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
- Highest of 46 plans here
- Most you pay in a year for covered care in network
- $4,451
- Higher than most plans here
- Drug deductible
- $700
- Tied for highest 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
- $500 for a 5-day hospital stay, lower than most plans here
- $130 for the emergency room, lower than most plans here
Watch out for
- $160 monthly premium, highest of 46 plans here
- Up to $4,451 a year for covered care, higher than most plans here
- $35 for specialist visits, higher than most plans here
- $700 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$1,920$1,920 in premiums + $0 for careHighest of 46 plans here2 checkups and 2 lab tests.
- A busier year$2,095$1,920 in premiums + $175 for careHighest of 46 plans here4 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 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$35Higher than most plans hereReferral neededPlan approval may be needed
- Urgent care$20
- Emergency room$130Lower than most plans here
- Hospital stay$500 per stayLower 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$200Higher than most plans hereReferral neededPlan approval may be needed
- Outpatient hospital care$300Higher than most plans here
- X-rays$15Higher than most plans hereReferral neededPlan approval may be needed
- MRI, CT and other scans$150Highest of 20 plans hereReferral 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. “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 | $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?”