Alignment Health smartHMO (HMO)
Alignment Health Plan · HMO · 2026 coverage
New name in 2027
In 2027 this plan is called Alignment Health Smart 040 (HMO). Read your letter for what else changes.
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
- $3,999
- Higher than most plans here
- Drug deductible
- $615
- Tied for highest here
- Most you pay for covered drugs in a year
- $2,100
- Lowers your Part B premium by
- $115 a month
- Medicare star rating
- 4 of 5
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
- Dental, vision and hearing extras included
Watch out for
- Up to $3,999 a year for covered care, higher than most plans here
- $1,000 for a 5-day hospital stay, higher than most plans here
- $5 for specialist visits, higher than most plans here
- $615 drug deductible, 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$0$0 in premiums + $0 for care2 checkups and 2 lab tests.
- A busier year$20$0 in premiums + $20 for care4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$1,280$0 in premiums + $1,280 for care6 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$0
- Specialist visit$5Higher than most plans hereReferral neededPlan approval may be needed
- Urgent care$0
- Emergency room$120Not charged if you stay in the hospital within 48 hours
- Hospital stay$200 a day for days 1 to 5, then $0 for days 6 to 90Higher than most plans hereReferral neededPlan approval may be needed
- Lab tests$0Referral neededPlan approval may be needed
More care: surgery, scans, mental health, therapy, home health and more
- Outpatient surgery center$50Lower than most plans hereReferral neededPlan approval may be needed
- Outpatient hospital care$200
- X-rays$0Referral neededPlan approval may be needed
- MRI, CT and other scans$0Referral neededPlan approval may be needed
- Ground ambulance$100Lower than most plans herePlan approval may be needed
- Skilled nursing facility$20 a day for days 1 to 20, then $100 a day for days 21 to 100Referral neededPlan approval may be needed
- Mental health therapy visit$10Referral neededPlan approval may be needed
- Psychiatrist visit$20Referral neededPlan approval may be needed
- Physical or speech therapy$0Referral neededPlan approval may be needed
- Occupational therapy$0Referral neededPlan approval may be needed
- Home health care$0Referral neededPlan approval may be needed
- Medical equipment, like a walker or oxygen20%Plan approval may be needed
- Kidney dialysis20%Referral neededPlan approval may be needed
- 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 rehab$0Referral neededPlan approval may be needed
- Foot doctor (podiatrist)$5Higher than most plans hereReferral neededPlan approval may be needed
- Chiropractor$10Higher than most plans hereReferral 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 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 Alignment Health smartHMO (HMO), plan number H3815-040, 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 | $3 |
| 3Preferred Brand | $45 |
| 4Non-Preferred DrugAfter the deductible | $100 |
| 5Specialty TierAfter the deductible | 25% of the price |
| 6Select Care Drugs | $5 |
For a 1-month supply. The $615 drug deductible applies only to the tiers marked. 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 Not included
- Fitness IncludedIncludes gym or fitness classes.
- Rides to care Not includedYou can buy it as an add-on. See below.
- Extra help for some members IncludedIf you have certain long-term health conditions: pest control, pet services and general support for living.The plan decides who qualifies.
Add-ons you can buy
Optional. Each costs extra every month, on top of the plan premium.
- Complete Package$64.90 a month · Adds emergency care outside the U.S., rides, help at home, dental, hearing and other extras
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.
This plan also lowers the Part B premium by $115 a month. If Medi-Cal or a Medicare Savings Program already pays your Part B premium, you may not see that money.
See who can get a Medicare Savings ProgramContact the plan
- Call about joining(888) 979-2247 · TTY 711
- Plan websitewww.alignmenthealthplan.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.