Advantage Care (HMO)
Align Senior Care · HMO · 2026 coverage
Not offered in Santa Clara County in 2027
Your plan’s letter says what happens to you.
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $0
- Most you pay in a year for covered care in network
- $1,900
- Lower than most plans here
- Drug deductible
- $0
- Most you pay for covered drugs in a year
- $2,100
- Medicare star rating
- No rating yet
In plain English
Compared with the 25 other plans in Santa Clara County that the same person could join.
What stands out
- No monthly premium
- At most $1,900 a year for covered care, lower than most plans here
- $0 for a 5-day hospital stay, tied for lowest here
- $90 for the emergency room, lower than most plans here
Watch out for
- $40 for urgent care, higher than most plans here
- No hearing extra, though most plans here have one
- Covers only the plan’s own doctors and hospitals, except in an emergency or for urgent care
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$0$0 in premiums + $0 for care2 checkups and 2 lab tests.
- A busier year$40$0 in premiums + $40 for care4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$215$0 in premiums + $215 for careLower than most plans here6 checkups, 12 specialist visits, 6 lab tests, 2 scans, an ambulance ride, an ER visit and a 5-day hospital stay.Not counted, because the plan charges a percentage: MRI, CT and other scans.
The visit counts are examples we chose to show how costs add up, not a prediction. Your costs depend on the care you get.
What you pay for care
Your cost each time, at doctors and hospitals in the plan’s network.
- Primary care visit$0
- Specialist visit$0
- Urgent care$40Higher than most plans here
- Emergency room$90Lower than most plans hereNot charged if you stay in the hospital within 3 days
- Hospital stay$0 per stayTied for lowest herePlan approval may be needed
- Lab tests$0Plan approval may be needed
More care: surgery, scans, mental health, therapy, home health and more
- Outpatient surgery center20%Plan approval may be needed
- Outpatient hospital care$0 to $225Depends on the service
- X-rays$0Plan approval may be needed
- MRI, CT and other scans20%Plan approval may be needed
- Ground ambulance$125Lower than most plans herePlan approval may be needed
- Skilled nursing facility$0 for days 1 to 100Plan approval may be needed
- Mental health therapy visit$0Tied for lowest here
- Psychiatrist visit20%
- Physical or speech therapy$0Plan approval may be needed
- Occupational therapy$0Plan approval may be needed
- Home health care$0Plan approval may be needed
- Medical equipment, like a walker or oxygen20%Plan approval may be needed
- Kidney dialysis20%
- Chemotherapy and radiation drugs0% to 20%Depends on the servicePlan approval may be needed
- Other drugs given at a clinic0% to 20%Depends on the servicePlan approval may be needed
- Heart rehab20%Plan approval may be needed
- Foot doctor (podiatrist)20%
- Chiropractor20%Plan approval may be needed
From the costs the plan filed with Medicare for 2026. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 25 other plans in Santa Clara County that the same person could join. Read the plan’s 2026 booklet (PDF)
Is my doctor in this plan?
Look up your doctors, then confirm with their office.
Add your doctors once. We’ll check them against each plan you look at.
Before you choose, call each doctor’s office and ask:
“Do you take Advantage Care (HMO), plan number H3274-005, for 2026?”
What medicines cost
The most you pay for covered drugs in 2026 is $2,100. After that, covered drugs cost $0 for the rest of the year.
| Drug tier | Network pharmacy |
|---|---|
| 1Preferred Generic | $0 |
| 2Generic | $10 |
| 3Preferred Brand | $45 |
| 4Non-Preferred Drug | $95 |
| 5Specialty Tier | 33% of the price |
For a 1-month supply. Covered insulin costs at most $35 for a month’s supply. Your medicine’s tier is on the plan’s drug list; check it below.
Check my medicines
See if this plan covers each medicine you take in 2026, and what a month costs.
Type the name on the bottle. Add the strength to narrow it down.
Add each medicine once. We’ll show if this plan covers it, what a month costs, and any rules.
Extras
Help Original Medicare doesn’t give you.
- Dental IncludedCleanings and exams: $0. Fillings, crowns and dentures: you pay $0.Plan pays up to $3,000 a year.
- Vision IncludedRoutine eye exam covered. Glasses or contacts covered.Eyewear: plan pays up to $225 a year.
- Hearing Not included
- Over-the-counter items IncludedCovered for things like vitamins, pain relief and bandages.
- Fitness Not included
- Rides to care Included24 one-way rides to medical visits a year.
- Help at home IncludedIncludes help at home with everyday tasks.Ask the plan who can get it.
- Extra help for some members IncludedIf you have certain long-term health conditions: rides to places other than medical visits and food and produce.Food and produce: up to $25 a month. The plan decides who qualifies.
- Other extras IncludedIncludes acupuncture.
Help paying for this plan
Programs that can lower your Medicare costs if your income is limited.
Extra Help with drug costs
The drug part of this plan’s premium is already $0, so Extra Help would not lower the premium.
Extra Help also lowers what you pay for each medicine.
See who can get Extra HelpHelp with your Part B premium
A Medicare Savings Program can pay your Part B premium, and for some people more of their Medicare costs.
See who can get a Medicare Savings ProgramContact the plan
- Call about joining(844) 305-3879 · TTY 711
- Plan websitewww.alignseniorcare.com
- Full 2026 rulesRead the plan’s booklet (PDF)
From the details the plan filed with Medicare for 2026. To check whether a doctor takes this plan, call the doctor’s office, not the plan.