Fitness Benefit
Physical Fitness
Cost not publishedMandatory
IncludedAlignment Health smartHMO (HMO)
Alignment Health Plan
HMOSanta Clara CountyIncludes Part DPlan year 2026
$0/momonthly premiumplus $115/mo back on your Part B premium
$3,999most you pay in-network per year
4overall CMS star rating
2,957members enrolled, January 2026
Plan-level limits
Premium, deductibles, and the most you can pay out of pocket in a year.
In-network out-of-pocket maximum$3,999
Part B premium giveback, per month$115
Plan premium, per month$0
What a year on this plan would likely cost
What you pay for care
In-network costs for every service in this plan's CMS benefit filing. A copay is a fixed dollar amount; coinsurance is a percentage of the bill.
Hospital stays
Inpatient hospital stay
Days 1–5$200 per day
Days 6–90$0 per day
Inpatient psychiatric stay
Days 1–10$120 per day
Days 11–90$0 per day
Skilled nursing facility stay
Days 1–20$20 per day
Days 21–100$100 per day
Doctor visits
Specialist visit
$5
Copay
Chiropractic care (Medicare-covered)
$10
Copay
Podiatry (Medicare-covered)
$5
Copay
Emergency and urgent care
Emergency room visit
$120
Copay
Emergency care outside the U.S.
$50
Copay
Up to $100,000
Urgent care outside the U.S.
$50
Copay
Mental health and substance use
Individual therapy session
$10
Copay
Group therapy session
$10
Copay
Opioid treatment program
20%
Coinsurance — your share of the bill
Partial hospitalization program
$55
Copay
Referral required
Prior authorization required
Tests, labs and imaging
Therapeutic radiology
20%
Coinsurance — your share of the bill
Outpatient hospital and surgery
Outpatient hospital services
$200
Copay
Ambulatory surgical center
$50
Copay
Ambulance
Ground ambulance
$100
Copay
Air ambulance
$200
Copay
Medical equipment and supplies
Durable medical equipment
20%
Coinsurance — your share of the bill
Medical supplies
20%
Coinsurance — your share of the bill
Prosthetic devices
20%
Coinsurance — your share of the bill
Dialysis
Dialysis
20%
Coinsurance — your share of the bill
Part B drugs
Part B drugs
0–20%
Coinsurance, depends on the service
Chemotherapy drugs
0–20%
Coinsurance, depends on the service
Part B insulin
0–20%
Coinsurance, depends on the service
Never more than $35 for a one-month supply
Vision
Eyewear allowance
Up to $100 every two years
Allowance
Extra benefits beyond Original Medicare
Supplemental benefits this plan filed with CMS, with the cap and period exactly as filed.
Not offered by this plan
Health EducationIn-Home Safety AssessmentPersonal Emergency Response System (PERS)Medical Nutrition Therapy (MNT)Post discharge In-Home Medication ReconciliationRe-admission PreventionWigs for Hair Loss Related to ChemotherapyWeight Management ProgramsAlternative TherapiesTherapeutic MassageAdult Day Health ServicesNutritional/Dietary BenefitHome-Based Palliative CareIn-Home Support ServicesSupport for Caregivers of EnrolleesAdditional Sessions of Smoking and Tobacco Cessation CounselingEnhanced Disease ManagementTelemonitoring ServicesRemote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)Home and Bathroom Safety Devices and ModificationsCounseling Services
Dental
No dental deductible.
Preventive
Oral examsBoth
CleaningsBoth
X-raysBoth
Fluoride treatmentBoth
Comprehensive
Restorative (fillings)$20–$400 copay
Endodontics (root canals)$25–$350 copay
Periodontics (gum treatment)$15–$550 copay
Oral surgery$25–$250 copay
Fixed prosthodontics (crowns, bridges)$40–$400 copay
Removable prosthodontics (dentures)$20–$570 copay
Prescription drugs (Part D)
$615 annual drug deductible · 6 formulary tiers · mail order available. Costs shown for a 30-day supply.
Before the deductible
| Tier | Preferred retail | Standard retail | Mail order | Insulin | Deductible |
|---|---|---|---|---|---|
| 1. Preferred Generic | — | No copay | — | — | Waived |
| 2. Generic | — | $3 copay | — | — | Waived |
| 3. Preferred Brand | — | $45 copay | — | — | Waived |
| 6. Select Care Drugs | — | $5 copay | — | — | Waived |
Initial coverage
| Tier | Preferred retail | Standard retail | Mail order | Insulin | Deductible |
|---|---|---|---|---|---|
| 1. Preferred Generic | — | No copay | — | — | Waived |
| 2. Generic | — | $3 copay | — | — | Waived |
| 3. Preferred Brand | — | $45 copay | — | — | Waived |
| 4. Non-Preferred Drug | — | $100 copay | — | — | Applies |
| 5. Specialty Tier specialty | — | 25% coinsurance | — | — | Applies |
| 6. Select Care Drugs | — | $5 copay | — | — | Waived |
Catastrophic (after the out-of-pocket threshold)
| Tier | Preferred retail | Standard retail | Mail order | Insulin | Deductible |
|---|---|---|---|---|---|
| 1. Preferred Generic | No copay | No copay | No copay | — | Waived |
| 2. Generic | No copay | No copay | No copay | — | Waived |
| 3. Preferred Brand | No copay | No copay | No copay | — | Waived |
| 4. Non-Preferred Drug | No copay | No copay | No copay | — | Applies |
| 5. Specialty Tier specialty | No copay | No copay | No copay | — | Applies |
| 6. Select Care Drugs | No copay | No copay | No copay | — | Waived |
Out-of-pocket threshold for the catastrophic phase: $2,100.
Is my medicine on this plan’s list?
Pharmacies near you in this plan's network
From the plan's filed Part D pharmacy network, matched to geocoded pharmacy locations. Preferred pharmacies come first: they carry the lower copay column in the tier table above. The ZIP you enter stays in this browser.
CMS star ratings
Star ratings are set by CMS for the whole contract, so every plan under this contract shares them.
4 out of 5Overall rating
3.5 out of 5Health services (Part C)
3.5 out of 5Drug plan (Part D)
Staying healthy: screenings, tests and vaccines
4- Annual flu vaccine4
- Breast cancer screening4
- Colorectal cancer screening5
- Monitoring physical activity4
- Improving or maintaining mental health2
- Improving or maintaining physical health5
Managing chronic (long-term) conditions
4- Readmissions4
- Kidney health4
- Blood pressure5
- Reducing falls3
- Statin therapy4
- Pain assessment4
- Bladder control5
- Medication review5
- Diabetes eye exam5
- Transitions of care3
- Diabetes blood sugar4
- Osteoporosis management5
- Followup after emergency department visit3
- Medication reconciliation5
- Special needs plan SNP care management5
Member experience with the health plan
3- Customer service2
- Healthcare quality3
- Health plan rating4
- Getting needed care1
- Getting appointments3
Member complaints and changes in the plan's performance
4- Complaints4
- Members leaving4
- Quality improvement3
Health plan customer service
3- Call center5
- Timely decisions3
- Appeals decisions2
Drug plan customer service
5- Call center foreign language interpreter and TTY availability5
Drug plan complaints and changes
3- Complaints4
- Members leaving4
- Quality improvement1
Member experience with the drug plan
- Drug plan rating4
Drug safety and accuracy of drug pricing
5- Price accuracy5
- Statin diabetes5
- Medication therapy management comprehensive medication review completion5
- Medication adherence for diabetes medications4
- Medication adherence for hypertension RAS antagonists s5
- Medication adherence for cholesterol statins4
Why members leave this contract
Service area and network
Sold in 4 California counties.
MercedSanta ClaraStanislausVentura
Doctor directory
12,427 providers are named in Alignment Health Plan’s directory for this plan, dated Jul 31, 2026.
A doctor named there is listed. A doctor missing from it is unknown, never out of network: carrier directories are partial and change monthly. Open the carrier directory
Contract with Medicare sinceJul 1, 2005
Medicare Advantage regionCalifornia
Ask about this plan
A question box grounded in this plan's filed benefits, drug list, and pharmacy network. It reads the same records shown on this page and says so when something is not filed.
Answers come from this plan’s filed benefits, drug list, and pharmacy network. They are not enrollment advice; the Evidence of Coverage is the final word.