additionally, Tier 5 specialty drugs require a 25% coinsurance for a one-month supply. These straightforward cost-sharing rates make it easy to plan your healthcare budget.
Additional Benefits
The Alignment Health Total Dual+ (HMO-POS D-SNP) plan offers comprehensive medical coverage with no copay for primary care visits, preventive care, and home health services. For outpatient hospital services, specialist visits, and emergency care, members generally enjoy no copay but are responsible for a 20% coinsurance. Inpatient hospital stays and skilled nursing facility care are also covered, though they require Medicare-defined cost-sharing or daily copays for extended stays. This plan features generous supplemental benefits, including no copay or coinsurance for routine hearing exams, prescription hearing aids, annual eye exams, and up to $400 in eyewear every two years. Dental care is covered with no copay or coinsurance for preventive and comprehensive services up to a $4,000 annual maximum. Additionally, members benefit from no copay or coinsurance for up to 50 one-way transportation trips per year and a $193 monthly over-the-counter reimbursement allowance.
Inpatient Hospital See details
Alignment Health Total Dual+ (HMO-POS D-SNP) partially covers inpatient hospital services, requiring Medicare-defined cost-sharing, such as copays and coinsurance, along with prior authorization and referrals. Specific services, including additional days, upgrades, and non-Medicare-covered stays for acute and psychiatric care, are not covered.
Outpatient Services See details
Alignment Health Total Dual+ (HMO-POS D-SNP) covers outpatient services with no copayments, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services. Prior authorization and referrals are required for these outpatient benefits, and the deductible is waived for the first three pints of blood.
Partial Hospitalization See details
Partial hospitalization is covered by Alignment Health Total Dual+ (HMO-POS D-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required to access these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Alignment Health Total Dual+ (HMO-POS D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 50 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Alignment Health Total Dual+ (HMO-POS D-SNP) covers emergency services with a 20% coinsurance up to $115 (waived if admitted to the hospital within 3 days) and no copay, and urgent care with a 20% coinsurance up to $40 and no copay. Worldwide emergency and urgent services are partially covered up to a $25,000 maximum with no copay or coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Primary Care services for Alignment Health Total Dual+ (HMO-POS D-SNP) are covered with no copay, featuring no coinsurance for primary care provider visits, telehealth, and routine chiropractic care up to 12 visits yearly. A 20% coinsurance and no copay apply to covered specialist visits, physical, occupational, and speech therapies, mental health, and psychiatric services, while podiatry and other chiropractic services are not covered.
Preventive Services See details
Alignment Health Total Dual+ (HMO-POS D-SNP) offers partially covered preventive services with no copay and no coinsurance for covered care, including annual physical exams, kidney disease education, and glaucoma screenings. Excluded services that are not covered include health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Alignment Health Total Dual+ (HMO-POS D-SNP) offers hearing services with no copay and no coinsurance, covering one routine hearing exam and one fitting evaluation annually. Prescription hearing aids are also covered with no copay or coinsurance for up to two devices per year, but the benefit is only partially covered because OTC hearing aids as well as inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Alignment Health Total Dual+ (HMO-POS D-SNP) offers partially covered vision services with no copay and no coinsurance for one routine eye exam per year and up to $400 in eyewear every two years. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Alignment Health Total Dual+ (HMO-POS D-SNP) provides partially covered dental services, featuring no copay and a 20% coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered preventive and comprehensive services up to a $4,000 annual maximum. Sub-services that are not covered under this plan include other diagnostic services, other preventive services, adjunctive general services, maxillofacial prosthetics, implants, and orthodontics.
Home Infusion bundled Services See details
Alignment Health Total Dual+ (HMO-POS D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy apply. Associated Medicare Part B chemotherapy and other drugs have no copay and require no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Alignment Health Total Dual+ (HMO-POS D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these services.
Medical Equipment See details
Alignment Health Total Dual+ (HMO-POS D-SNP) covers durable medical equipment with no copay and 20% coinsurance, and prosthetic devices and medical supplies with no copay and 10% coinsurance. For diabetic equipment, some services are covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Alignment Health Total Dual+ (HMO-POS D-SNP) provides partial coverage for diagnostic and radiological services with no copay, though prior authorization and referrals are required. Covered diagnostic procedures, lab services, and therapeutic radiological services require a 20% coinsurance, while diagnostic radiological services and outpatient x-ray services are not covered.
Home Health Services See details
Alignment Health Total Dual+ (HMO-POS D-SNP) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to receive these covered services.
Cardiac Rehabilitation Services See details
Alignment Health Total Dual+ (HMO-POS D-SNP) covers some cardiac rehabilitation services with no copay, though prior authorization and a referral are required. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Alignment Health Total Dual+ (HMO-POS D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Alignment Health Total Dual+ (HMO-POS D-SNP) offers other services with no copay and no coinsurance, including up to 12 acupuncture treatments per year, a $193 monthly over-the-counter reimbursement allowance, home meal benefits for qualifying medical conditions, and digital health technology support. Highly integrated services for dual-eligible SNPs are not covered under this benefit.
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