2027 Medicare Advantage plan

Alignment Health BRIDGE 013 (HMO-POS): 2027 benefits and costs

Alignment Health Plan HMO-POS

CMS plan ID: H5472-013-0 · Plan year: 2027

Alignment Health BRIDGE 013 (HMO-POS) is a 2027 Medicare Advantage plan offered by Alignment Health Plan. It is listed in Texas.

2027 plan costs at a glance

Monthly plan premium$0.00

Drug deductible$700.00

In-network medical out-of-pocket maximum$2,800.00

Organization: Alignment Health Plan
Plan organization: ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC
Parent company: Alignment Healthcare USA, LLC
Plan type: HMO-POS
Part C premium: $0.00
Part D premium: $0.00
Prescription drug coverage: Yes
2027 CMS Star Rating

Standard monthly Medicare Part B premium: $209.50 (estimated)

You must continue to pay your Medicare Part B premium.

In-network medical deductible: None
Combined in/out-of-network medical deductible: None
Out-of-network medical deductible: None
In-network medical maximum: $2,800.00
Combined in/out-of-network medical maximum: Not applicable
Out-of-network medical maximum: Not applicable

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
Service	In-network	Point-of-service	What to know
Primary care doctor	$0 Service-specific deductible No	Not summarized. Check coverage with the plan.
Specialist visit	$15.00 copay Service-specific deductible No	$15.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required Yes
Telehealth	$0.00 to $20.00 copay Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Emergency care	$150.00 copay	Not summarized. Check coverage with the plan.
Urgent care	$0	Not summarized. Check coverage with the plan.
Home health	$0 Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required Yes
Dialysis	20% coinsurance Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required Yes
Part B chemotherapy and radiation drugs	0% to 20% coinsurance Deductible applies No	Not summarized. Check coverage with the plan.	Approval required Yes
Other Part B drugs	0% to 20% coinsurance Deductible applies No	Not summarized. Check coverage with the plan.	Approval required Yes
Kidney disease education services	$0 Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Medicare-covered chiropractic	$0 Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required Yes
Medicare-covered foot care	$5.00 copay Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required Yes
Other health professionals	$0 Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required Yes

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
Care	Your share of the cost	What to know
Inpatient hospital stay	$0.00 copay per stay Days 1–5: $75.00 copay per day Days 6–90: $0.00 copay per day	Approval required Yes Referral required Yes Benefit period Per Admission or Per Stay
Inpatient mental health care	$0.00 copay per stay Days 1–10: $120.00 copay per day Days 11–90: $0.00 copay per day	Approval required Yes Referral required Yes Benefit period Original Medicare
Skilled nursing facility	Days 1–20: $20.00 copay per day Days 21–100: $100.00 copay per day	Approval required Yes Referral required Yes Benefit period Original Medicare

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
Service	In-network	What to know
Outpatient hospital care	$75.00 copay Service-specific deductible No
Hospital observation services	$0 Service-specific deductible No
Ambulatory surgical center	$0 Service-specific deductible No	Approval required Yes Referral required Yes
Outpatient blood	$0 Service-specific deductible No	Approval required Yes Referral required Yes

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
Service	In-network	What to know
Diagnostic procedures and tests	$0 Service-specific deductible No	Approval required Yes Referral required Yes
Laboratory services	$0 Service-specific deductible No	Approval required Yes Referral required Yes
Diagnostic radiology (CT, MRI)	$0 Service-specific deductible No	Approval required Yes Referral required Yes
Therapeutic radiology	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
X-rays	$0 Service-specific deductible No	Approval required Yes Referral required Yes

Mental health and substance use treatment

Mental health and substance use treatment and member costs
Service	In-network	What to know
Partial hospitalization	$55.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Intensive outpatient program	$55.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Substance use treatment, individual sessions	$50.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Substance use treatment, group sessions	$50.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Opioid treatment program	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Mental health, individual sessions	$20.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Mental health, group sessions	$20.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Psychiatry, individual sessions	$20.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Psychiatry, group sessions	$20.00 copay Service-specific deductible No	Approval required Yes Referral required Yes

Therapy and rehabilitation

Therapy and rehabilitation and member costs
Service	In-network	What to know
Occupational therapy	$0 Service-specific deductible No	Approval required Yes Referral required Yes
Physical and speech therapy	$0 Service-specific deductible No	Approval required Yes Referral required Yes
Cardiac rehabilitation	$0 Service-specific deductible No	Approval required Yes Referral required Yes
Intensive cardiac rehabilitation	$0 Service-specific deductible No	Approval required Yes Referral required Yes
Pulmonary rehabilitation	$0 Service-specific deductible No	Approval required Yes Referral required Yes
Supervised exercise for peripheral artery disease	$0 Service-specific deductible No	Approval required Yes Referral required Yes

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
Service	In-network	What to know
Ground ambulance	$200.00 copay Service-specific deductible No	Approval required Yes
Air ambulance	$200.00 copay Service-specific deductible No	Approval required Yes
Durable medical equipment	0% to 20% coinsurance Service-specific deductible No	Approval required Yes
Prosthetic devices	20% coinsurance Service-specific deductible No	Approval required Yes
Medical supplies	20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic supplies	$0 Service-specific deductible No	Approval required Yes
Diabetic shoes and inserts	20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic monitors	20% coinsurance Service-specific deductible No	Approval required Yes

Dental benefits

Dental benefits and member costs
Service	In-network	What to know
Medicare-covered dental	$0
Oral examsAdditional plan benefit	$0
Dental X-raysAdditional plan benefit	$0
Dental cleaningAdditional plan benefit	$0
FluorideAdditional plan benefit	$0
Restorative dental careAdditional plan benefit	$0
Root canal treatment (endodontics)Additional plan benefit	$0
Gum treatment (periodontics)Additional plan benefit	$0
Removable dentures (prosthodontics)Additional plan benefit	$0
Fixed dental restorations (prosthodontics)Additional plan benefit	$0
Oral surgeryAdditional plan benefit	$0

Vision benefits

Vision benefits and member costs
Service	In-network	What to know
Medicare-covered eye exams	$0 Service-specific deductible No	Approval required No Referral required No
Routine eye examsAdditional plan benefit	$0	Approval required No Referral required No
Medicare-covered eyewear	$0 Service-specific deductible No	Approval required No Referral required No
Contact lensesAdditional plan benefit	$0	Approval required No Referral required No
Eyeglasses, lenses and framesAdditional plan benefit	$0	Approval required No Referral required No
Eyeglass lensesAdditional plan benefit	$0	Approval required No Referral required No
Eyeglass framesAdditional plan benefit	$0	Approval required No Referral required No

Hearing benefits

Hearing benefits and member costs
Service	In-network	What to know
Medicare-covered hearing exams	$0 Service-specific deductible No	Approval required No Referral required No
Routine hearing examsAdditional plan benefit	$0	Approval required No Referral required No
Hearing aid fitting and evaluationAdditional plan benefit	$0	Approval required No Referral required No
Prescription hearing aids (all types)Additional plan benefit	$195.00 to $1,750.00 copay Service-specific deductible No	Approval required No Referral required No

Extra benefits

Extra benefits and member costs
Service	In-network	What to know
Supplemental acupunctureAdditional plan benefit	$0 Service-specific deductible No	Approval required Yes Referral required Yes
Over-the-counter health itemsAdditional plan benefit	$0 Service-specific deductible No
Limited-duration mealsAdditional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No
Annual physical examAdditional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No
Fitness benefitAdditional plan benefit	$0 Service-specific deductible No	Approval required Yes Referral required No

Allowances and optional benefits

IHSS + Support for Caregiver

One shared limit covers the listed services, not a separate allowance for each service.

Services sharing this allowance: In-Home Support Services; Support for caregivers
How benefits are provided: Other; Reimbursement
How to use the benefit: Member visit
Advance choice of benefits required: Yes
Shared limit on visits or trips: No

Chiro and Acupuncture

One shared limit covers the listed services, not a separate allowance for each service.

Services sharing this allowance: Routine Chiropractic Care; Acupuncture Treatments
How benefits are provided: Claims Processing
Advance choice of benefits required: No
Shared limit on visits or trips: Yes
Indicate number of shared visits/trips: 24
How often this limit applies: Every year

Combined Supplemental Benefits 1

One shared limit covers the listed services, not a separate allowance for each service.

Services sharing this allowance: Over-the-counter health items; Weight Management Programs; Additional Benefits for SSBCI
Service categories that apply to the combined supplemental benefits group for Special Supplemental Benefits for Chronically Ill (SSBCI) package(s): Food and produce (SSBCI: Package 1)
How benefits are provided: Debit Card
Advance choice of benefits required: No
Shared benefit limit: $75.00
How often this limit applies: Every one month
Are the benefits combined such that a single benefit maximum available to all enrollees in the benefit details section is extended to an SSBCI or MA UF benefit for eligible enrollees?: Yes
Shared limit on visits or trips: No

Benefits for qualifying members

Package 1

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions: Overweight, obesity, and metabolic syndrome
Included services: Food and produce; Pest control; Other 1 Non-Primarily Health Related Benefit; Other 2 Non-Primarily Health Related Benefit
Applies to out-of-network or point-of-service care: No
Some package benefits are exempt from the deductible: No

Prescription drug coverage

Costs shown are for initial coverage.

Drug deductible exceptions: Tier 1; Tier 2; Tier 3; Tier 6 are exempt from the deductible.

Standard retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard retail: initial-coverage cost per prescription fill
Drug tier	30 days	60 days	100 days
Tier 1Preferred Generic	$0.00	$0.00	$0.00
Tier 2Generic	$0.00	$0.00	$0.00
Tier 3Preferred Brand	$45.00	$90.00	$135.00
Tier 4Non-Preferred Drug	32%	32%	32%
Tier 5Specialty Tier	25%	Not listed	Not listed
Tier 6Select Care Drugs	$5.00	$10.00	$0.00

Mail-order and other pharmacies

Out-of-network pricing: You pay the standard retail copay or coinsurance, plus any difference between the pharmacy’s billed charge and the amount the plan allows at a standard retail pharmacy.

Standard mail order costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard mail order: initial-coverage cost per prescription fill
Drug tier	30 days	60 days	100 days
Tier 1Preferred Generic	$0.00	$0.00	$0.00
Tier 2Generic	$0.00	$0.00	$0.00
Tier 3Preferred Brand	$45.00	$90.00	$135.00
Tier 4Non-Preferred Drug	32%	32%	32%
Tier 5Specialty Tier	25%	Not listed	Not listed
Tier 6Select Care Drugs	$5.00	$10.00	$0.00

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier	31 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$0.00
Tier 3Preferred Brand	$45.00
Tier 4Non-Preferred Drug	32%
Tier 5Specialty Tier	25%
Tier 6Select Care Drugs	$5.00

Out-of-network pharmacy costs

Out-of-network pharmacy: initial-coverage cost per prescription fill
Drug tier	30 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$0.00
Tier 3Preferred Brand	$45.00
Tier 4Non-Preferred Drug	32%
Tier 5Specialty Tier	25%
Tier 6Select Care Drugs	$5.00

Drug coverage rules and exceptions

Tier 1: Preferred Generic

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 2: Generic

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 3: Preferred Brand

Drugs included in this tier: Both Part D and Excluded Drugs
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 4: Non-Preferred Drug

Drugs included in this tier: Both Part D and Excluded Drugs
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 5: Specialty Tier

Drugs included in this tier: Part D Drugs Only

Tier 6: Select Care Drugs

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Initial-coverage prices also apply to drugs exempt from the deductible: Yes

Special cost protections apply to covered insulin and recommended adult vaccines.

Where this plan is offered

CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.

Texas

Bexar, Texas