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Alignment Health Heart & Diabetes CalPlus (C-SNP) Plan Details for Madera County, CA

This page provides coverage and cost details for Alignment Health Plan’s H3815-039-0 Medicare SNP plan for 2025. Enrollment is subject to eligibility.

CMS 2025 Rating: ☆☆☆☆☆*

*CMS rated this Alignment Health Plan plan (H3815-039-0) 4 (Good) out of 5 stars.

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. The Alignment Health Plan logo is a registered trademark.[2] Its use by MedicareWire is strictly for editorial purposes. This is not a solicitation of insurance.

This private health insurance option offers all of the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may include additional benefits that Medicare Part A and Part B do not cover.

Individuals must meet all Chronic or Disabling Condition SNP qualification requirements to join this C-SNP plan.

Alignment Health Heart & Diabetes CalPlus Basic Plan Details

Plan ID
H3815-039-0
Plan Type
HMO C-SNP
Plan Year
2025
Premium
$29.70/mo
Plus your Medicare Part B premium.
Health Plan Deductible
$0.00
Out-of-Pocket Maximum
7,350.00 /yr (in-network)
Part B Reduction
$0.00/mo
Drug Plan Benefit
Basic
$590.00 deductible
Supplemental Benefits
Vision, Hearing
Availability
Madera County, CA
Insured By
Alignment Health Plan
Summary of Benefits

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Health Plan Out-of-Pocket Costs

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:

Doctor's Office Visits

Primary
Not Covered
Specialist
Not Covered

Emergency, Urgent, and Inpatient Hospital Coverage

Emergency room care
20% Coinsurance
Urgent care
Not Covered
Ground ambulance
20% Coinsurance
Inpatient hospital care
$275.00 per day for days 1 through 6
$0.00 per day for days 7 and beyond
Skilled Nursing Facility

Foot Care

Foot Exams and Treatments (Medicare-covered)
Not Covered
Routine Foot Care
Not Covered

Chiropractic Care

Medicare-covered chiropractic
Not Covered
Routine chiropractic
Not Covered

Mental Health Services

Outpatient individual therapy
20% Coinsurance
Outpatient group therapy
20% Coinsurance
Inpatient psychiatric hospital care

Rehabilitation Services

Physical therapy and speech and language therapy
20% Coinsurance
Prior Authorization Required, Referral Required
Occupational therapy
20% Coinsurance
Prior Authorization Required, Referral Required

Medical Equipment and Supplies

Diabetes supplies
Not Covered
Durable medical equipment
20% Coinsurance
Prior Authorization Required
Prosthetics
20% Coinsurance

Diagnostics, Lab Services, and Imaging

Diagnostic radiology services
Not Covered
Lab services
20% Coinsurance
Prior Authorization Required
Outpatient x-rays
Not Covered
Diagnostic tests and procedures
20% Coinsurance
Prior Authorization Required

Medicare Part B Drugs

Chemotherapy
20% Coinsurance
Other Part B drugs (Medicare-covered)
20% Coinsurance

Dental Services

Medicare Covered Preventive Dental
Not Covered
Oral exam
$10 Copay
Dental x-rays
$30 Copay
Cleaning
$20 Copay
Periodontics
Not Covered
Endodontics
Not Covered
Restorative Services
Not Covered

Hearing Aids and Services

Fitting/evaluation
Covered
Limits may apply
Hearing aids
Not Covered
Hearing exam
Covered
Limits may apply

Vision Services

Medicare-covered eye exam
Routine eye exam
Covered
Limits may apply
Eyewear benefits
None
If you qualify for Medicare Advantage but don't know where to begin, we have licensed insurance agents[1] at 1-855-728-0510 (TTY 711) who can answer your questions (Mon-Fri 5am-6pm, Sat 6am-5pm PT) and help you get enrolled. There's no obligation.

Prescription Drug Costs & Benefits

Alignment Health Heart & Diabetes CalPlus includes an basic benefit Medicare Part D plan (PDP). This simply means that the plan covers the minimum amount required by the Centers for Medicare & Medicaid Services, whereas enhanced benefit plans cover more.

Prescription Drug Premium with Extra Help

Extra Help is a Social Security program that helps people with limited income and resources lower or cut Part D costs. The following table outlines premium assistance details with Extra Help.

Low Income Premium Subsidy: ${part_d_lips_amount}
Low Income Premium Subsidy CMS Pays: $29.70
Low Income Subsidy Premium: $0.00

If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.

Prescription Drug Deductible

The Medicare Part D annual deductible with this plan is $590.00. You must pay this amount at the pharmacy before Alignment Health Plan begins paying its share.

Prescription Drug Out-of-Pocket Costs

In addition to the plan's monthly premium and deductible, Alignment Health Heart & Diabetes CalPlus has out-of-pocket costs you must pay when you pick up your prescriptions.

Drug Tier Retail Mail Order
Cost data not available.
*The Part D deductible does not apply.

How to Qualify to Enroll in
Alignment Health Heart & Diabetes CalPlus

To be eligible to enroll in Alignment Health Heart & Diabetes CalPlus , you must meet these requirements:

  1. You are eligible for Medicare;
  2. You live in Madera County (the plan’s service area); and
  3. You have been diagnosed with one or more severe or disabling chronic conditions.

A disabling 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