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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 2025, 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 4 out of 5 stars in 2025.
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 $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 a $590.00 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 $8850.00 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) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. After the deductible, you will pay coinsurance for your drugs. For preferred and standard pharmacies, you'll pay 25% coinsurance for generic drugs, 28% for preferred brand drugs, 25% for non-preferred drugs, and 15% for specialty tier drugs.
Additional Benefits
The Alignment Health the ONE (HMO D-SNP) plan offers a wide range of benefits with varying cost-sharing. Many services such as ambulance services, urgently needed services, and home health services have no copay. The plan also offers coverage for outpatient services, primary care, preventive services, hearing, vision, dental, and other services, often with coinsurance or specific maximum benefits. This plan provides additional benefits including coverage for OTC items, and home infusion, and covers a variety of services with a 20% coinsurance, such as outpatient blood services, substance abuse sessions, and dialysis services. There is also coverage for specialized services such as cardiac rehabilitation and skilled nursing facilities, with prior authorization required.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization and a doctor's referral, but specific services such as additional days, non-Medicare-covered stays, and upgrades are not covered. The plan does not specify the copay or coinsurance.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services, are covered, but may require prior authorization and a doctor referral. Outpatient blood services are covered with a 20% coinsurance, and individual and group substance abuse sessions have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by Alignment Health the ONE (HMO D-SNP) with a 20% coinsurance, and requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Alignment Health the ONE (HMO D-SNP), with no copay or coinsurance for all ambulance services. Transportation Services to a plan-approved health-related location are covered for up to 50 one-way medical transport trips per year, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Alignment Health the ONE (HMO D-SNP) plan, with a 20% coinsurance. Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Services are covered, with a maximum benefit of $25,000, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The Alignment Health the ONE (HMO D-SNP) plan covers Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services (Individual and Group Sessions), Other Health Care Professional, Psychiatric Services (Individual and Group Sessions), Physical Therapy and Speech-Language Pathology Services (20% coinsurance), Additional Telehealth Benefits, and Opioid Treatment Program Services (20% coinsurance). Chiropractic Services are covered, but Routine Chiropractic Care is not. Podiatry Services are not covered.
Preventive Services See details
The Alignment Health the ONE (HMO D-SNP) plan covers preventive services, including Medicare-covered services, annual physical exams, and additional preventive services, with some services requiring prior authorization and others not covered. The plan also offers In-Home Support Services, Caregiver Support with a $300 maximum benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas (prior authorization required), Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids (all types), with no deductible or coinsurance. Routine hearing exams and fitting/evaluation for hearing aids are limited to one visit per year, while prescription hearing aids (all types) are limited to two visits per year. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
The Alignment Health the ONE (HMO D-SNP) plan covers vision services, including routine eye exams once per year. Eyewear is covered with a combined maximum benefit of $300.00 every year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered once per year. Upgrades are not covered.
Dental Services See details
The Alignment Health the ONE (HMO D-SNP) plan covers a range of dental services, including oral exams (1 visit every six months), dental x-rays (1 visit every three years), prophylaxis (cleaning) (1 visit every six months), and fluoride treatment (1 visit every six months), with a maximum plan benefit of $4,000 per year. Orthodontic services are covered under Diagnostic and Preventive Dental. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are also covered. Adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay, with coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Alignment Health the ONE (HMO D-SNP) plan, but require prior authorization and a doctor's referral. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered by Alignment Health the ONE (HMO D-SNP), including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, but Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. Diabetic Equipment requires prior authorization and has a $0 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests and Lab Services with a coinsurance of at most 20%, as well as Therapeutic Radiological Services with a coinsurance of at most 20%, but Diagnostic Radiological Services and Outpatient X-Ray Services are not covered. There is no copay for any of these services.
Home Health Services See details
Home Health Services are covered by Alignment Health the ONE (HMO D-SNP), with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and coinsurance applies.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Alignment Health the ONE (HMO D-SNP), but require prior authorization and a doctor's referral. The plan does not cover additional days beyond Medicare-covered SNF stays, or non-Medicare-covered SNF stays.
Other Services See details
Other Services for the Alignment Health the ONE (HMO D-SNP) plan covers Over-the-Counter (OTC) Items with a maximum benefit of $164.00 every month, and a meal benefit is also offered. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), 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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