Alignment Health Advantage 005 (PPO)
Alignment Health Plan · PPO · 2027 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $160
- Most you pay in a year for covered care in network
- $4,451
- Drug deductible
- $700
- Medicare star rating
- No rating yet
In plain English
Watch out for
- 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$1,920$1,920 in premiums + $0 for care2 checkups and 2 lab tests.
- A busier year$2,095$1,920 in premiums + $175 for care4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$3,520$1,920 in premiums + $1,600 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$35Referral neededPlan approval may be needed
- Urgent care$20
- Emergency room$130
- Hospital stay$500 per stayReferral 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$200Referral neededPlan approval may be needed
- Outpatient hospital care$300
- X-rays$15Referral neededPlan approval may be needed
- MRI, CT and other scans$150Referral neededPlan approval may be needed
- Ground ambulance$250Plan 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. Read the plan’s 2027 booklet (PDF)
What medicines cost
| Drug tier | Network pharmacy |
|---|---|
| 1Preferred Generic | $0 |
| 2Generic | $5 |
| 3Preferred Brand | $40 |
| 4Non-Preferred DrugAfter the deductible | 32% of the price |
| 5Specialty TierAfter the deductible | 25% of the price |
| 6Select Care Drugs | $5 |
For a 1-month supply. The $700 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 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 Not included
- 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
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 005 (PPO), plan number H8832-005, for 2027?”