Alignment Healthcare USA, LLC
Plan ID: H5472-2-0
2025 Alignment Health Heart & Diabetes (HMO-POS C-SNP) H5472 — 002 — 0 is a Medicare Advantage plan with drug coverage. 0
Learn more about Alignment Health Heart & Diabetes (HMO-POS C-SNP) H5472 - 002 - 0, including the health and drug services it covers, by reading our easy-to-use guide. Or contact a licensed insurance agent for help now.
$0.00 /mo
Monthly premium
$0
Drug deductible
$2400.00
Out-of-pocket maximum (Out-of-Network)
Enroll online
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week!
2025 Alignment Health Heart & Diabetes (HMO-POS C-SNP) H5472 — 002 — 0 is a HMO-POS C-SNP offered in El Paso & Hudspeth by Alignment Healthcare USA, LLC. It has a monthly premium of $0.00.
Important:
2025 Alignment Health Heart & Diabetes (HMO-POS C-SNP) H5472 — 002 — 0 is a Chronic or Disabling Condition Special Needs Type plan. You can only enroll in this plan if you meet specific criteria.
Standard Part B Premium
$185.00
Part B premium reduction
- $0
Monthly Plan Premium
$0.00
Total Premium:
$185.00
Note:
The standard Medicare Part B premium for 2025 is $185.00. Your premium may differ based on factors like late enrollment, income (IRMAA), or disability status. Most people enrolled in Medicare Part B are required to pay this premium.
Special needs plan type
Yes
Out-of-pocket maximum (In-Network)
N/A
Out-of-pocket maximum (Out-of-Network)
$2400.00
Out-of-pocket maximum (Combined)
N/A
Conditions Covered
Cardiovascular Disorders, Chronic Heart Failure, Diabetes
Plan Organization:
Alignment Healthcare USA, LLC
Plan Type:
HMO-POS C-SNP
Location:
El Paso & Hudspeth
Drugs Covered:
Yes
Drug Formulary:
Pharmacies:
Doctors Link:
The amount you must pay each year before your plan starts to pay for covered services or drugs.
Drug deductible
$0
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Alignment Health Heart & Diabetes (HMO-POS C-SNP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Benefit Type
Enhanced Alternative
Prescription drug deductible
$0
This plan's premium may be reduced for you if you qualify for the low-income subsidy (also known as LIS or "Extra help"). The following is what you'll pay for with LIS.
Part D | LIS Full |
---|---|
$0.00 | $0.00 |
After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2000.00. Once you reach that amount, you will enter the next coverage phase.
Tier | Preferred Pharmacy | Standard Pharmacy | Preferred Mail | Standard Mail |
---|---|---|---|---|
1. Preferred Generic | - | $0.00 copay | - | $0.00 copay |
2. Standard Generic | - | $45.00 copay | - | $45.00 copay |
3. Preferred Brand | - | $100.00 copay | - | $100.00 copay |
4. Non-Preferred Drug | - | 33% coinsurance | - | 33% coinsurance |
5. Specialty Tier | - | $5.00 copay | - | $5.00 copay |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Alignment Health Heart & Diabetes (HMO-POS C-SNP) also provides the following benefits.
Hearing Services benefits are covered.
Hearing Exams benefits are covered – including services not usually covered by Medicare plans.
More Details:
Is there a deductible?
No
Is there a deductible?
No
Is there a maximum plan benefit coverage?
No
Routine Hearing Exams benefits are covered.
More Details:
Is this benefit unlimited?
No, indicate number
Number of visits
1
Periodicity
Every year
Fitting/Evaluation for Hearing Aid benefits are covered.
More Details:
Is this benefit unlimited?
No, indicate number
Number of visits
1
Periodicity
Every year
Prescription Hearing Aids benefits are covered – including services not usually covered by Medicare plans.
Cost Sharing:
More Details:
Service maximum plan benefit coverage
No
Prescription Hearing Aids (all types) benefits are covered.
More Details:
Is this benefit unlimited?
No, indicate number
Number of visits
2
Periodicity
Every year
Minimum copayment
195.00
Maximum copayment
1750.00
Not covered.
Not covered.
Not covered.
Not covered.
Vision Services benefits are covered.
Eye Exams benefits are covered – including services not usually covered by Medicare plans.
More Details:
Is there a deductible?
No
Is there a deductible?
No
Is there a maximum plan benefit coverage?
No
Routine Eye Exams benefits are covered.
More Details:
Is this benefit unlimited?
No, indicate number
Number of visits
1
Periodicity
Every year
Eyewear benefits are covered – including services not usually covered by Medicare plans.
More Details:
Is there a deductible?
No
Is there a deductible?
No
Is there a maximum plan benefit coverage?
Yes
Maximum plan benefit coverage type
Plan-specified amount per period
Do you offer a Combined Max Plan Benefit Coverage Amount for all Eyewear?
Yes
Combined maximum amount
200.00
Periodicity
Every year
Contact Lenses benefits are covered.
More Details:
Is this benefit unlimited?
No, indicate number
Number of pairs
1
Periodicity
Every year
Eyeglasses (lenses and frames) benefits are covered.
More Details:
Is this benefit unlimited?
No, indicate number
Number of pairs
1
Periodicity
Every year
Eyeglass lenses benefits are covered.
More Details:
Is this benefit unlimited?
No, indicate number
Number of pairs
1
Periodicity
Every year
Eyeglass frames benefits are covered.
More Details:
Is this benefit unlimited?
No, indicate number
Number of eyeglass frames
1
Periodicity
Every year
Not covered.
Dental Services benefits are covered.
Medicare Dental Services benefits are covered.
Other Dental Services benefits are covered.
More Details:
Is there a maximum plan benefit coverage?
Yes
Maximum amount
2000.00
Periodicity
Every year
Oral Exams benefits are covered.
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Every six months
Dental X-Rays benefits are covered.
More Details:
Is this benefit unlimited?
No
Number of X-Rays
1
Periodicity
Every three years
Prophylaxis (Cleaning) benefits are covered.
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Every six months
Fluoride Treatment benefits are covered.
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Every six months
Orthodontic Services benefits are covered.
More Details:
Is there a maximum plan benefit coverage?
Yes
Maximum plan benefit coverage type
Covered under Diagnostic and Preventive Dental (16b)
Restorative Services benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Not covered.
Endodontics benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Periodontics benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Prosthodontics, removable benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Not covered.
Not covered.
Prosthodontics, fixed benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Oral and Maxillofacial Surgery benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Not covered.
Home Infusion bundled Services benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Which Medicare Part B Rx Drugs have a Coinsurance
Medicare Part B Chemotherapy/Radiation Drugs, Other Medicare Part B Drugs
Does this plan have a service specific maximum enrollee out-of-pocket cost (MOOP)?
No
Does the plan offer step therapy?
Yes
Does the benefit step from?
Part B to Part B, Part B to Part D, Part D to Part B
Does the plan provide Part D home infusion drugs as part of a bundled service as a mandatory supplemental benefit?
No
Insulin benefits are covered.
Medicare Part B Insulin Drugs benefits are covered.
Cost Sharing:
More Details:
Minimum coinsurance
0
Maximum coinsurance
20
Does the Part B drugs - Insulin cost sharing count towards any plan-level deductible?
No
Medicare Part B Chemotherapy/Radiation Drugs benefits are covered.
More Details:
Minimum coinsurance
0
Maximum coinsurance
20
Other Medicare Part B Drugs benefits are covered.
More Details:
Minimum coinsurance
0
Maximum coinsurance
20
Preventive Services benefits are covered.
Medicare-covered Zero Dollar Preventive Services benefits are covered.
Annual Physical Exam benefits are covered – including services not usually covered by Medicare plans.
More Details:
Is there a maximum plan benefit coverage amount?
No
Additional Preventive Services benefits are covered – including services not usually covered by Medicare plans. Prior Authorization and a doctor referral are required.
More Details:
Is there a service-specific Maximum Plan Benefit Coverage amount for Other Defined Supplemental Benefits?
Yes
Which Other Defined Supplemental Benefits have a Maximum Plan Benefit Coverage amount
14c22: Support for Caregivers of Enrollees
Not covered.
Not covered.
Personal Emergency Response System (PERS) benefits are covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
In-Home Support Services benefits are covered.
More Details:
Type of benefit for In-Home Support Services
Mandatory
Support for Caregivers of Enrollees benefits are covered.
More Details:
Type of benefit for Support for Caregivers of Enrollees
Mandatory
Type of benefit offered for Support for Caregivers of Enrollees
Caregiver Training
Maximum plan benefit coverage amount
300.00
Periodicity
Every year
Not covered.
Fitness Benefit benefits are covered.
More Details:
Type of Fitness Benefit offered
Memory Fitness
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Kidney Disease Education Services benefits are covered.
Other Preventive Services benefits are covered.
More Details:
Is a referral required for any Services?
No
Glaucoma Screening benefits are covered.
Diabetes Self-Management Training benefits are covered.
Barium Enemas benefits are covered. Prior Authorization is required.
Digital Rectal Exams benefits are covered.
EKG following Welcome Visit benefits are covered.
Other Services benefits are covered.
Acupuncture benefits are covered – including services not usually covered by Medicare plans. Prior Authorization is required.
More Details:
Is this benefit unlimited for Number of Treatments?
Yes
Is there a maximum plan benefit coverage amount?
No
Over-the-Counter (OTC) Items benefits are covered.
More Details:
Does the plan provide Over-The-Counter (OTC) Items as a supplemental benefit under Part C?
Yes
Is there a maximum plan benefit coverage amount?
Yes
Maximum plan benefit coverage amount
40.00
Periodicity
Every month
Does your Maximum Plan Benefit Coverage amount carry forward to the next period if it is unused?
No
Plan offers Nicotine Replacement Therapy (NRT) as a Part C OTC benefit?
Yes
The Nicotine Replacement Therapy (NRT) being offered does not duplicate any Part D OTC or formulary drugs.
The Nicotine Replacement Therapy (NRT) being offered does not duplicate any Part D OTC or formulary drugs.
Plan offers Naloxone coverage as a Part C OTC benefit?
Yes
Does this cover all of the drugs on the CMS OTC list which may be found in Chapter 4 of the Medicare Managed Care Manual
No
Meal Benefit benefits are covered.
More Details:
Does the plan provide a limited duration Meal Benefit as a supplemental benefit under Part C? Note: Only primarily health-related meals offered in accordance with Chapter 4 of the MMCM should be entered in this section.
Yes
Type of primarily health related meals benefit offered
For a chronic illness, For a medical condition or potential medical condition that requires the enrollee to remain at home for a period of time
Is there a maximum plan benefit coverage amount?
No
Other 1 benefits are covered.
More Details:
Service Name
Digital Health Technology Support
Is there a maximum plan benefit coverage?
No
Not covered.
Other Services benefits are covered.
More Details:
Is Authorization required for one or more Additional Services?
No
Is a referral required for one or more Additional Services?
No
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Not covered.
Dialysis Services benefits are covered. A doctor referral is required.
Cost Sharing:
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Medical Equipment benefits are covered.
Durable Medical Equipment (DME) benefits are covered.
More Details:
Is there a coinsurance?
Yes
Minimum coinsurance
0
Maximum coinsurance
20
Is there a copayment ?
No
Are there preferred vendors/manufacturers for Durable Medical Equipment (DME)?
Yes
Authorization required for this benefit?
Yes
Not covered.
Prosthetics/Medical Supplies - Non-Medicare benefit benefits are covered.
More Details:
Is there a coinsurance?
No
Is there a copayment ?
No
Authorization required for this benefit?
Yes
Not covered.
Not covered.
Diabetic Equipment benefits are covered. Prior Authorization is required.
More Details:
Do you limit Diabetic supplies and services to those from specified manufacturers
Yes
Not covered.
Not covered.
Ambulance and Transportation Services benefits are covered.
All Ambulance Services benefits are covered. Prior Authorization is required.
More Details:
Is there a coinsurance?
No
Is there a copayment ?
Yes
Which Services have a Copayment
Medicare-covered Ground Ambulance Services, Medicare-covered Air Ambulance Services
Is this Copayment waived if admitted to hospital?
Yes
Ground Ambulance Services benefits are covered.
Cost Sharing:
Air Ambulance Services benefits are covered.
Cost Sharing:
Transportation Services benefits are covered – including services not usually covered by Medicare plans. Prior Authorization is required.
More Details:
Enhanced benefit (10b)
Plan Approved Health-related Location
Is there a service specific maximum plan benefit coverage amount?
No
Transportation Services - Plan Approved Health-related Location benefits are covered.
More Details:
Is this benefit unlimited?
No
Number of trips
50
Periodicity
Every year
Type of transportation
One-way
Mode of Transportation
Medical Transport
Not covered.
Outpatient Services benefits are covered.
All Outpatient Hospital Services benefits are covered.
Outpatient Hospital Services benefits are covered. Prior Authorization and a doctor referral are required.
Observation Services benefits are covered. Prior Authorization and a doctor referral are required.
Ambulatory Surgical Center (ASC) Services benefits are covered. Prior Authorization and a doctor referral are required.
Outpatient Substance Abuse Services benefits are covered. Prior Authorization and a doctor referral are required.
Cost Sharing:
More Details:
Which Outpatient Substance Abuse services have a Copayment
Medicare-covered Individual Sessions, Medicare-covered Group Sessions
Individual Sessions for Outpatient Substance Abuse benefits are covered.
More Details:
Minimum copayment
15.00
Maximum copayment
15.00
Group Sessions for Outpatient Substance Abuse benefits are covered.
More Details:
Minimum copayment
15.00
Maximum copayment
15.00
Outpatient Blood Services benefits are covered – including services not usually covered by Medicare plans. Prior Authorization and a doctor referral are required.
More Details:
Enhanced benefit
Three (3) Pint Deductible Waived
Diagnostic and Radiological Services benefits are covered.
All Diagnostic services benefits are covered. Prior Authorization is required.
More Details:
Is there a copayment?
No
Not covered.
Not covered.
All Radiological Services benefits are covered. Prior Authorization and a doctor referral are required.
Cost Sharing:
More Details:
Which Outpatient Diagnostic/Therapeutic Radiological Services have a Coinsurance
Medicare-covered X-Ray Services
Is there a copayment?
No
Not covered.
Therapeutic Radiological Services benefits are covered.
Cost Sharing:
More Details:
Minimum coinsurance
20
Not covered.
Primary Care benefits are covered.
Primary Care Physician Services benefits are covered.
Chiropractic Services benefits are covered – including services not usually covered by Medicare plans. Prior Authorization and a doctor referral are required.
More Details:
Is there a maximum plan benefit coverage amount?
No
Routine Chiropractic Care benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Occupational Therapy Services benefits are covered.
More Details:
Is there a coinsurance?
No
Is there a copayment ?
No
Authorization required for this benefit?
Yes
Referral required for this benefit?
Yes
Physician Specialist Services benefits are covered.
Cost Sharing:
Mental Health Specialty Services benefits are covered.
Not covered.
Not covered.
Podiatry Services benefits are covered – including services not usually covered by Medicare plans.
More Details:
Enhanced benefits (7f)
Routine Foot Care
Is this benefit unlimited?
Yes
Is there a maximum plan benefit coverage amount?
No
Other Health Care Professional benefits are covered.
Psychiatric Services benefits are covered.
Not covered.
Not covered.
Physical Therapy and Speech-Language Pathology Services benefits are covered.
More Details:
Is there a coinsurance?
No
Is there a copayment ?
No
Authorization required for this benefit?
Yes
Referral required for this benefit?
Yes
Additional Telehealth Benefits benefits are covered – including services not usually covered by Medicare plans.
More Details:
Medicare-covered benefits that may have Additional Telehealth Benefits available
7a: Primary Care Physician Services, 7e1: Individual Sessions for Mental Health Specialty Services, 7h1: Individual Sessions for Psychiatric Services
Opioid Treatment Program Services benefits are covered. Prior Authorization and a doctor referral are required.
Cost Sharing:
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Home Health Services benefits are covered.
More Details:
Is there a coinsurance?
No
Is there a copayment ?
No
Authorization required for this benefit?
Yes
Referral required for this benefit?
Yes
Not covered.
Not covered.
Partial Hospitalization benefits are covered. Prior Authorization and a doctor referral are required.
Cost Sharing:
Emergency Services benefits are covered.
Emergency Services benefits are covered.
Cost Sharing:
More Details:
Is there a coinsurance?
No
Is there a copayment?
Yes
Is the copayment for Medicare-covered benefits waived if admitted to hospital?
Yes
Select either days or hours within which admission must occur for waiver
Hours
Enter number of days or hours
48
Does the cost sharing count towards any plan-level deductible?
No
Urgently Needed Services benefits are covered.
More Details:
Is there a coinsurance?
No
Is there a copayment?
No
Worldwide Emergency Services benefits are covered – including services not usually covered by Medicare plans.
More Details:
Is there a maximum plan benefit coverage?
Yes
Is the maximum plan benefit coverage amount unlimited?
No
Maximum amount
25000.00
Worldwide Emergency Coverage benefits are covered.
Worldwide Urgent Coverage benefits are covered.
Not covered.
Cardiac Rehabilitation Services benefits are covered. Prior Authorization and a doctor referral are required.
Not covered.
Not covered.
Not covered.
Not covered.
Skilled Nursing Facility (SNF) benefits are covered. Prior Authorization and a doctor referral are required.
Cost Sharing:
Days 1-31: | Days 32-100: | |
---|---|---|
Copayment | 0.00 | 50.00 |
More Details:
Does the plan provide Skilled Nursing Facility Services as a supplemental benefit under Part C?
No
Do you allow less than 3 day inpatient hospital stay prior to SNF admission?
Yes
Days
Zero
Do you charge the Medicare-defined cost share for tier 1?
No
Periodicity
Original Medicare
Not covered.
Not covered.
Inpatient Hospital benefits are covered.
Inpatient Hospital-Acute benefits are covered – including services not usually covered by Medicare plans. Prior Authorization and a doctor referral are required.
Cost Sharing:
Days 1-5: | Days 6-90: | |
---|---|---|
Copayment | 120.00 | 0.00 |
More Details:
Enhanced benefits
Non-Medicare-covered Stay
Do you charge the Medicare-defined cost share for tier 1?
No
Copayment for Medicare-covered stay
0.00
Periodicity
Per Admission or Per Stay
Do you charge cost sharing on the day of discharge?
No
Additional Days for Inpatient Hospital-Acute benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Not covered.
Not covered.
Inpatient Hospital Psychiatric benefits are covered – including services not usually covered by Medicare plans. Prior Authorization and a doctor referral are required.
Cost Sharing:
More Details:
Enhanced benefits (1b)
Non-Medicare-covered Stay
Do you charge the Medicare-defined cost share for tier 1?
No
Copayment for Medicare-covered stay
250.00
Periodicity
Original Medicare
Additional Days for Inpatient Hospital Psychiatric benefits are covered.
More Details:
Is this benefit unlimited?
No, indicate number
Number of Additional Days per benefit period
40
Not covered.
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