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Alignment Health smartHMO (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health smartHMO (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health smartHMO (HMO) in 2026, please refer to our full plan details page.
Alignment Health smartHMO (HMO) is a HMO plan offered by Alignment Healthcare USA, LLC available for enrollment in 2026 to people living in Washoe. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that Alignment Health smartHMO (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Alignment Health smartHMO (HMO).
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 smartHMO (HMO), 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. Additionally, this plan comes with a Part B Premium reduction of $90.00. You must continue to pay paying your reduced 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 $5000.00 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 smartHMO (HMO) prescription drug plan features an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 2 generic drugs when filled at standard pharmacies or through standard mail order. Additionally, Tier 6 select care drugs are highly accessible, with a $5 copay for a 1-month supply, a $10 copay for a 2-month supply, and no copay for a 3-month supply. For higher-tier medications, costs are structured as copays or coinsurance depending on the tier. Tier 3 preferred brand drugs cost a $45 copay for a 1-month supply, which scales to $135 for a 3-month supply. Meanwhile, Tier 4 non-preferred drugs require a 32% coinsurance, and Tier 5 specialty tier drugs carry a 25% coinsurance for a 1-month supply.
Additional Benefits
The Alignment Health smartHMO (HMO) plan offers comprehensive coverage for essential medical services, featuring no copay and no coinsurance for primary care, telehealth, preventive services, and home health care. Specialist doctor visits require a $30 copay, urgent care has a $15 copay, and emergency room services carry a $120 copay with no coinsurance. Inpatient hospital stays require a $300 daily copay for days 1 through 5, while outpatient services carry a $300 copay, both with no coinsurance. Routine dental, vision, and hearing exams are covered with low or no copays, including a $100 eyewear allowance every two years, though hearing aids are not covered under this plan. For specialized medical needs, dialysis services and durable medical equipment require a 20% coinsurance with no copay. Skilled nursing facility stays are also covered with no coinsurance, requiring a $10 daily copay for the first 20 days and a $100 daily copay for days 21 through 100.
Inpatient Hospital See details
Alignment Health smartHMO (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $300 daily copay for days 1-5 of acute stays and a $120 daily copay for days 1-10 of psychiatric stays, followed by no copays for subsequent days. Prior authorization and referrals are required, and upgrades as well as non-Medicare-covered stays are not covered.
Outpatient Services See details
Alignment Health smartHMO (HMO) covers outpatient services with no coinsurance, featuring a $300 copay for outpatient hospital and observation services, and a $200 copay for ambulatory surgical center services. Outpatient substance abuse services require a $35 copay per session with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Alignment Health smartHMO (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Both prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Alignment Health smartHMO (HMO) covers ambulance services with no coinsurance, requiring a $200 copay for ground ambulance and a $300 copay for air ambulance, which is waived if you are admitted to the hospital. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Alignment Health smartHMO (HMO) covers emergency services with a $120 copay (waived if admitted within 48 hours) and no coinsurance, and urgently needed services with a $15 copay and no coinsurance. Worldwide emergency and urgent services are partially covered up to a $25,000 limit with no copay or coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Alignment Health smartHMO (HMO) provides primary care, occupational therapy, physical therapy, speech-language pathology, and telehealth services with no copay and no coinsurance. Specialist visits require a $30 copay, mental health services require a $10 copay, and psychiatric services require a $20 copay, all with no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Alignment Health smartHMO (HMO) partially covers preventive services with no copay and no coinsurance, offering annual physical exams, kidney disease education, glaucoma screenings, diabetes training, a personal emergency response system, and memory fitness. Sub-services that are not covered under this benefit include health education, in-home safety assessments, medical nutrition therapy, medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation counseling, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Alignment Health smartHMO (HMO) covers routine hearing exams and fitting evaluations with no copay and no coinsurance, limited to one visit each per year. While some prescription hearing aid services are covered, in practice, prescription hearing aids (including inner ear, outer ear, and over the ear types) and over-the-counter hearing aids are not covered.
Vision Services See details
Alignment Health smartHMO (HMO) provides partially covered vision services with no copay and no coinsurance, though other eye exam services and eyewear upgrades are not covered. Eligible members receive one routine eye exam every year and a $100 allowance for eyewear every two years.
Dental Services See details
Alignment Health smartHMO (HMO) partially covers dental services, offering Medicare dental services with no copay and no coinsurance. Covered preventive care includes oral exams ($10 copay), cleanings ($20 copay), fluoride ($10 copay), and x-rays ($30 copay) with no coinsurance, while orthodontic, implant, adjunctive general, and maxillofacial prosthetic services are not covered.
Home Infusion bundled Services See details
Alignment Health smartHMO (HMO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization and step therapy may apply. Medicare Part B chemotherapy, radiation, and other drugs feature no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by Alignment Health smartHMO (HMO) with no copay and a 20% coinsurance. Both prior authorization and a referral are required to receive these services.
Medical Equipment See details
Alignment Health smartHMO (HMO) partially covers medical equipment with no copay and a 20% coinsurance, though prior authorization is required for these services. While durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes are covered, diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Alignment Health smartHMO (HMO) diagnostic and radiological services are partially covered with no copays, but require prior authorization and referrals. Covered diagnostic services have no coinsurance and therapeutic radiological services require a 20% coinsurance, but lab services, diagnostic procedures, diagnostic radiological services, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by Alignment Health smartHMO (HMO) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Alignment Health smartHMO (HMO) plan, as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Alignment Health smartHMO (HMO) with no coinsurance, requiring a $10 daily copayment for days 1 through 20 and a $100 daily copayment for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
Other Services are partially covered by Alignment Health smartHMO (HMO), which features Digital Health Technology Support with no copay and no coinsurance. Acupuncture, over-the-counter items, and meal benefits are not covered under this benefit.
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