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Alignment Health Plan

Plan ID: H5472-3-0

Alignment Health smartHMO (HMO-POS)

2024 Alignment Health smartHMO (HMO-POS) H54720030 is a Medicare Advantage plan with drug coverage.

Learn more about Alignment Health smartHMO (HMO-POS) H5472 - 003 - 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

Health deductible

$545.00

Drug deductible

$5000.00

Out-of-pocket maximum

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1-877-649-2073 TTY 711. 8am-11pm EST. 7 days a week!

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Plan Overview

2024 Alignment Health smartHMO (HMO-POS) H54720030 is a Local HMO offered in El Paso, Hudspeth by Alignment Health Plan. It has a monthly premium of $0.00 and includes a Part B premium discount of $164.90.

Premium Breakdown

Standard Part B Premium

$174.70

Part B premium reduction

- $164.90

Monthly Plan Premium

$0.00

Total Premium:

$9.80

Note:

The standard Part B premium for 2024 is $174.70. Your Part B premium may differ based on factors including late enrollment, income, and disability status. Higher-income beneficiaries may pay an income-related monthly adjustment amount (IRMAA). The Part B premium is required to be paid by everyone enrolled in Medicare Part B.

Special needs plan type

No

Out-of-pocket maximum

$5000.00

Plan Organization:

Alignment Health Plan

Plan Type:

Local HMO

Location:

El Paso, Hudspeth

Drugs Covered:

Yes

Drug Formulary:

Pharmacies:

Doctor Choice:

Plan Doctors Only (some exceptions)

Doctors Link:

Deductibles

The amount you must pay each year before your plan starts to pay for covered services or drugs.

Health deductible

$0

Drug deductible

$545

Note:

This plan does not charge an annual deductible for all drugs. The $545.00 annual deductible only applies to drugs in certain tiers.

Other Plan Notes

  • This plan does not charge an annual deductible for all drugs. The $545 annual deductible only applies to drugs on certain tiers.

Sign up for Alignment Health smartHMO (HMO-POS)

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Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 TTY 711. 8am-11pm EST. 7 days a week

Drug Coverage Icon

Drug Coverage

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

Drug Benefit Type

Enhanced

Prescription drug deductible

$545.00

Increased initial coverage limit

No

Additional gap coverage

Yes

Part D Premium Reduction

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 25%

LIS 50%

LIS 75%

LIS Full

$0.00

$0.00

$0.00

$0.00

$0.00

Initial Coverage Phase

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

30 Days
60 Days
90 Days

Tier

Preferred Pharmacy

Standard Pharmacy

Preferred Mail

Standard Mail

1. Preferred Generic

-

$0.00 copay

-

$0.00 copay

2. Standard Generic

-

$0.00 copay

-

$0.00 copay

3. Preferred Brand

-

$45.00 copay

-

$45.00 copay

4. Non-Preferred Drug

-

$100.00 copay

-

$100.00 copay

5. Specialty Tier

-

25%

-

25%

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.

30 Days
60 Days
90 Days

Tier

Preffered Pharmacy

Standard Pharmacy

Preffered Mail

Standard Mail

Preferred Generic

-

$0.00 copay

-

$0.00 copay

Select Care Drugs

-

$5.00 copay

-

$5.00 copay

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.

Generic Drugs

$4.15 copay or 5% (whichever costs more)

Brand-name

$10.35 copay or 5% (whichever costs more)

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Additional Benefits

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

Note:

Limits, Authorizations, and Referrals may apply for the benefits below. Contact the plan for details.

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Comprehensive dental

Non-routine services
Not covered
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Diagnostic services
Not covered
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Restorative services
Not covered
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Endodontics
Not covered
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Periodontics
Not covered
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Extractions
Not covered
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Prosthodontics, other oral/maxillofacial surgery, other services
Not covered
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Preventive dental

Oral exam
In-Network: $0 copay
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Cleaning
In-Network: $0 copay
Limit Icon
Fluoride treatment
In-Network: $0 copay
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Dental x-ray(s)
In-Network: $0 copay
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Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures
In-Network: $0 copay
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Lab services
In-Network: $0 copay
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Diagnostic radiology services (eg, MRI)
In-Network: $0 copay
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Outpatient x-rays
In-Network: $0 copay
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Doctor visits

Primary
In-Network: $0 copay
Specialist
In-Network: $20 copay per visit
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Emergency care/Urgent care

Emergency
$120 copay per visit (always covered)
Urgent care
$20 copay per visit (always covered)
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Foot care (podiatry services)

Foot exams and treatment
In-Network: $5 copay
Routine foot care
Not covered
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Ground ambulance

Service
In-Network: $200 copay
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Hearing

Hearing exam
In-Network: $0 copay
Fitting/evaluation
In-Network: $0 copay
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Hearing aids - inner ear
Not covered
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Hearing aids - outer ear
Not covered
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Hearing aids - over the ear
Not covered
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Inpatient hospital coverage

Service
In-Network: $300 per day for days 1 through 3 $0 per day for days 4 through 90
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Out-Of-Network: $350 per day for days 1 through 5 $0 per day for days 6 through 90
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Additional Coverage Icon

Outpatient hospital coverage

Service
In-Network: $200 copay per visit
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Additional Coverage Icon

Outpatient prescription drugs

Alignment Health smartHMO (HMO-POS) does not provide this type of benefit.

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Optional benefits

Alignment Health smartHMO (HMO-POS) does not provide this type of benefit.

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Medical equipment/supplies

Durable medical equipment (eg, wheelchairs, oxygen)
In-Network: 20% coinsurance per item
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Prosthetics (eg, braces, artificial limbs)
In-Network: 20% coinsurance per item
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Diabetes supplies
In-Network: $0 copay
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Medicare Part B drugs

Chemotherapy
In-Network: 0-20% coinsurance
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Other Part B drugs
In-Network: 0-20% coinsurance
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Part B Insulin drugs
In-Network: 0-20% coinsurance (up to $35)
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Mental health services

Inpatient hospital - psychiatric
In-Network: $120 per day for days 1 through 10 $0 per day for days 11 through 90
Exclamation IconReferral Icon
Out-Of-Network: Not Applicable
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Outpatient group therapy visit with a psychiatrist
In-Network: $20 copay
Outpatient individual therapy visit with a psychiatrist
In-Network: $20 copay
Outpatient group therapy visit
In-Network: $10 copay
Outpatient individual therapy visit
In-Network: $10 copay
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Preventive care

Service
In-Network: $0 copay
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Rehabilitation services

Occupational therapy visit
In-Network: $0 copay
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Physical therapy and speech and language therapy visit
In-Network: $0 copay
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Additional Coverage Icon

Skilled Nursing Facility

Service
In-Network: $20 per day for days 1 through 20 $100 per day for days 21 through 100
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Out-Of-Network: Not Applicable
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Transportation

Service
Not covered
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Vision

Routine eye exam
In-Network: $0 copay
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Other
Not covered
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Contact lenses
In-Network: $0 copay
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Eyeglasses (frames and lenses)
In-Network: $0 copay
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Eyeglass frames
In-Network: $0 copay
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Eyeglass lenses
In-Network: $0 copay
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Upgrades
Not covered
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Wellness programs (eg, fitness, nursing hotline)

Service
Covered
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Plan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.

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Get Personalized Help from a licensed insurance agent

1-877-649-2073 TTY 711. 8am-11pm EST. 7 days a week

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