Alignment Health AVA (PPO)
Medicare Advantage Health Plan Details
Health insurance company offering plan: Alignment Health Plan
- Rx
- Dental
- Vision
- Hearing
General Plan Details
Additional Benefits
Doctor & Hospital Coverage
Out-of-network: $40 copay
Out-of-network: $50 copay
Out-of-network: 30% coinsurance
Emergency Room
$85 copay
Ambulance Coverage
In-network: $250 copay
Out-of-network: 30% coinsurance
Lab, X-Ray, Radiology Coverage
Diagnostic tests & procedures:
In-network: $0 copay
Out-of-network: 30% coinsurance
Lab services:
In-network: $0 copay
Out-of-network: 30% coinsurance
Diagnostic radiology services (e.g., CT, MRI, etc):
In-network: $150 copay
Out-of-network: 30% coinsurance
Outpatient x-rays:
In-network: $15 copay
Out-of-network: 30% coinsurance
Hospital Services
Inpatient hospital coverage:
In-network:
Tier 1
$200 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Out-of-network:
10% per stay
Outpatient hospital coverage:
In-network: $165 copay
Out-of-network: 25% coinsurance
Rehabilitation Coverage
Occupational therapy services:
In-network: $0 copay
Out-of-network: 30% coinsurance
Urgent Care Coverage
$85 copay
Skilled Nursing Facility (SNF)
In-network:
Tier 1
$0 per day for days 1-20
$100 per day for days 21-51
$0 per day for days 52-100
Out-of-network:
30% per stay
Mental Health Coverage
Outpatient group therapy with a psychiatrist:
In-network: $40 copay
Out-of-network: 30% coinsurance
Outpatient individual therapy with a psychiatrist:
In-network: $40 copay
Out-of-network: 30% coinsurance
Outpatient group therapy visits:
In-network: $0 copay
Out-of-network: 30% coinsurance
Outpatient individual therapy visit:
In-network: $0 copay
Out-of-network: 30% coinsurance
Dental, Vision, Hearing Benefits
Dental Services
Oral exams:
In-network: $0 copay
Out-of-network: $0 copay
Prophylaxis (cleaning):
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays:
In-network: $0 copay
Out-of-network: $0 copay
Vision Benefits
Routine eye exams:
In-network: $0 copay
Out-of-network: 30% coinsurance
Contact Lenses:
In-network: $0 copay
Out-of-network: 50% coinsurance
Eyeglasses:
In-network: $0 copay
Out-of-network: 50% coinsurance
Hearing Benefits
Hearing exam:
In-network: $0 copay
Out-of-network: 30% coinsurance
Fitting/evaluation:
In-network: $0 copay
Out-of-network: 30% coinsurance
Rx Drug Coverage - Standard Retail Cost
Tier 1: Preferred Generic
$0.00 copay (30-day supply)
$0.00 copay (90-day supply)
Tier 2: Generic
$0.00 copay (30-day supply)
$0.00 copay (90-day supply)
Tier 3: Preferred Brand
$40.00 copay (30-day supply)
$120.00 copay (90-day supply)
Tier 4: Non-Preferred Drug
40% coinsurance (30-day supply)
40% coinsurance (90-day supply)
Tier 5: Specialty Tier
33% coinsurance (30-day supply)
Rx Drug Coverage - Standard Mail Order Cost
Tier 1: Preferred Generic
$0.00 copay (30-day supply)
$0.00 copay (90-day supply)
Tier 2: Generic
$0.00 copay (30-day supply)
$0.00 copay (90-day supply)
Tier 3: Preferred Brand
$40.00 copay (30-day supply)
$120.00 copay (90-day supply)
Tier 4: Non-Preferred Drug
40% coinsurance (30-day supply)
40% coinsurance (90-day supply)
Tier 5: Specialty Tier
33% coinsurance (30-day supply)
Additional Added Benefits
Plan Links
Ready to Enroll Online?
Or call and get free advice from licensed insurance agents
Looking for other plans in your area?