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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 2026, 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. This plan received an overall rating of 5 out of 5 stars in 2026.
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 $1999.00 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 features a $0 drug deductible, meaning your prescription drug coverage begins immediately. Under this plan, there is no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) medications filled at standard pharmacies or through standard mail order. Additionally, Tier 6 (Select Care Drugs) are highly affordable, requiring a small $5 copay for a one-month supply and no copay for a three-month supply. For higher-tier medications, costs are structured based on the drug tier for both standard retail and mail-order options. Tier 3 (Preferred Brand) drugs require a $40 copay for a one-month supply, while Tier 4 (Non-Preferred Drugs) have a $100 monthly copay. Specialty medications in Tier 5 require a 33% coinsurance for a one-month supply.
Additional Benefits
The Alignment Health Heart & Diabetes (HMO C-SNP) plan offers comprehensive coverage with no copays and no coinsurance for primary care, specialist visits, outpatient hospital services, and preventive care. Emergency room visits require a $70 copay, which is waived if you are admitted, while urgently needed services have no copay or coinsurance. For inpatient hospital stays, members pay no coinsurance and no copay for days 1 to 4 and 11 to 90, with a $100 daily copay only applying to days 5 to 10. This plan also features robust supplemental benefits, including up to 36 one-way medical transportation trips per year with no copay and no coinsurance. Routine hearing and vision exams, as well as Medicare-covered dental services, are available with no copay or coinsurance, though select preventive dental services require small copays ranging from $10 to $30. Additionally, prescription hearing aids are covered with no coinsurance and copays ranging from $195 to $1,750.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Alignment Health Heart & Diabetes (HMO C-SNP) with no coinsurance, though prior authorization and referrals are required. Acute care stays feature no copay for days 1 to 4 and 11 to 90, a $100 daily copay for days 5 to 10, and psychiatric stays require a $250 copay, while upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Alignment Health Heart & Diabetes (HMO C-SNP) covers outpatient hospital, ambulatory surgical center, and blood services with no copay and no coinsurance. Outpatient substance abuse individual and group sessions are also covered with a $15 copay and no coinsurance.
Partial Hospitalization See details
Alignment Health Heart & Diabetes (HMO C-SNP) covers partial hospitalization services with a $15.00 copay and no coinsurance. Prior authorization and a referral are required for these covered services.
Ambulance and Transportation Services See details
Alignment Health Heart & Diabetes (HMO C-SNP) covers ground and air ambulance services with a $100 copay and no coinsurance, which is waived if you are admitted to the hospital. The plan also provides up to 36 one-way medical transportation trips per year to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services under the Alignment Health Heart & Diabetes (HMO C-SNP) plan are covered with a $70 copay and no coinsurance, which is waived if you are admitted to the hospital within 48 hours. Urgently needed services are covered with no copay or coinsurance, and worldwide emergency and urgent services are partially covered up to a $25,000 maximum with no copay or coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Alignment Health Heart & Diabetes (HMO C-SNP) covers primary care, specialist, therapy, routine podiatry, and routine chiropractic services with no copay and no coinsurance. Opioid treatment is covered with no copay and a 20% coinsurance, but individual and group sessions for mental health and psychiatric services are not covered.
Preventive Services See details
Preventive services under the Alignment Health Heart & Diabetes (HMO C-SNP) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and glaucoma screenings. Additional preventive services are partially covered with no copay and no coinsurance under prior authorization, covering memory fitness, caregiver support, and in-home support, but excluding health education, weight management, and home safety assessments.
Hearing Services See details
Hearing services are covered by Alignment Health Heart & Diabetes (HMO C-SNP), offering one routine exam and fitting annually with no copay, no coinsurance, and no deductible. Prescription hearing aids are partially covered for up to two devices per year with no coinsurance and a copay ranging from $195.00 to $1,750.00, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Alignment Health Heart & Diabetes (HMO C-SNP) offers partially covered vision services with no copay and no coinsurance for covered eye exams and eyewear, including a $350 combined maximum benefit every two years. Routine eye exams are covered once annually and eyewear is covered once every two years, while other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered under the Alignment Health Heart & Diabetes (HMO C-SNP) plan, offering no copay and no coinsurance for Medicare dental, restorative, endodontics, periodontics, prosthodontics, and oral surgery up to a $3,500 annual limit. Preventive care requires no coinsurance with copays of $10 for exams and fluoride, $20 for cleanings, and $30 for X-rays, while other diagnostic, other preventive, adjunctive general, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Alignment Health Heart & Diabetes (HMO C-SNP) covers home infusion bundled services with no copay, although prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Alignment Health Heart & Diabetes (HMO C-SNP) covers Dialysis Services with no copay and no coinsurance, though prior authorization and a referral are required.
Medical Equipment See details
Alignment Health Heart & Diabetes (HMO C-SNP) covers durable medical equipment with no copay, 0% to 20% coinsurance, and prior authorization. While some prosthetics, medical supplies, and diabetic equipment services are covered with no copay and no coinsurance, prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Alignment Health Heart & Diabetes (HMO C-SNP) with no copays, but require prior authorization and referrals. For diagnostic services, some services are covered with no coinsurance, though diagnostic procedures, tests, and lab services are not covered. Radiological services are partially covered, with therapeutic services requiring a 20% coinsurance, while diagnostic radiological services and outpatient X-ray services are not covered.
Home Health Services See details
Home health services are covered by Alignment Health Heart & Diabetes (HMO C-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Alignment Health Heart & Diabetes (HMO C-SNP) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Alignment Health Heart & Diabetes (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 31 and a $50 daily copay for days 32 through 100. Prior authorization and referrals are required, and additional days beyond the standard 100-day Medicare benefit period are not covered.
Other Services See details
Alignment Health Heart & Diabetes (HMO C-SNP) provides other services with no copay and no coinsurance, including acupuncture limited to 24 treatments annually, a meal benefit for chronic conditions, digital health technology support, and a $10 monthly reimbursement for over-the-counter items. This benefit is partially covered, as dual-eligible SNP services and other additional services are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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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