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Alignment Health Heart & Diabetes (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Heart & Diabetes (HMO 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 (HMO C-SNP) in 2025, please refer to our full plan details page.
Alignment Health Heart & Diabetes (HMO C-SNP) is a HMO C-SNP plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in Clark, Washoe. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Alignment Health Heart & Diabetes (HMO 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 (HMO 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 (HMO 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 (HMO C-SNP), 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.
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 $1450.00 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 Heart & Diabetes (HMO C-SNP) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy type. For example, you'll pay no copay for preferred generic drugs at a standard pharmacy, while standard generic drugs have a $40 copay at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, your Part D costs are $0.00.
Additional Benefits
The Alignment Health Heart & Diabetes (HMO C-SNP) plan offers comprehensive coverage with a variety of benefits. This plan provides coverage for inpatient hospital stays with a $0 copay for most of the stay, along with coverage for outpatient services and partial hospitalization with a $15 copay. Emergency services have a $70 copay, while primary care services and many therapies have no copay. Additional benefits include coverage for hearing and vision services, with set maximums, and dental services with copays for certain services. The plan also covers ambulance services, transportation to health-related locations, and home infusion services. Other covered services include home health, skilled nursing facilities, and medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with the former having a copay of $0 for days 1-4, $100 for days 5-10, and $0 for days 11-90, and the latter having a copay of $250. Additional days for both are covered. 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 include coverage for outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, with prior authorization and a doctor referral required for all services. Individual and group sessions for outpatient substance abuse have a copay of $15.00, and outpatient blood services include an enhanced benefit of a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Alignment Health Heart & Diabetes (HMO C-SNP) plan, requiring prior authorization and a doctor referral. The copay for this benefit is $15.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Alignment Health Heart & Diabetes (HMO C-SNP) plan. Ground and air ambulance services have a $100 copay, which is waived if admitted to the hospital, and there is no coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 36 one-way trips per year via medical transport, but 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. Emergency Services have a $70 copay and no coinsurance, while Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Services have a maximum plan benefit coverage of $25,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health Heart & Diabetes (HMO C-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Individual and group sessions for mental health and psychiatric services are not covered. Occupational therapy and physical therapy services have no copay or coinsurance. Opioid treatment program services have 20% coinsurance.
Preventive Services See details
Preventive services, including annual physical exams, are covered. Additional services, including In-Home Support Services, Support for Caregivers of Enrollees, and Fitness Benefits are covered, while others such as Health Education and Counseling Services are not covered.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, with a maximum plan benefit of $500 every six months. Prescription hearing aids (all types) are covered, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams with a maximum plan benefit of $500 every six months, and one routine eye exam per year. Eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, are also covered. Upgrades are not covered.
Dental Services See details
Dental services include coverage for oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments, each limited to one visit every six months, as well as restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Orthodontic services have a maximum benefit of $500 every six months, while adjunctive general services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Alignment Health Heart & Diabetes (HMO C-SNP) plan. Prior authorization and a doctor referral are required for coverage.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME) and Diabetic Equipment, is covered. For DME, there is no copay, but you may have to pay a coinsurance between 0% and 20% and services require prior authorization. Prosthetics/Medical Supplies are covered with no copay or coinsurance, but also require prior authorization. However, Durable Medical Equipment for use outside the home, prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes/inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Alignment Health Heart & Diabetes (HMO C-SNP) plan, although many of the sub-services are not covered. There is no copay for the services, but some services may have a coinsurance of up to 20%.
Home Health Services See details
Home Health Services are covered by the Alignment Health Heart & Diabetes (HMO C-SNP) plan with no copay or coinsurance, but require authorization and a referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but not in practice, as Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Alignment Health Heart & Diabetes (HMO C-SNP) plan, but require prior authorization and a doctor's referral. For days 1-31, there is no copay, and for days 32-100, the copay is $50.
Other Services See details
The Alignment Health Heart & Diabetes (HMO C-SNP) plan covers acupuncture, over-the-counter items up to $15 per month, meal benefits for chronic or medical conditions, and digital health technology support. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management, Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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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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