Fitness Benefit
Physical Fitness
Cost not publishedMandatory
IncludedAlignment Health Advantage PPO (PPO)
Alignment Health Plan
PPOSanta Clara CountyIncludes Part DPlan year 2026
$75/momonthly premium
$2,850most you pay in-network per year
Plan Too New To Be Measuredoverall CMS star rating
460members enrolled, January 2026
Plan-level limits
Premium, deductibles, and the most you can pay out of pocket in a year.
Combined in- and out-of-network out-of-pocket maximum$5,150
In-network out-of-pocket maximum$2,850
Plan premium, per month$75
Out-of-network out-of-pocket maximum$5,150
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$75 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$0 per day
Days 21–100$50 per day
Emergency and urgent care
Emergency room visit
$75
Copay
Emergency care outside the U.S.
Up to $25,000
Allowance
Mental health and substance use
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
$100
Copay
Ambulance
Ground ambulance
$100
Copay
Air ambulance
$100
Copay
Medical equipment and supplies
Durable medical equipment
0–20%
Coinsurance, depends on the service
Medical supplies
20%
Coinsurance — your share of the bill
Prosthetic devices
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 $200 per year
Allowance
Extra benefits
Over-the-counter items
Up to $20 per month
Allowance
Personalized Health Risk Screening
$75
Copay
Out of network
What you pay when a provider is not in the plan's network. Out-of-network costs stop at $5,150 a year, $5,150 combined with in-network.
Doctor visits
Primary care visit
40%
Coinsurance — your share of the bill
Chiropractic care (Medicare-covered)
40%
Coinsurance — your share of the bill
Specialist visit
40%
Coinsurance — your share of the bill
Podiatry (Medicare-covered)
40%
Coinsurance — your share of the bill
Other health care professional
40%
Coinsurance — your share of the bill
Mental health and substance use
Partial hospitalization program
40%
Coinsurance — your share of the bill
Intensive outpatient program
40%
Coinsurance — your share of the bill
Individual therapy session
40%
Coinsurance — your share of the bill
Group therapy session
40%
Coinsurance — your share of the bill
Psychiatrist visit, individual
40%
Coinsurance — your share of the bill
Psychiatrist visit, group
40%
Coinsurance — your share of the bill
Opioid treatment program
40%
Coinsurance — your share of the bill
Substance use treatment, individual
40%
Coinsurance — your share of the bill
Substance use treatment, group
40%
Coinsurance — your share of the bill
Therapy and rehabilitation
Cardiac rehabilitation
40%
Coinsurance — your share of the bill
Intensive cardiac rehabilitation
40%
Coinsurance — your share of the bill
Pulmonary rehabilitation
40%
Coinsurance — your share of the bill
Supervised exercise therapy for peripheral artery disease
40%
Coinsurance — your share of the bill
Occupational therapy
40%
Coinsurance — your share of the bill
Physical and speech therapy
40%
Coinsurance — your share of the bill
Tests, labs and imaging
Diagnostic procedures and tests
40%
Coinsurance — your share of the bill
Lab services
40%
Coinsurance — your share of the bill
Diagnostic radiology (MRI, CT, PET)
40%
Coinsurance — your share of the bill
Therapeutic radiology
40%
Coinsurance — your share of the bill
X-rays
40%
Coinsurance — your share of the bill
Outpatient hospital and surgery
Outpatient hospital services
40%
Coinsurance — your share of the bill
Observation services
40%
Coinsurance — your share of the bill
Ambulatory surgical center
40%
Coinsurance — your share of the bill
Blood services
40%
Coinsurance — your share of the bill
Home health care
Home health visit
40%
Coinsurance — your share of the bill
Ambulance
Ground ambulance
40%
Coinsurance — your share of the bill
Air ambulance
40%
Coinsurance — your share of the bill
Medical equipment and supplies
Durable medical equipment
40%
Coinsurance — your share of the bill
Prosthetic devices
40%
Coinsurance — your share of the bill
Medical supplies
40%
Coinsurance — your share of the bill
Diabetes monitoring supplies
40%
Coinsurance — your share of the bill
Therapeutic shoes or inserts for diabetes
40%
Coinsurance — your share of the bill
Dialysis
Dialysis
40%
Coinsurance — your share of the bill
Part B drugs
Part B insulin
40%
Coinsurance — your share of the bill
Chemotherapy drugs
40%
Coinsurance — your share of the bill
Other Part B drugs
40%
Coinsurance — your share of the bill
Preventive and wellness
Medicare-covered preventive services
40%
Coinsurance — your share of the bill
Annual physical exam
40%
Coinsurance — your share of the bill
Kidney disease education
40%
Coinsurance — your share of the bill
Diabetes screening
40%
Coinsurance — your share of the bill
Digital rectal exam
40%
Coinsurance — your share of the bill
Electrocardiogram (EKG)
40%
Coinsurance — your share of the bill
Glaucoma screening
40%
Coinsurance — your share of the bill
Vision
Eye exam (Medicare-covered)
40%
Coinsurance — your share of the bill
Routine eye exam
40%
Coinsurance — your share of the bill
Eyewear after cataract surgery (Medicare-covered)
40%
Coinsurance — your share of the bill
Eyeglasses (lenses and frames)
40%
Coinsurance — your share of the bill
Contact lenses
40%
Coinsurance — your share of the bill
Eyeglass lenses
40%
Coinsurance — your share of the bill
Eyeglass frames
40%
Coinsurance — your share of the bill
Hearing
Hearing exam (Medicare-covered)
40%
Coinsurance — your share of the bill
Routine hearing exam
40%
Coinsurance — your share of the bill
Hearing aid fitting and evaluation
40%
Coinsurance — your share of the bill
Extra benefits
Transportation to plan-approved locations
40%
Coinsurance — your share of the bill
Over-the-counter items
40%
Coinsurance — your share of the bill
Personalized Health Risk Screening
40%
Coinsurance — your share of the bill
Digital Health Technology Support
40%
Coinsurance — your share of the bill
Dental
Dental services (Medicare-covered)
40%
Coinsurance — your share of the bill
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
Prescription drugs (Part D)
$0 annual drug deductible · 6 formulary tiers · mail order available. Costs shown for a 30-day supply.
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 | — | $40 copay | — | — | Waived |
| 4. Non-Preferred Drug | — | 32% coinsurance | — | — | Waived |
| 5. Specialty Tier specialty | — | 33% coinsurance | — | — | Waived |
| 6. Select Care Drugs | — | $3 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 | 0% coinsurance | 0% coinsurance | 0% coinsurance | — | Waived |
| 5. Specialty Tier specialty | No copay | No copay | No copay | — | Waived |
| 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.
Not yet ratedNot yet ratedOverall rating
Not yet ratedNot yet ratedHealth services (Part C)
Not yet ratedNot yet ratedDrug plan (Part D)
Health plan customer service
- Call center5
Drug plan customer service
5- Call center foreign language interpreter and TTY availability5
Service area and network
Sold in 1 California county.
Santa Clara
Doctor directory
5,739 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 sinceJan 1, 2025
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.