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Alignment Health Premium (HMO-POS)

H5472 - 005 - 0

Plan Not Rated

Alignment Health Premium (HMO-POS) is a Medicare Advantage Plan by Alignment Health Plan.

This page features plan details for 2025 Alignment Health Premium (HMO-POS) H5472 – 005 – 0 available in El Paso, Hudspeth.

Locations

Alignment Health Premium (HMO-POS) is offered in the following locations.

El Paso County, Texas

Hudspeth County, Texas

Texas

Click to see more locations

Plan Overview

Alignment Health Premium (HMO-POS) offers the following coverage and cost-sharing.

Insurer:	Alignment Health Plan
Health Plan Deductible:	$0
MOOP:	$2,950 In-network
Drugs Covered:	Yes

Ready to sign up for Alignment Health Premium (HMO-POS) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

Alignment Health Premium (HMO-POS) has a monthly premium of $8.00. 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
$185.00	$8.00	$0.00	$	$

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 Premium (HMO-POS) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible:	$0.00
Drug Out-Of-Pocket maximum:	$2,000.00
Drug Benefit Type:	Enhanced Alternative

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 Full
$0.00	$0.00

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 $2,000.00. Once you reach that amount, you will enter the next coverage phase.

30 Day

60 Day

90 Day

30 Day

Tier	Std. Pharm	Std. Mail
1) Preferred Generic
3) Preferred Brand	$45.00 Copay	$45.00 Copay
4) Non-Preferred Drug	$100.00 Copay	$100.00 Copay
6) Select Care Drugs	$5.00 Copay	$5.00 Copay

60 Day

Tier	Std. Pharm	Std. Mail
1) Preferred Generic
3) Preferred Brand	$90.00 Copay	$90.00 Copay
4) Non-Preferred Drug	$200.00 Copay	$200.00 Copay
6) Select Care Drugs	$10.00 Copay	$10.00 Copay

90 Day

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, 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 Alternative benefit type.

Additional Benefits

Alignment Health Premium (HMO-POS) also provides the following benefits.

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

- In-Network: No

Comprehensive Dental

Endodontics
- In-Network: No Coins – No Co pay (Limits Apply)
Oral and Maxillofacial Surgery
- In-Network: No Coins – No Co pay (Limits Apply)
Periodontics
- In-Network: No Coins – No Co pay (Limits Apply)
Prosthodontics, fixed
- In-Network: No Coins – No Co pay (Limits Apply)
Prosthodontics, removable
- In-Network: No Coins – No Co pay (Limits Apply)
Restorative Services
- In-Network: No Coins – No Co pay (Limits Apply)

Diagnostic and Preventive Dental

Dental X-Rays
- In-Network: No Coins – No Copay
Fluoride Treatment
- In-Network: No Coins – No Copay
Oral Exams
- In-Network: No Coins – No Copay
Prophylaxis (cleaning)
- In-Network: No Coins – No Copay

Diagnostic procedures/lab services/imaging

Outpatient x-rays
- In-Network: $0 copay (Authorization Required, Referral Required)
Diagnostic radiology services (e.g., MRI)
- In-Network: $0 copay (Authorization Required, Referral Required)
Diagnostic tests and procedures
- In-Network: $0 copay (Authorization Required)
Lab services
- In-Network: $0 copay (Authorization Required)

Doctor visits

Primary
- In-Network: $0 copay
Specialist
- Out-of-Network: $15 copay per visit
- In-Network: $15 copay per visit

Emergency care/Urgent care

Urgent care
- $0 copay
Emergency
- $100 copay per visit (always covered)

Foot care (podiatry services)

Foot exams and treatment
- In-Network: $5 copay
Routine foot care
- In-Network: $0 copay

Ground ambulance

- In-Network: $200 copay

Health plan deductible

- $0

Hearing

Hearing aids
- In-Network: $195-1,750 copay (Limits Apply)
Fitting/evaluation
- In-Network: $0 copay (Limits Apply)
Medicare-Covered Hearing Exam
- In-Network: $0 copay
Hearing aids OTC
- Not covered

Inpatient hospital coverage

- In-Network: $0 per day for days 1 through 2
  $120 per day for days 3 through 7
  $0 per day for days 8 through 90 (Authorization Required, Referral Required)
- Out-of-Network: $100 per day for days 1 through 2
  $250 per day for days 3 through 7
  $0 per day for days 8 through 90 (Authorization Required, Referral Required)

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

- $2,950 In-network

Medical equipment/supplies

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

Medicare Part B drugs

Chemotherapy
- In-Network: 0-20% coinsurance (Authorization Required)
Other Part B drugs
- In-Network: 0-20% coinsurance (Authorization Required)

Mental health services

Inpatient hospital – psychiatric
- Out-of-Network: Not Applicable (Authorization Required, Referral Required)
Outpatient group therapy visit with a psychiatrist
- In-Network: $20 copay
Outpatient group therapy visit
- In-Network: $5 copay
Outpatient individual therapy visit
- In-Network: $5 copay
Outpatient individual therapy visit with a psychiatrist
- In-Network: $20 copay
Inpatient hospital – psychiatric
- In-Network: $120 per day for days 1 through 10
  $0 per day for days 11 through 90 (Authorization Required, Referral Required)

Optional supplemental benefits

- No

Other health plan deductibles?

- In-Network: No

Outpatient hospital coverage

- In-Network: $0 copay (Authorization Required, Referral Required)

Preventive care

- In-Network: $0 copay

Rehabilitation services

Occupational therapy visit
- In-Network: $0 copay (Authorization Required, Referral Required)
Physical therapy and speech and language therapy visit
- In-Network: $0 copay (Authorization Required, Referral Required)

Skilled Nursing Facility

- In-Network: $20 per day for days 1 through 20
  $100 per day for days 21 through 100 (Authorization Required, Referral Required)
- Out-of-Network: Not Applicable (Authorization Required, Referral Required)

Transportation

- In-Network: $0 copay (Limits Apply, Authorization Required)

Vision

Eyeglasses (frames and lenses)
- In-Network: $0 copay (Limits Apply)
Other
- Not covered
Contact lenses
- In-Network: $0 copay (Limits Apply)
Eyeglass frames
- In-Network: $0 copay (Limits Apply)
Eyeglass lenses
- In-Network: $0 copay (Limits Apply)
Routine eye exam
- In-Network: $0 copay (Limits Apply)
Upgrades
- Not covered

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

- Covered