Alignment Health Advantage 001 (PPO)
Alignment Health Plan · PPO · 2027 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $70
- Higher than most plans here
- Most you pay in a year for covered care in network
- $4,451
- Higher than most plans here
- Drug deductible
- $0
- Medicare star rating
- No rating yet
In plain English
Compared with the 17 other plans in Madera County that the same person could join.
What stands out
- $120 for the emergency room, tied for lowest here
- No drug deductible
- Dental, vision and hearing extras included
Watch out for
- $70 monthly premium, higher than most plans here
- Up to $4,451 a year for covered care, higher than most plans here
- $20 for specialist visits, higher than most plans here
- $20 for urgent care, higher than most plans here
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$840$840 in premiums + $0 for careHigher than most plans here2 checkups and 2 lab tests.
- A busier year$955$840 in premiums + $115 for careHigher than most plans here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$2,500$840 in premiums + $1,660 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$20Higher than most plans hereReferral neededPlan approval may be needed
- Urgent care$20Higher than most plans here
- Emergency room$120Tied for lowest here
- Hospital stay$250 a day for days 1 to 3, then $0 for days 4 to 90Referral 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$200Tied for highest here
- X-rays$15Higher than most plans hereReferral neededPlan approval may be needed
- MRI, CT and other scans$150Highest of 9 plans hereReferral neededPlan approval may be needed
- Ground ambulance$250Lower than most plans herePlan approval may be needed
- Skilled nursing facility$0 for days 1 to 20, then $100 a day for days 21 to 51, then $0 for days 52 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 17 other plans in Madera 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 | $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 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. Some bigger dental work included, more with an optional add-on you can buy.Cleanings and exams: plan pays up to $1,000 a year. Plan pays up to $1,000 a year for all dental.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear: plan pays up to $150 every two years.
- Hearing IncludedHearing test: $0.
- Over-the-counter items Not included
- 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 Advantage PPO (PPO).
- Monthly premium2026$45 a month2027$70 a month
- Most you pay in a year2026$4,2012027$4,451
- Emergency room2026$902027$120
- Over-the-counter items2026Up to $10 a month for things like vitamins, pain relief and bandages. Unused money does not carry over2027Not covered
- 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 Advantage 001 (PPO), plan number H8832-001, for 2027?”