Alignment Health ValorCare 053 (HMO)
Alignment Health Plan · HMO · 2027 coverage
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
- $6,000
- Higher than most plans here
- Drug deductible
- $0
- Tied for lowest here
- Medicare star rating
- No rating yet
In plain English
Compared with the 45 other plans in San Diego County that the same person could join.
What stands out
- No monthly premium
- $130 for the emergency room, lower than most plans here
- No drug deductible, tied for lowest here
- Dental: plan pays up to $2,000 a year, more than most plans here
Watch out for
- Up to $6,000 a year for covered care, higher than most plans here
- $2,000 for a 5-day hospital stay, higher than most plans here
- $40 for specialist visits, tied for highest here
- You need a referral to see a specialist
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$160$0 in premiums + $160 for care4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$2,910$0 in premiums + $2,910 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$0
- Specialist visit$40Tied for highest hereReferral neededPlan approval may be needed
- Urgent care$0
- Emergency room$130Lower than most plans hereNot charged if you stay in the hospital within 24 hours
- Hospital stay$400 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, X-rays, scans, ambulance, nursing home
- Outpatient surgery center$0Tied for lowest hereReferral neededPlan approval may be needed
- Outpatient hospital care$0Tied for lowest here
- X-rays$0Referral neededPlan approval may be needed
- MRI, CT and other scans$0Referral neededPlan approval may be needed
- Ground ambulance$300Higher than most plans herePlan approval may be needed
- Skilled nursing facility$10 a day for days 1 to 20, then $100 a day for days 21 to 100Referral neededPlan approval may be needed
From the costs the plan filed with Medicare for 2027. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 45 other plans in San Diego County that the same person could join. Read the plan’s 2027 booklet (PDF)
What medicines cost
| Drug tier | Network pharmacy |
|---|---|
| 1Preferred Generic | $0 |
| 2Generic | $0 |
| 3Preferred Brand | $30 |
| 4Non-Preferred Drug | $100 |
| 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 2027, 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.Cleanings and exams: plan pays up to $2,000 a year. Plan pays up to $2,000 a year for all dental.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear: plan pays up to $300 a year.
- Hearing IncludedHearing test: $0. Hearing aids covered.
- Over-the-counter items IncludedUp to $20 a month for things like vitamins, pain relief and bandages.Unused money does not carry over.
- Fitness IncludedIncludes gym or fitness classes and a home fitness kit.
- Rides to care Not included
What changed from 2026
In 2026 this plan was called Alignment Health ValorCare (HMO).
- Emergency room2026$1202027$130
- Fitness2026Includes gym or fitness classes2027Includes gym or fitness classes and a home fitness kit
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 ValorCare 053 (HMO), plan number H3815-053, for 2027?”