Alignment Health Heart & Diabetes (HMO C-SNP)

H5296 - 005 - 0
5 out of 5 stars (5 / 5)

Alignment Health Heart & Diabetes (HMO C-SNP) is a Medicare Advantage (Part C) Special Needs Plan by Alignment Health Plan.

This page features plan details for 2023 Alignment Health Heart & Diabetes (HMO C-SNP) H5296 – 005 – 0 available in Mountains and Piedmont Regions.

IMPORTANT: This page features the 2023 version of this plan. See the 2024 version using the link below:

Locations

Alignment Health Heart & Diabetes (HMO C-SNP) is offered in the following locations.

Plan Overview

Alignment Health Heart & Diabetes (HMO C-SNP) offers the following coverage and cost-sharing.

Special Needs Plan Type:Chronic or Disabling Condition
Conditions Covered:
  • Cardiovascular Disorders, Chronic Heart Failure and Diabetes
  • Insurer:Alignment Health Plan
    Health Plan Deductible:$0.00
    MOOP:$3,400 In-network
    Drugs Covered:Yes

    Ready to sign up for Alignment Health Heart & Diabetes (HMO C-SNP) ?

    Get help from a licensed insurance agent.

    Call 1-877-354-4611 TTY 711.

    8am – 11pm EST. 7 days a week

    Premium Breakdown

    Alignment Health Heart & Diabetes (HMO C-SNP) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
    Part B Part C Part D Part B Give Back Total
    $164.90 $0.00 $0.00 $0.00 $164.90
    Please Note:
    • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
    • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

    Drug Info

    Alignment Health Heart & Diabetes (HMO C-SNP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

    Drug Deductible: $0.00
    Initial Coverage Limit: $4,660.00
    Catastrophic Coverage Limit: $7,400.00
    Drug Benefit Type: Enhanced
    Gap Coverage: Yes
    Formulary Link: Formulary Link

    Part D Premium Reduction

    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 25% LIS 50% LIS 75% LIS Full
    $0.00 $43.40 $34.80 $26.30 $17.70

    Initial Coverage Phase

    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 $4,660.00. Once you reach that amount, you will enter the next coverage phase.

    Gap Coverage Phase

    After your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00, you will pay no more than the amounts below for any drug tier until you reach $7,400.00.

    Tier Cost
    All other tiers (Generic)25%
    All other tiers (Brand-name)25%

    Catastrophic Coverage Phase

    After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.

    Drug TypeCost Share
    Generic drugs$4.15 copay or 5% (whichever costs more)
    Brand-name drugs$10.35 copay or 5% (whichever costs more)

    Additional Benefits

    Alignment Health Heart & Diabetes (HMO C-SNP) also provides the following benefits.

    Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    In-Network: No

    Dental (comprehensive)

    Diagnostic services: $0 copay (limits may apply) (authorization required) (referral required)
    Endodontics: $0 copay (limits may apply) (authorization required) (referral required)
    Extractions: $0 copay (limits may apply) (authorization required) (referral required)
    Non-routine services: Not covered (no limits)
    Periodontics: $0 copay (limits may apply) (authorization required) (referral required)
    Prosthodontics, other oral/maxillofacial surgery, other services: $0 copay (limits may apply) (authorization required) (referral required)
    Restorative services: $0 copay (limits may apply) (authorization required) (referral required)

    Dental (preventive)

    Cleaning: $0 copay (limits may apply) (authorization required) (referral required)
    Dental x-ray(s): $0 copay (limits may apply) (authorization required) (referral required)
    Fluoride treatment: $0 copay (limits may apply) (authorization required) (referral required)
    Oral exam: $0 copay (limits may apply) (authorization required) (referral required)

    Diagnostic procedures/lab services/imaging

    Diagnostic radiology services (e.g., MRI): $0 copay (authorization required) (referral required)
    Diagnostic tests and procedures: $0 copay (authorization not required) (referral not required)
    Lab services: $0 copay (authorization not required) (referral not required)
    Outpatient x-rays: $0 copay (authorization required) (referral required)

    Doctor visits

    Primary: $0 copay
    Specialist: $0 copay (authorization required) (referral required)

    Emergency care/Urgent care

    Emergency: $70 copay per visit (always covered)
    Urgent care: $0 copay

    Foot care (podiatry services)

    Foot exams and treatment: $0 copay (authorization required) (referral required)
    Routine foot care: $0 copay (limits may apply) (authorization required) (referral required)

    Ground ambulance

    $100 copay

    Health plan deductible

    $0.00

    Health plan deductibles (other)

    In-Network: No

    Hearing

    Fitting/evaluation: $0 copay (limits may apply) (authorization required) (referral required)
    Hearing aids: $0 copay (no limits) (authorization required) (referral required)
    Hearing exam: $0 copay (authorization required) (referral required)

    Hospital coverage (inpatient)

    $100 per day for days 1 through 6
    $0 per day for days 7 through 90
    $0 per day for days 91 and beyond (authorization required) (referral required)

    Hospital coverage (outpatient)

    $200 copay per visit (authorization required) (referral required)

    Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    $3,400 In-network

    Medical equipment/supplies

    Diabetes supplies: $0 copay (authorization required)
    Durable medical equipment (e.g., wheelchairs, oxygen): 0-20% coinsurance per item (authorization required)
    Prosthetics (e.g., braces, artificial limbs): $0 copay (authorization required)

    Medicare Part B drugs

    Chemotherapy: 20% coinsurance (authorization required)
    Other Part B drugs: 20% coinsurance (authorization required)

    Mental health services

    Inpatient hospital – psychiatric: $250 per stay (authorization required) (referral required)
    Outpatient group therapy visit: $0 copay (authorization required) (referral required)
    Outpatient group therapy visit with a psychiatrist: $0 copay (authorization required) (referral required)
    Outpatient individual therapy visit: $0 copay (authorization required) (referral required)
    Outpatient individual therapy visit with a psychiatrist: $0 copay (authorization required) (referral required)

    Optional supplemental benefits

    No

    Preventive care

    $0 copay (authorization not required) (referral not required)

    Rehabilitation services

    Occupational therapy visit: $0 copay (authorization required) (referral required)
    Physical therapy and speech and language therapy visit: $0 copay (authorization required) (referral required)

    Skilled Nursing Facility

    $0 per day for days 1 through 20
    $100 per day for days 21 through 51
    $0 per day for days 52 through 100 (authorization required) (referral required)

    Transportation

    $0 copay (limits may apply) (authorization required) (referral required)

    Vision

    Contact lenses: $0 copay (no limits) (authorization required) (referral not required)
    Eyeglass frames: $0 copay (no limits) (authorization required) (referral not required)
    Eyeglass lenses: $0 copay (no limits) (authorization required) (referral not required)
    Eyeglasses (frames and lenses): $0 copay (no limits) (authorization required) (referral not required)
    Other: Not covered (no limits)
    Routine eye exam: $0 copay (limits may apply) (authorization not required) (referral not required)
    Upgrades: Not covered

    Wellness programs (e.g., fitness, nursing hotline)

    Covered (authorization not required) (referral not required)

    Ready to sign up for Alignment Health Heart & Diabetes (HMO C-SNP) ?

    Get help from a licensed insurance agent.

    Call 1-877-354-4611 TTY 711.

    8am – 11pm EST. 7 days a week

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