A non-government entity
Alignment Health Heart & Diabetes NVPlus (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Heart & Diabetes NVPlus (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 NVPlus (HMO C-SNP) in 2026, please refer to our full plan details page.
Alignment Health Heart & Diabetes NVPlus (HMO C-SNP) is a HMO C-SNP plan offered by Alignment Healthcare USA, LLC available for enrollment in 2026 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 Heart & Diabetes NVPlus (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 NVPlus (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 NVPlus (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 NVPlus (HMO C-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:
Sign up for Alignment Health Heart & Diabetes NVPlus (HMO C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Alignment Health Heart & Diabetes NVPlus (HMO C-SNP) Medicare plan features an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when using standard pharmacies or standard mail order. For other medication tiers, cost-sharing is structured as coinsurance, requiring a 25% coinsurance for Tier 2 generic, Tier 3 preferred brand, and Tier 5 specialty drugs. Tier 4 non-preferred drugs require a 31% coinsurance for standard pharmacy and mail-order fills.
Additional Benefits
The Alignment Health Heart & Diabetes NVPlus (HMO C-SNP) plan offers comprehensive medical coverage with no copays or coinsurance for primary care visits, outpatient hospital services, and preventive care. For specialist visits, diagnostics, and medical equipment, members generally pay no copay and a 20% coinsurance, while emergency services also feature a 20% coinsurance and no copay. Inpatient hospital and skilled nursing stays are covered under standard Medicare-defined cost-sharing. This plan also includes valuable supplemental benefits with no copays or coinsurance, including routine vision exams with a $300 annual eyewear allowance and routine hearing exams with up to two prescription hearing aids per year. Dental care is covered up to a $3,700 annual maximum, and members receive up to 50 one-way transportation trips to health-related locations with no copay and no coinsurance. Additionally, the plan provides a monthly over-the-counter allowance of up to $210 and covered meal benefits with no copay or coinsurance.
Inpatient Hospital See details
Alignment Health Heart & Diabetes NVPlus (HMO C-SNP) covers inpatient acute and psychiatric hospital stays, with cost-sharing like copays, deductibles, and coinsurance determined by Medicare-defined standards. Prior authorization and referrals are required for these services, and the plan does not cover upgrades, additional days, or non-Medicare-covered stays.
Outpatient Services See details
Alignment Health Heart & Diabetes NVPlus (HMO C-SNP) covers outpatient hospital and observation services with no copay and no coinsurance. Ambulatory surgical center, outpatient substance abuse, and outpatient blood services are also covered with no copay and 20% coinsurance.
Partial Hospitalization See details
Alignment Health Heart & Diabetes NVPlus (HMO C-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Both prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Alignment Health Heart & Diabetes NVPlus (HMO C-SNP) offers transportation services to plan-approved health-related locations with no copay and no coinsurance for up to 50 one-way trips per year, though prior authorization is required. However, ambulance services, including both ground and air transport, are not covered under this plan.
Emergency Services See details
Emergency services are covered by Alignment Health Heart & Diabetes NVPlus (HMO C-SNP) with a 20% coinsurance (maximum $75 per visit, waived if admitted within 3 days) and no copay, while urgently needed services require no copay or coinsurance. Worldwide emergency and urgent services are also covered with no copay or coinsurance up to a $25,000 lifetime maximum, though worldwide emergency transportation is not covered.
Primary Care See details
Alignment Health Heart & Diabetes NVPlus (HMO C-SNP) covers primary care physician services and additional telehealth benefits with no copay and no coinsurance. Other covered services, including specialist visits, physical, occupational, speech, mental health, psychiatric, and opioid treatment therapies, feature no copay and a 20% coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Alignment Health Heart & Diabetes NVPlus (HMO C-SNP) with no copay and no coinsurance for services such as annual physical exams, kidney disease education, and diabetes self-management. The benefit is partially covered, meaning that while caregiver training and in-home support are included, other services like health education, weight management programs, and home safety assessments are not covered.
Hearing Services See details
Alignment Health Heart & Diabetes NVPlus (HMO C-SNP) covers hearing services with no copay and no coinsurance for annual routine hearing exams, fitting evaluations, and up to two prescription hearing aids per year. However, this benefit is only partially covered, as 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
Alignment Health Heart & Diabetes NVPlus (HMO C-SNP) covers vision services with no copay and no coinsurance, offering one routine eye exam per year and a $300 annual allowance for eyewear. However, other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Alignment Health Heart & Diabetes NVPlus (HMO C-SNP) features partially covered dental services with no copay and no coinsurance up to a $3,700 annual maximum, though prior authorization is required for most care. Covered services include exams, cleanings, x-rays, fluoride, restorative services, endodontics, periodontics, prosthodontics, and oral surgery, while implants, orthodontics, adjunctive general services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Alignment Health Heart & Diabetes NVPlus (HMO C-SNP) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by Alignment Health Heart & Diabetes NVPlus (HMO C-SNP) with no copay and a 20% coinsurance. Both prior authorization and a referral are required to receive these services.
Medical Equipment See details
Medical equipment is covered by Alignment Health Heart & Diabetes NVPlus (HMO C-SNP) with no copay and 20% coinsurance for durable medical equipment and prosthetics, requiring prior authorization. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Alignment Health Heart & Diabetes NVPlus (HMO C-SNP) offers diagnostic and radiological services with no copay, though prior authorization and referrals are required. Covered diagnostic procedures, lab services, and therapeutic radiological services require a 20% coinsurance, while diagnostic radiological services and outpatient X-ray services are not covered.
Home Health Services See details
Alignment Health Heart & Diabetes NVPlus (HMO C-SNP) covers home health services with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Alignment Health Heart & Diabetes NVPlus (HMO C-SNP) with no copay and a 20% coinsurance, requiring prior authorization and referrals. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Alignment Health Heart & Diabetes NVPlus (HMO C-SNP) under Medicare-defined cost-sharing, which determines your specific copay and coinsurance amounts. Prior authorization, a referral, and a prior three-day inpatient hospital stay are required, and the plan does not cover additional days beyond the standard Medicare-covered limit.
Other Services See details
Other Services are partially covered by Alignment Health Heart & Diabetes NVPlus (HMO C-SNP), as acupuncture is not covered. Eligible members receive a meal benefit and over-the-counter (OTC) items with no copay and no coinsurance, including up to $210 per month in OTC reimbursement.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved