Align Kidney Care (HMO-POS C-SNP) is a Medicare Advantage (Part C) Special Needs Plan by Align Senior Care.
This page features plan details for 2024 Align Kidney Care (HMO-POS C-SNP) H1277 – 004 – 0 available in Virginia (partial).
IMPORTANT: This page has been updated with plan and premium data for 2024.
Align Kidney Care (HMO-POS C-SNP) is offered in the following locations.
Align Kidney Care (HMO-POS C-SNP) offers the following coverage and cost-sharing.
| Special Needs Plan Type: | Chronic or Disabling Condition |
| Conditions Covered: | End-stage Renal Disease Requiring Dialysis (any mode of dialysis) |
| Insurer: | Align Senior Care |
| Health Plan Deductible: | Coming soon |
| MOOP: | $8,850 In and Out-of-network $8,850 In-network |
| Drugs Covered: | Yes |
Ready to sign up for Align Kidney Care (HMO-POS C-SNP) ?
| Part B | Part C | Part D | Part B Give Back | Total |
|---|---|---|---|---|
| $174.70 | $0.00 | $38.50 | $0.00 | $213.20 |
Align Kidney Care (HMO-POS C-SNP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
| Drug Deductible: | $545.00 |
| Initial Coverage Limit: | $5,030.00 |
| Catastrophic Coverage Limit: | $8,000.00 |
| Drug Benefit Type: | Enhanced |
| Additional Gap Coverage: | No |
| Formulary Link: | Formulary Link |
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.
The table below shows how the LIS impacts the Part D premium of this plan.
| Part D | LIS Full |
|---|---|
| $38.50 | $0.00 |
NOTE: The Inflation Reduction Act of 2022 has expanded full subsidy eligibility under the LIS program to individuals with incomes up to 150% of the Federal Poverty Level. People who qualify for Extra Help generally will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug.
After you pay your $545.00 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 $5,030.00. Once you reach that amount, you will enter the next coverage phase.
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $2.00 copay | $2.00 copay | ||
| 2 (Generic) | $15.00 copay | $15.00 copay | ||
| 3 (Preferred Brand) | $45.00 copay | $45.00 copay | ||
| 4 (Non-Preferred Brand) | $95.00 copay | $95.00 copay | ||
| 5 (Specialty Tier) | 25% | 25% | ||
| 6 (Select Care Drugs) | $0.00 copay | $0.00 copay |
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | ||||
| 2 (Generic) | ||||
| 3 (Preferred Brand) | ||||
| 4 (Non-Preferred Brand) | ||||
| 5 (Specialty Tier) | ||||
| 6 (Select Care Drugs) |
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $6.00 copay | $6.00 copay | ||
| 2 (Generic) | $45.00 copay | $45.00 copay | ||
| 3 (Preferred Brand) | $135.00 copay | $135.00 copay | ||
| 4 (Non-Preferred Brand) | $285.00 copay | $285.00 copay | ||
| 5 (Specialty Tier) | ||||
| 6 (Select Care Drugs) | $0.00 copay | $0.00 copay |
After your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00, you will pay no more than the amounts below for any drug tier until you reach $8,000.00.
| Tier | Cost |
|---|---|
| All other tiers (Generic) | 25% |
| All other tiers (Brand-name) | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, 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. Please note, that this plan has a Enhanced benefit type.
Align Kidney Care (HMO-POS C-SNP) also provides the following benefits.
| Coming soon |
| In-network | Yes |
| $8,850 In and Out-of-network $8,850 In-network |
| No |
| In-network | No |
| In-network | 20% coinsurance per visit (Authorization is required.) (Referral is not required.) |
| out-of-network | 20% coinsurance per visit (Authorization is required.) (Referral is not required.) |
| In-network Primary | $0 copay (Not applicable.) (Not applicable.) |
| out-of-network Primary | $0 copay (Not applicable.) (Not applicable.) |
| In-network Specialist | 0-20% coinsurance per visit (Authorization is not required.) (Referral is not required.) |
| out-of-network Specialist | 20% coinsurance per visit (Authorization is not required.) (Referral is not required.) |
| In-network | $0 copay (Authorization is not required.) (Referral is not required.) |
| Emergency | $90 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Urgent care | $25 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| In-network Diagnostic tests and procedures | 20% coinsurance (Authorization is required.) (Referral is not required.) |
| out-of-network Diagnostic tests and procedures | 20% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Lab services | $0 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Lab services | $0 copay (Authorization is required.) (Referral is not required.) |
| In-network Diagnostic radiology services (e.g., MRI) | 20% coinsurance (Authorization is required.) (Referral is not required.) |
| out-of-network Diagnostic radiology services (e.g., MRI) | 20% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Outpatient x-rays | 20% coinsurance (Authorization is required.) (Referral is not required.) |
| out-of-network Outpatient x-rays | 20% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Hearing exam | 20% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Fitting/evaluation | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Hearing aids | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Fluoride treatment | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Non-routine services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| In-network Diagnostic services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| In-network Restorative services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| In-network Endodontics | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| In-network Periodontics | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| In-network Extractions | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| In-network Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| In-network Routine eye exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| In-network Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Upgrades | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Occupational therapy visit | 20% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Physical therapy and speech and language therapy visit | 20% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network | 20% coinsurance (Not applicable.) (Not applicable.) |
| In-network | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Foot exams and treatment | 20% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Routine foot care | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| In-network Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| In-network Diabetes supplies | $0 copay (Authorization is not required.) (Not applicable.) |
| Covered (Authorization is not required.) (Referral is not required.) |
| In-network Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| In-network Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| In-network Part B Insulin drugs | 0-20% coinsurance (up to $35) (Authorization is required.) (Not applicable.) |
| In-network | Coming soon (Authorization is required.) (Referral is not required.) |
| out-of-network | Coming soon (Authorization is required.) (Referral is not required.) |
| In-network Inpatient hospital – psychiatric | Coming soon (Authorization is required.) (Referral is not required.) |
| out-of-network Inpatient hospital – psychiatric | Coming soon (Authorization is required.) (Referral is not required.) |
| In-network Outpatient group therapy visit with a psychiatrist | 20% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Outpatient individual therapy visit with a psychiatrist | 20% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Outpatient group therapy visit | 20% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Outpatient individual therapy visit | 20% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network | Coming soon (Authorization is required.) (Referral is not required.) |
| out-of-network | Not Applicable (Authorization is required.) (Referral is not required.) |
Ready to sign up for Align Kidney Care (HMO-POS C-SNP) ?
SMID: MULTIPLAN_HCIHNDOGMED01_M
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