Alignment Health Heart & Diabetes Care (C-SNP) Plan Details for Madera County, CA
This page provides coverage and cost details for Alignment Health Plan’s H3815-048-0 Medicare SNP plan for 2025. Enrollment is subject to eligibility.
*CMS rated this Alignment Health Plan plan (H3815-048-0) 4 (Good) out of 5 stars.
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 Care Basic Plan Details
- Plan ID
- H3815-048-0
- Plan Type
- HMO C-SNP
- Plan Year
- 2025
- Premium
- $0.00/mo
Plus your Medicare Part B premium. - Health Plan Deductible
- $0.00
- Out-of-Pocket Maximum
- 990.00 /yr (in-network)
- Part B Reduction
- $0.00/mo
- Drug Plan Benefit
- Enhanced
$0.00 deductible - Supplemental Benefits
- Vision, Hearing
- Availability
- Madera County, CA
- Insured By
- Alignment Health Plan
| Summary of Benefits |
|---|
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
- $70 Copay
- Urgent care
- Not Covered
- Ground ambulance
- $100 Copay
- Inpatient hospital care
- Coming Soon
- Skilled Nursing Facility
- $0.00 per day for days 1 through 31
$50.00 per day for days 32 and beyond
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
- Not Covered
- Outpatient group therapy
- Not Covered
- Inpatient psychiatric hospital care
- $250.00 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- Not Covered
- Occupational therapy
- Not Covered
Medical Equipment and Supplies
- Diabetes supplies
- Not Covered
- Durable medical equipment
- 20% Coinsurance
Prior Authorization Required - Prosthetics
- Not Covered
Diagnostics, Lab Services, and Imaging
- Diagnostic radiology services
- Not Covered
- Lab services
- Not Covered
- Outpatient x-rays
- Not Covered
- Diagnostic tests and procedures
- Not Covered
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
- $0
- Dental x-rays
- $0
- Cleaning
- $0
- 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
Prescription Drug Costs & Benefits
Alignment Health Heart & Diabetes Care includes enhanced benefit Medicare Part D. Enhanced benefits offer greater coverage than basic, typically providing lower cost-sharing, broader drug coverage, and additional benefits, such as covering drugs not included in the standard formulary. These plans usually have higher premiums due to the extra coverage and flexibility they provide, but they cover a larger percentage of overall drug costs.
As of 2023, approximately 75% of people on Medicare are enrolled in enhanced plans.
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: | $0.00 |
| 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 $0.00. 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 Care has out-of-pocket costs you must pay when you pick up your prescriptions.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 | $0.00 |
| Generic | $5.00 | $5.00 |
| Preferred Brand | $30.00 | $30.00 |
| Non-Preferred Drug | $75.00 | $75.00 |
| Specialty Tier | 33.00% | 33.00% |
| Select Care Drugs | $5.00 | $5.00 |
| *The Part D deductible does not apply. | ||
CMS Rating Marks
Each year Medicare rates C-SNP plans, using a 5-star rating system, in nine major categories. These ratings are designed to help you understand the quality of care and service you can expect if you qualify and choose to join Alignment Health Heart & Diabetes Care .
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| 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 Care
To be eligible to enroll in Alignment Health Heart & Diabetes Care , you must meet these requirements:
- You are eligible for Medicare;
- You live in Madera County (the plan’s service area); and
- 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
Additional C-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
Contact Us About Alignment Health Plan
| Website: | Alignment Health Plan Plan Page (opens in new tab) |
|---|---|
| Providers: | Alignment Health Plan Providers Page (opens in new tab) |
| Formulary: | Alignment Health Plan Formulary Page (opens in new tab) |
| Pharmacy: | Alignment Health Plan Pharmacy Page (opens in new tab) |
| New Member Health Plan Help: | (888)979-2247 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (888)979-2247 |
| New Member Part D 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.
Health Plan Compatibility
Medicare Advantage Special Needs Plans (SNPs) are generally incompatible with most other health insurance options. Enrolling in an SNP plan while having Medicare Part A and/or Medicare Part B will result in disenrollment from Original Medicare. Additionally, it is not possible to simultaneously hold a Medicare Supplement Insurance policy and be part of an SNP plan.
Members of a D-SNP maintain their current Medicaid plan and Medicaid benefits. Veterans with VA Health Benefits might have the option to receive care at a nearby VA hospital.
Citations & References
- Alignment Health Plan, http://www.alignmenthealthplan.com, Last Accessed October 13, 2024
- Medicaid.gov, "Medicaid & CHIP in California", Last Accessed October 1, 2024
- CMS.gov, Landscape Source Files, Last Accessed October 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 5, 2024
Research Note: This content is based on independent analysis of CMS data by David Bynon, Medicare analyst and founder of MedicareWire.
For details on how this plan was analyzed and constructed using CMS data, see our Medicare Plan Research Methodology.
Disclaimer: MedicareWire does not endorse or rank Medicare plans. Plan information is provided for educational and research purposes only and may not reflect the most current data available from CMS or the plan provider.
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