Alignment Health AVA Instacart (HMO-POS) is a Medicare Advantage Plan by Alignment Health Plan.
This page features plan details for 2024 Alignment Health AVA Instacart (HMO-POS) H3815 – 026 – 0 available in LA, OC, SD, SC, Stanislaus.
IMPORTANT: This page features the 2024 version of this plan. See the 2025 version using the link below:
Alignment Health AVA Instacart (HMO-POS) is offered in the following locations.
Alignment Health AVA Instacart (HMO-POS) offers the following coverage and cost-sharing.
Insurer: | Alignment Health Plan |
Health Plan Deductible: | $0.00 |
MOOP: | $1,999 In-network |
Drugs Covered: | Yes |
Ready to sign up for Alignment Health AVA Instacart (HMO-POS) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans.
Alignment Health AVA Instacart (HMO-POS) qualifies for a monthly Medicare Give Back Benefit of $50.00.
Premium Reduction: | $50.00 |
Part B | Part C | Part D | Part B Give Back | Total |
---|---|---|---|---|
$174.70 | $0.00 | $0.00 | $50.00 | $ |
Alignment Health AVA Instacart (HMO-POS) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Deductible: | $0.00 |
Initial Coverage Limit: | $5,030.00 |
Catastrophic Coverage Limit: | $8,000.00 |
Drug Benefit Type: | Enhanced Alternative |
Additional Gap Coverage: | Yes |
Formulary Link: | Formulary Link |
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.
The table below shows how the LIS impacts the Part D premium of this plan.
Part D | LIS Full |
---|---|
$0.00 | $ |
After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00. Once you reach that amount, you will enter the next coverage phase.
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $0.00 copay | ||
2 (Generic) | $3.00 copay | $3.00 copay | ||
3 (Preferred Brand) | $40.00 copay | $40.00 copay | ||
4 (Non-Preferred Drug) | $93.00 copay | $93.00 copay | ||
5 (Specialty Tier) | 33% | 33% | ||
6 (Select Care Drugs) | $3.00 copay | $3.00 copay |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | ||||
2 (Generic) | ||||
3 (Preferred Brand) | ||||
4 (Non-Preferred Drug) | ||||
5 (Specialty Tier) | ||||
6 (Select Care Drugs) |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $0.00 copay | ||
2 (Generic) | $9.00 copay | $9.00 copay | ||
3 (Preferred Brand) | $120.00 copay | $120.00 copay | ||
4 (Non-Preferred Drug) | $279.00 copay | $279.00 copay | ||
5 (Specialty Tier) | ||||
6 (Select Care Drugs) | $0.00 copay | $0.00 copay |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
6 (Select Care Drugs) | $3.00 copay | $3.00 copay | ||
1 (Preferred Generic) | ||||
2 (Generic) | ||||
3 (Preferred Brand) | ||||
4 (Non-Preferred Drug) | ||||
5 (Specialty Tier) | ||||
6 (Select Care Drugs) |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
6 (Select Care Drugs) | $0.00 copay | $0.00 copay | ||
1 (Preferred Generic) | ||||
2 (Generic) | ||||
3 (Preferred Brand) | ||||
4 (Non-Preferred Drug) | ||||
5 (Specialty Tier) | ||||
6 (Select Care Drugs) |
Tier | Cost |
---|---|
All other tiers (Generic) | 25% |
All other tiers (Brand-name) | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.
Alignment Health AVA Instacart (HMO-POS) also provides the following benefits.
$0 |
In-network | No |
$1,999 In-network |
Yes |
In-network | No |
In-network | $100 copay per visit (Authorization is required.) (Referral is required.) |
In-network Primary | $35 copay per visit (Not applicable.) (Not applicable.) |
out-of-network Primary | $35 copay per visit (Not applicable.) (Not applicable.) |
In-network Specialist | $35 copay per visit (Authorization is required.) (Referral is required.) |
out-of-network Specialist | $35 copay per visit (Authorization is required.) (Referral is required.) |
In-network | $0 copay (Authorization is not required.) (Referral is not required.) |
Emergency | $120 copay per visit (always covered) (Not applicable.) (Not applicable.) |
Urgent care | $0 copay (Not applicable.) (Not applicable.) |
In-network Diagnostic tests and procedures | $0 copay (Authorization is not required.) (Referral is not required.) |
In-network Lab services | $0 copay (Authorization is not required.) (Referral is not required.) |
In-network Diagnostic radiology services (e.g., MRI) | $0 copay (Authorization is required.) (Referral is required.) |
In-network Outpatient x-rays | $0 copay (Authorization is required.) (Referral is required.) |
In-network Hearing exam | $0 copay (Authorization is not required.) (Referral is not required.) |
In-network Fitting/evaluation | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Hearing aids | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Oral exam | $0 copay (Limits may apply.) (Authorization is required.) (Referral is required.) |
In-network Cleaning | $0 copay (Limits may apply.) (Authorization is required.) (Referral is required.) |
In-network Fluoride treatment | $0 copay (Limits may apply.) (Authorization is required.) (Referral is required.) |
In-network Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is required.) (Referral is required.) |
In-network Non-routine services | $0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
In-network Diagnostic services | $0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
In-network Restorative services | $20-350 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
In-network Endodontics | $15-295 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
In-network Periodontics | $15-375 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
In-network Extractions | $25-140 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
In-network Prosthodontics, other oral/maxillofacial surgery, other services | $20-425 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
In-network Routine eye exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
In-network Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Upgrades | Not covered (Not applicable.) (Not applicable.) |
In-network Occupational therapy visit | $0 copay (Authorization is required.) (Referral is required.) |
In-network Physical therapy and speech and language therapy visit | $35 copay (Authorization is required.) (Referral is required.) |
In-network | $115 copay (Not applicable.) (Not applicable.) |
Not covered (Not applicable.) (Not applicable.) |
In-network Foot exams and treatment | $35 copay (Authorization is required.) (Referral is required.) |
Routine foot care | Not covered (Not applicable.) (Not applicable.) |
In-network Durable medical equipment (e.g., wheelchairs, oxygen) | 0-20% coinsurance per item (Authorization is required.) (Not applicable.) |
In-network Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
In-network Diabetes supplies | $0 copay (Authorization is required.) (Not applicable.) |
Covered (Authorization is required.) (Referral is required.) |
In-network Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
In-network Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
In-network Part B Insulin drugs | 0-20% coinsurance (up to $35) (Authorization is required.) (Not applicable.) |
In-network | $0 per day for days 1 through 4 $100 per day for days 5 through 10 $0 per day for days 11 through 90 (Authorization is required.) (Referral is required.) |
out-of-network | Not Applicable (Authorization is required.) (Referral is required.) |
In-network Inpatient hospital – psychiatric | $120 per day for days 1 through 10 $0 per day for days 11 through 90 (Authorization is required.) (Referral is required.) |
out-of-network Inpatient hospital – psychiatric | Not Applicable (Authorization is required.) (Referral is required.) |
In-network Outpatient group therapy visit with a psychiatrist | $35 copay (Authorization is required.) (Referral is required.) |
In-network Outpatient individual therapy visit with a psychiatrist | $35 copay (Authorization is required.) (Referral is required.) |
In-network Outpatient group therapy visit | $35 copay (Authorization is required.) (Referral is required.) |
In-network Outpatient individual therapy visit | $35 copay (Authorization is required.) (Referral is required.) |
In-network | $0 per day for days 1 through 20 $50 per day for days 21 through 100 (Authorization is required.) (Referral is required.) |
out-of-network | Not Applicable (Authorization is required.) (Referral is required.) |
Monthly Premium | $27.00 |
Deductible | nan |
Ready to sign up for Alignment Health AVA Instacart (HMO-POS) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
Need more information on Alignment Health AVA Instacart (HMO-POS)? See 2025 Alignment Health AVA Instacart (HMO-POS) at MedicareAdvantageRX.com.
Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint
SMID: MULTIPLAN_HCIHNDOGMED01PY25_M
Factsonmedicare.com is a free-to-use informational website by Dog Media Solutions LLC. All insurance agents and enrollment platforms linked to this site have their own terms and conditions.
Medicare has neither approved nor endorsed any information on this site.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
All plan-related information on this site is from CMS.gov and Medicare.gov. We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period.
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.