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Alignment Health smartSavings (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health smartSavings (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 smartSavings (HMO-POS) in 2026, please refer to our full plan details page.
Alignment Health smartSavings (HMO-POS) is a HMO-POS 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 smartSavings (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 smartSavings (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 smartSavings (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 $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 $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 smartSavings (HMO-POS) Medicare plan features an annual drug deductible of $615. Beneficiaries enjoy savings on lower-tier prescriptions, with no copay for Tier 1 preferred generic and Tier 2 generic drugs filled through standard pharmacies or mail order. Additionally, Tier 6 select care drugs are highly affordable, costing only a $5 copay for a one-month supply, a $10 copay for a two-month supply, and no copay for a three-month supply. For brand-name and specialty medications, costs vary by tier and supply duration. Tier 3 preferred brand drugs require a $45 copay for a one-month supply, whereas Tier 4 non-preferred drugs carry a 40% coinsurance. Tier 5 specialty drugs are covered with a 25% coinsurance for a one-month supply through standard pharmacy or standard mail order services.
Additional Benefits
The Alignment Health smartSavings (HMO-POS) plan offers affordable coverage with no copay for primary care visits, telehealth, and annual preventive services. Specialist visits require a $35 copay, while emergency room visits carry a $120 copay and urgent care visits have a $20 copay. Inpatient hospital stays are covered with no coinsurance, requiring a $375 copay for days 1 to 6 of acute care. Members benefit from no copay on routine vision exams, routine hearing exams, and preventive dental services like cleanings and X-rays. Additionally, the plan covers home health and cardiac rehabilitation with no copay, while medical equipment and dialysis require a 20% coinsurance.
Inpatient Hospital See details
Alignment Health smartSavings (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a $375 copay for days 1 to 6 of acute care and a $120 copay for days 1 to 10 of psychiatric care. While additional days are covered, upgrades and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
Alignment Health smartSavings (HMO-POS) covers outpatient services with no coinsurance, featuring a $200 copay for outpatient hospital services, a $50 copay for ambulatory surgical center services, and a $35 copay for outpatient substance abuse sessions. Outpatient blood services are also fully covered with no copay or coinsurance, and prior authorization and referrals are required for these services.
Partial Hospitalization See details
Alignment Health smartSavings (HMO-POS) covers partial hospitalization with a $55.00 copay and no coinsurance. This benefit requires both a referral and prior authorization.
Ambulance and Transportation Services See details
Alignment Health smartSavings (HMO-POS) covers ground and air ambulance services requiring prior authorization with a $200 copay and no coinsurance, which is waived if you are admitted to the hospital. Transportation services are not covered.
Emergency Services See details
Alignment Health smartSavings (HMO-POS) covers emergency services with a $120 copay (waived if admitted within 48 hours) and urgently needed services with a $20 copay, with no coinsurance required for either service. Worldwide emergency and urgent care are also covered with no copay or coinsurance up to a $25,000 maximum benefit, though worldwide emergency transportation is not covered.
Primary Care See details
Alignment Health smartSavings (HMO-POS) covers primary care, physical, occupational, and speech therapies, and telehealth services with no copay and no coinsurance. Specialist visits require a $35 copay and no coinsurance, mental health services have a $10 copay and no coinsurance, psychiatric services have a $20 copay and no coinsurance, and opioid treatment has no copay and 20% coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Alignment Health smartSavings (HMO-POS) covers preventive services with no copay and no coinsurance, including annual physicals, kidney disease education, glaucoma screenings, diabetes self-management, digital rectal exams, EKGs, memory fitness, and personal emergency response systems. This benefit is partially covered, as health education, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by Alignment Health smartSavings (HMO-POS), providing one routine hearing exam and one fitting evaluation every year with no copay and no coinsurance. Prescription hearing aids and OTC hearing aids are not covered under this plan.
Vision Services See details
Alignment Health smartSavings (HMO-POS) provides partially covered vision services with no copay, no coinsurance, and no deductible. Covered benefits include one routine eye exam every year and up to $100 every two years for contact lenses or eyeglasses, while other eye exams and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Alignment Health smartSavings (HMO-POS), offering select preventive care such as oral exams, cleanings, fluoride treatments, and dental X-rays with no copay and no coinsurance. However, other diagnostic and preventive services, as well as restorative, endodontic, periodontic, prosthodontic, implant, oral surgery, and orthodontic services, are not covered.
Home Infusion bundled Services See details
Home Infusion bundled services are covered by Alignment Health smartSavings (HMO-POS) with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy and other drugs require no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Alignment Health smartSavings (HMO-POS) with no copay and a 20% coinsurance, though prior authorization and a referral are required.
Medical Equipment See details
Alignment Health smartSavings (HMO-POS) partially covers medical equipment with no copay and a 20% coinsurance, subject to prior authorization. While durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes are covered, diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Alignment Health smartSavings (HMO-POS) partially covers diagnostic and radiological services, requiring prior authorization and referrals for all care. Covered diagnostic services feature no copay and no coinsurance, though diagnostic procedures, tests, and lab services are not covered. Covered therapeutic radiological services require a 20% coinsurance and no copay, while diagnostic radiological and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered under the Alignment Health smartSavings (HMO-POS) plan with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Alignment Health smartSavings (HMO-POS) covers some cardiac rehabilitation services with no copay and no coinsurance, although prior authorization and referrals are required. However, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Alignment Health smartSavings (HMO-POS) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $100 daily copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Alignment Health smartSavings (HMO-POS) partially covers other services, offering digital health technology support with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan.
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