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Alignment Health the ONE (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health the ONE (HMO 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 the ONE (HMO D-SNP) in 2026, please refer to our full plan details page.
Alignment Health the ONE (HMO D-SNP) is a HMO D-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 5 out of 5 stars in 2026.
It's important to know that Alignment Health the ONE (HMO 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 the ONE (HMO 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 the ONE (HMO 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 the ONE (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $9.50. 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 the ONE (HMO D-SNP) Medicare plan has an annual drug deductible of $615. Beneficiaries pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. This no-copay benefit is available for one-month, two-month, and three-month supplies. For remaining medication categories, members are responsible for a 25% coinsurance. This 25% coinsurance applies to Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs across all available supply durations. Tier 5 specialty drugs also require a 25% coinsurance, which is restricted to a one-month supply.
Additional Benefits
Alignment Health the ONE (HMO D-SNP) offers robust coverage with no copay and no coinsurance for primary care, telehealth, preventive screenings, and home health services. Members also benefit from no copays for routine dental care up to a $3,700 annual limit, routine vision exams with a $300 eyewear allowance, and up to two prescription hearing aids yearly. Additionally, the plan includes no copays or coinsurance for up to 50 one-way medical transportation trips and a $200 monthly over-the-counter item allowance. For specialized care, including specialist visits, physical therapy, dialysis, and durable medical equipment, members generally pay a 20% coinsurance with no copay. Emergency services require a 20% coinsurance that is waived if admitted to the hospital, while urgently needed care is covered with no copay or coinsurance. Inpatient hospital stays and skilled nursing facility services are subject to standard Original Medicare-defined deductibles, copays, and coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Alignment Health the ONE (HMO D-SNP), with acute and psychiatric stays requiring prior authorization and referrals, while additional days, upgrades, and non-Medicare-covered stays are not covered. Covered services are subject to Original Medicare-defined cost-sharing, including standard deductibles, copays, and coinsurance.
Outpatient Services See details
Alignment Health the ONE (HMO D-SNP) covers outpatient services with no copays across all categories, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services. There is no coinsurance for outpatient hospital services, while a 20% coinsurance applies to ambulatory surgical center services, outpatient substance abuse sessions, and outpatient blood services.
Partial Hospitalization See details
Partial hospitalization services are covered by Alignment Health the ONE (HMO D-SNP) with no copay and a 20% coinsurance. Both prior authorization and a referral are required to receive this care.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by Alignment Health the ONE (HMO D-SNP), offering no copay and no coinsurance for up to 50 one-way medical transportation trips per year to plan-approved locations. Ground and air ambulance services are not covered under this plan, and prior authorization is required for the covered transportation services.
Emergency Services See details
Alignment Health the ONE (HMO D-SNP) covers emergency services with a 20% coinsurance and no copay, which is waived if you are admitted to the hospital within three days, and urgently needed services with no copay or coinsurance. Worldwide emergency and urgent care are also 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 the ONE (HMO D-SNP) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits, mental health, psychiatric, occupational, physical, and speech therapies require no copay and a 20% coinsurance. Podiatry and chiropractic services are not covered under these benefits.
Preventive Services See details
Preventive Services are covered by Alignment Health the ONE (HMO D-SNP) with no copay and no coinsurance for annual physical exams, kidney disease education, and other screenings. Additional preventive services are partially covered with no copay and no coinsurance, but do not cover health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, weight management, alternative therapies, and home-based palliative care.
Hearing Services See details
Hearing services are partially covered by Alignment Health the ONE (HMO D-SNP) with no copay and no coinsurance for covered routine exams, fitting evaluations, and up to two prescription hearing aids per year. However, over-the-counter (OTC) hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Alignment Health the ONE (HMO D-SNP) with no copay, no coinsurance, and no deductible. The plan covers one routine eye exam and up to $300 annually for eyewear, though other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Alignment Health the ONE (HMO D-SNP) with no copay and no coinsurance up to a $3,700 annual maximum. While many preventive and comprehensive services are covered, exclusions apply to other diagnostic, other preventive, adjunctive general, maxillofacial prosthetics, implants, and orthodontics.
Home Infusion bundled Services See details
Alignment Health the ONE (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Associated Medicare Part B drugs, including chemotherapy and radiation, have no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Alignment Health the ONE (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Alignment Health the ONE (HMO D-SNP) partially covers medical equipment, offering durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. While diabetic equipment is covered with no copay and no coinsurance, diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Alignment Health the ONE (HMO D-SNP) diagnostic and radiological services are partially covered, requiring prior authorization and referrals. Covered diagnostic procedures, lab services, and therapeutic radiological services have no copay and 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 the ONE (HMO D-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to access these services.
Cardiac Rehabilitation Services See details
Alignment Health the ONE (HMO D-SNP) offers cardiac rehabilitation services with no copay, though only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Alignment Health the ONE (HMO D-SNP) covers Skilled Nursing Facility (SNF) services under Original Medicare guidelines, requiring a prior three-day inpatient hospital stay, referral, and prior authorization. Medicare-defined copayments and coinsurance apply, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Alignment Health the ONE (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance, while acupuncture is not covered. Eligible members receive up to $200 monthly in OTC reimbursements and a meal benefit for qualifying chronic or home-confining medical conditions.
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