Alignment Health Balance (PPO)
Alignment Health Plan · PPO · 2026 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $41
- Higher than most plans here
- Most you pay in a year for covered care in network
- $2,850
- Lower than most plans here
- Drug deductible
- $0
- Tied for lowest here
- Medicare star rating
- 4 of 5
In plain English
Compared with the 20 other plans in Stanislaus County that the same person could join.
What stands out
- At most $2,850 a year for covered care, lower than most plans here
- $225 for a 5-day hospital stay, lower than most plans here
- $0 for specialist visits, tied for lowest here
- $75 for the emergency room, tied for lowest here
Watch out for
- $41 monthly premium, higher than most plans 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$492$492 in premiums + $0 for careHigher than most plans here2 checkups and 2 lab tests.
- A busier year$492$492 in premiums + $0 for careHigher than most plans here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$892$492 in premiums + $400 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.
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$0Tied for lowest hereReferral neededPlan approval may be needed
- Urgent care$0
- Emergency room$75Tied for lowest here
- Hospital stay$75 a day for days 1 to 3, then $0 for days 4 to 90Lower 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$100Referral 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$0 for days 1 to 20, then $50 a day for days 21 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 20 other plans in Stanislaus 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 | $3 |
| 3Preferred Brand | $40 |
| 4Non-Preferred Drug | 32% of the price |
| 5Specialty Tier | 33% of the price |
| 6Select Care Drugs | $3 |
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: 50%.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear: plan pays up to $200 a year.
- Hearing IncludedHearing test: $0.
- 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.
- Rides to care Included26 one-way rides to medical visits a year.
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 Balance (PPO), plan number H4961-006, for 2026?”