Alignment Health Heart & Diabetes C-SNP: H3443-003-0
What is Plan H3443-003-0 from Alignment Health Plan?
Alignment Health Heart & Diabetes (HMO C-SNP) is a 2024 Medicare Advantage Special Needs Plan from Alignment Health Plan. Delivery of healthcare services and costs are significantly different than in Original Medicare, and the plan offers additional benefits that are not included with Medicare Part A and Part B.
You must meet all qualification requirements to join this C-SNP plan.
| Plan Basics | |
|---|---|
| Plan ID: | H3443-003-0 |
| Plan Type: | HMO |
| Plan Year: | 2024 |
| Premium: | $0.00/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | /yr |
| Part B Reduction: | $0.00/mo |
| Drug Plan Benefit: | Enhanced $0.00 deductible |
| Rx Gap Coverage: | {gap} |
| Supplemental Benefits: | Vision, Hearing |
| Availability: | Maricopa County, AZ |
| Insured By: | Alignment Health Plan |
| Summary of Benefits |
|---|
Health Plan Costs & Benefits
Alignment Health Heart & Diabetes is a Health Maintenance Organization (HMO) plan. HMO plan members usually receive health care services through the plan’s local network of providers. Referrals are almost always required to see a specialist and other providers. However, Alignment Health Heart & Diabetes does allow out-of-network care for emergencies and out-of-area dialysis.
The following table is a summary of the most common out-of-pocket costs you will incur if you join this Alignment Health Plan plan:
| Healthcare Service | Member Cost |
|---|---|
| Doctor Visits (In-Network) | |
| Primary: | $0 |
| Specialist: | $0 |
| Wellness programs (e.g., fitness, nursing hotline): | |
| Preventive care: | $0 |
| Foot Care (In-Network) | |
| Foot exams and treatment (Medicare-covered): | $0 |
| Routine foot care: | $0 |
| Chiropractic Care (In-Network) | |
| Medicare-covered chiropractic care: | $0 |
| Routine chiropractic care: | $0 |
| Emergency Care / Urgent Care | |
| Emergency room care: | $75 Copay |
| Urgent care: | $0 |
| Ground ambulance: | $100 Copay |
| Inpatient hospital coverage: | $125.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
| Outpatient hospital coverage: | $0 |
| Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $100.00 per day for days 21 and beyond |
| Optional supplemental benefits: | Not Covered |
| Mental Health Services (In-Network) | |
| Outpatient individual therapy visit with a psychiatrist: | $0 |
| Outpatient group therapy visit with a psychiatrist: | $0 |
| Inpatient hospital - psychiatric: | $250.00 per stay |
| Outpatient group therapy visit: | $0 |
| Outpatient individual therapy visit: | $0 |
| Rehabilitation Services (In-Network) | |
| Physical therapy and speech and language therapy visit: | $0 |
| Occupational therapy visit: | $0 |
| Medical Equipment / Supplies (In-Network) | |
| Diabetes supplies: | $0 |
| Durable medical equipment (e.g., wheelchairs, oxygen): | 20% Coinsurance Authorization Required |
| Prosthetics (e.g., braces, artificial limbs): | $0 |
| Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
| Diagnostic radiology services (e.g., MRI): | $0 |
| Lab services: | $0 |
| Outpatient x-rays: | $0 |
| Diagnostic tests and procedures: | $0 |
| Medicare Part B Drugs (In-Network) | |
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Feel free to download our Alignment Health Heart & Diabetes Summary of Benefits information.
Supplemental Health Plan Benefits (H3443-003-0)
The following is a summary of the supplemental benefits Alignment Health Plan includes with this plan:
| Supplemental Healthcare Service | Member Cost |
|---|---|
| Preventive Dental | |
| Oral exam (In-Network) | Not Covered |
| Fluoride treatment (In-Network) | Not Covered |
| Dental x-ray(s) (In-Network) | Not Covered |
| Cleaning (In-Network) | Not Covered |
| Comprehensive Dental | |
| Periodontics (In-Network) | Not Covered |
| Non-routine services (In-Network) | Not Covered |
| Diagnostic services (In-Network) | Not Covered |
| Extractions (In-Network) | Not Covered |
| Endodontics (In-Network) | Not Covered |
| Restorative services (In-Network) | Not Covered |
| Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
| Hearing | |
| Fitting/evaluation (In-Network) | Covered Limits may apply |
| Hearing aids (In-Network) | Covered Limits may apply |
| Hearing exam (In-Network) | Covered Limits may apply |
| Vision | Maximum vision benefit: | $200.00 Every year |
| Eyeglasses (frames and lenses) (In-Network) | Covered Limits may apply |
| Routine eye exam (In-Network) | Covered Limits may apply |
| Contact lenses (In-Network) | Covered Limits may apply |
Additional Supplemental Benefits
None specified.
Prescription Drug Plan Costs & Benefits
Alignment Health Heart & Diabetes includes an enhanced benefit Medicare Part D plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.
| Basic Part D Premium: | $0.00 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $0.00 |
| Part D Premium with Full LIS Assistance: | $0.00 |
For more information about the Low-Income Subsidy (aka, "Extra Help") program, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $0.00. This is the amount you must pay at the pharmacy before Alignment Health Plan begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Alignment Health Heart & Diabetes has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Drug Tier | Preferred | Standard |
|---|---|---|
| 1 (Preferred Generic) | N/A | $0.00 copay |
| 2 (Generic) | N/A | $0.00 copay |
| 3 (Preferred Brand) | N/A | $40.00 copay |
| 4 (Non-Preferred Drug) | N/A | $100.00 copay |
| 5 (Specialty Tier) | N/A | 33% |
| 6 (Select Care Drugs) | N/A | $5.00 copay |
CMS 5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage C-SNP's in nine broad categories using a 5-star rating system. Medicare's star ratings will help you understand the quality of care and service you can expect if you join this Alignment Health Plan plan.
| CMS Measure | Star Rating |
|---|---|
| 2024 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Plan too new to be measured |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | Plan too new to be measured |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
How to Qualify to Enroll in
Alignment Health Heart & Diabetes
To be eligible to enroll in Alignment Health Heart & Diabetes, you must meet these requirements:
- You are eligible for Medicare;
- You live in Maricopa County (the plan’s service area); and
- You have been diagnosed with one or more severe or disabling chronic conditions.
A disabiling chronic condition (disease) is one that lasts one or more years and requires ongoing medical attention and/or limits activities of daily living. They include:
- Autoimmune disorders
- End-stage renal disease
- Cancer
- Cardiovascular disorders
- Hematologic disorders
- HIV/AIDS
- Chronic heart failure
- Chronic lung disorders
- Neurologic disorders
- Dementia
- Diabetes
- End-stage liver disease
- Neurologic disorders
- Stroke
- Mental health conditions
This plan is for individuals with cardiovascular disorders, chronic heart failure, and/or diabetes.
Additional C-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
- Wellcare Specialty No Premium
- Alignment Health Heart & Diabetes Plus
- Dialysis Complete
- UHC Complete Care AZ-001P
- Super Plus
Contact Alignment Health Plan
| Plan Website: | http://www.alignmenthealthplan.com |
|---|---|
| Formulay Information: | http://www.alignmenthealthplan.com |
| Pharmacy Information: | Alignment Health Plan Pharmacy Page |
| Prospective Members: | (888)979-2247 |
| TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
Citations & References
- Alignment Health Plan, http://www.alignmenthealthplan.com, Last Accessed October 13, 2022
- Medicaid.gov, "Medicaid & CHIP in Arizona", Last Accessed January 20, 2023
- CMS.gov, "Chronic Condition Special Needs Plans (C-SNPs)", Last Accessed January 20, 2023
- CMS.gov, Landscape Source Files, Last Accessed January 21, 2023
- CMS.gov, Medicare Part C & D Performance, Last Accessed January 21, 2023
- CMS.gov, Plan Benefits Package, Last Accessed January 21, 2023