A non-government entity
Alignment Health + Intermountain Health (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health + Intermountain Health (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health + Intermountain Health (HMO) in 2026, please refer to our full plan details page.
Alignment Health + Intermountain Health (HMO) is a HMO plan offered by Alignment Healthcare USA, LLC available for enrollment in 2026 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 + Intermountain Health (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 + Intermountain Health (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 + Intermountain Health (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.
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 $1490.00 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 + Intermountain Health (HMO)
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 + Intermountain Health (HMO) plan features a $0 drug deductible, allowing your prescription coverage to begin immediately. Beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 2 generic medications across one, two, and three-month supplies at standard pharmacies or standard mail order. Tier 3 preferred brand drugs carry a copay of $30 for a one-month supply, $60 for two months, and $90 for three months. For higher-tier medications, Tier 4 non-preferred drugs require a 32% coinsurance, while Tier 5 specialty drugs require a 33% coinsurance for a one-month supply. Tier 6 select care drugs feature low cost-sharing with a $5 copay for one month, $10 for two months, and no copay for a three-month supply. These standard pharmacy and standard mail-order rates help you easily estimate your annual out-of-pocket prescription costs.
Additional Benefits
The Alignment Health + Intermountain Health (HMO) plan offers robust coverage with no copay and no coinsurance for many essential services, including inpatient hospital acute care, primary and specialist doctor visits, and skilled nursing facility stays. Emergency room visits and ambulance services are available for a flat $50 copay, which is waived if you are admitted, while urgent care and outpatient hospital services require no copay. Additionally, members can access up to 60 one-way medical transportation trips per year to approved locations at no cost. For everyday wellness, the plan features a $3,000 annual maximum dental benefit, a $300 eyewear allowance, and routine vision and hearing exams with no copay. While most preventive care and home health services require no copay or coinsurance, other services like dialysis, durable medical equipment, and Part B drugs require a coinsurance of up to 20%. Covered hearing aids are also available with copays ranging from $195 to $1,750.
Inpatient Hospital See details
Alignment Health + Intermountain Health (HMO) partially covers inpatient hospital services, offering acute care stays with no copay or coinsurance, though upgrades and non-Medicare-covered stays are not covered. Psychiatric care is covered with no coinsurance and a $120 daily copay for days 1 through 10 (no copay for days 11 through 90), but non-Medicare-covered stays are excluded.
Outpatient Services See details
Alignment Health + Intermountain Health (HMO) covers outpatient services, including outpatient hospital, ambulatory surgical center, and blood services with no copay and no coinsurance. Outpatient substance abuse services are also covered with no coinsurance and a $25 copay for individual or group sessions, with prior authorization and referrals required.
Partial Hospitalization See details
Alignment Health + Intermountain Health (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Alignment Health + Intermountain Health (HMO) with a $50 copay and no coinsurance for ground and air ambulance services, which is waived if you are admitted to the hospital. The plan also offers up to 60 one-way medical transport trips per year to plan-approved health-related locations with no copay and no coinsurance, though trips to other non-approved health-related locations are not covered.
Emergency Services See details
Alignment Health + Intermountain Health (HMO) covers emergency services with a $50 copay and no coinsurance, which is waived if admitted to the hospital within 48 hours, and urgently needed services with no copay or coinsurance. Worldwide emergency and urgent care are partially covered up to a $25,000 maximum with no copay or coinsurance, although worldwide emergency transportation is not covered.
Primary Care See details
Alignment Health + Intermountain Health (HMO) covers primary care, specialist, therapy, and podiatry services with no copay and no coinsurance. Routine chiropractic care is covered with no copay and no coinsurance, but other chiropractic services are not covered. Psychiatric services require a $5 copay and no coinsurance, opioid treatment has no copay and a 20% coinsurance, and some mental health specialty services are covered with no copay and no coinsurance, though individual and group sessions are excluded.
Preventive Services See details
Preventive services are partially covered by Alignment Health + Intermountain Health (HMO) with no copay and no coinsurance for covered services such as annual physicals, caregiver support, and fitness benefits. However, this plan does not cover health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Alignment Health + Intermountain Health (HMO) hearing services are partially covered, providing one routine exam and one fitting evaluation per year with no copay and no coinsurance. Up to two prescription hearing aids are covered annually with a copay ranging from $195.00 to $1,750.00 and no coinsurance, while OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Alignment Health + Intermountain Health (HMO) offers partially covered vision services with no copay, no coinsurance, and no deductible. This benefit includes one routine eye exam per year and a $300 annual allowance for eyewear, though other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are covered by Alignment Health + Intermountain Health (HMO) with no copay and no coinsurance up to a maximum annual benefit of $3,000. This benefit is partially covered, as other diagnostic, other preventive, adjunctive general, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Alignment Health + Intermountain Health (HMO) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs carry 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 + Intermountain Health (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required to access these covered services.
Medical Equipment See details
Medical equipment is partially covered by Alignment Health + Intermountain Health (HMO) with no copay, though prior authorization is required and diabetic supplies are not covered. Durable medical equipment features no coinsurance to 20% coinsurance, while covered prosthetic devices, medical supplies, and diabetic therapeutic shoes require a 20% coinsurance.
Diagnostic and Radiological Services See details
Alignment Health + Intermountain Health (HMO) partially covers diagnostic and radiological services, requiring prior authorization and referrals for care. Some diagnostic services are covered with no copay or coinsurance, but diagnostic procedures, tests, and lab services are not covered. Therapeutic radiological services are covered with no copay and a 20% coinsurance, while diagnostic radiological and outpatient X-ray services are not covered.
Home Health Services See details
Alignment Health + Intermountain Health (HMO) covers home health services 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 + Intermountain Health (HMO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Alignment Health + Intermountain Health (HMO) with no copay and no coinsurance, though prior authorization and a referral are required. A prior three-day inpatient hospital stay is not required for admission, but additional days beyond Medicare-covered limits are not covered.
Other Services See details
Alignment Health + Intermountain Health (HMO) partially covers other services, excluding meal benefits. Covered services include acupuncture, digital health technology support, and monthly over-the-counter items with no copay and no coinsurance, as well as personalized health risk screenings with a $75 copay and no coinsurance.
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