Alignment Health Sutter Advantage +More (HMO)
Alignment Health Plan · HMO · 2026 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $59
- Most you pay in a year for covered care in network
- $4,900
- Tied for highest here
- Drug deductible
- $0
- Medicare star rating
- 4 of 5
In plain English
Compared with the 4 other plans in Santa Cruz County that the same person could join.
What stands out
- $120 for the emergency room, lower than most plans here
- No drug deductible
- Dental, vision and hearing extras included
Watch out for
- Up to $4,900 a year for covered care, tied for highest here
- $1,375 for a 5-day hospital stay, highest of 5 plans here
- $25 for specialist visits, higher than most plans here
- $5 for primary care visits, tied for highest here
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$718$708 in premiums + $10 for care2 checkups and 2 lab tests.
- A busier year$843$708 in premiums + $135 for care4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$3,083$708 in premiums + $2,375 for careHigher 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.
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$5Tied for highest here
- Specialist visit$25Higher than most plans hereReferral neededPlan approval may be needed
- Urgent care$0
- Emergency room$120Lower than most plans here
- Hospital stay$275 a day for days 1 to 5, then $0 for days 6 to 90Highest of 5 plans hereReferral neededPlan approval may be needed
- Lab tests$0Referral neededPlan approval may be needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center$100Referral neededPlan approval may be needed
- Outpatient hospital care$325Highest of 4 plans here
- X-rays$15Tied for highest hereReferral neededPlan approval may be needed
- MRI, CT and other scans$150Tied for highest hereReferral neededPlan approval may be needed
- Ground ambulance$250Plan approval may be needed
- Skilled nursing facility$10 a day for days 1 to 20, then $160 a day for days 21 to 62, then $0 for days 63 to 100Referral neededPlan 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 4 other plans in Santa Cruz County that the same person could join. Read the plan’s 2026 booklet (PDF)
What medicines cost
| Drug tier | Network pharmacy |
|---|---|
| 1Preferred Generic | $0 |
| 2Generic | $5 |
| 3Preferred Brand | $40 |
| 4Non-Preferred Drug | 32% of the price |
| 5Specialty Tier | 33% of the price |
| 6Select Care Drugs | $5 |
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. Some bigger dental work included, more with an optional add-on you can buy.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear: plan pays up to $100 every two years.
- Hearing IncludedHearing test: $0.
- Over-the-counter items IncludedUp to $15 a month for things like vitamins, pain relief and bandages.Unused money does not carry over.
- Fitness IncludedIncludes gym or fitness classes.
- Rides to care Not included
Is my doctor in this plan?
Look up your doctors, then confirm with their office.
Call each doctor’s office and ask:
“Do you take Alignment Health Sutter Advantage +More (HMO), plan number H3815-021, for 2026?”