Alignment Health Platinum 012 (HMO) Medicare Advantage Plan H5296-012 • 2027 • Rowan County, NC
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $3500.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $225.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Rowan County, NC
- Local Enrollment
- 0 beneficiaries in Rowan County
Alignment Health Platinum 012 (HMO) Introduction
This Medicare Advantage HMO plan, Alignment Health Platinum 012, is offered by Alignment Health Plan and uses a Health Maintenance Organization (HMO) provider network. It comes with prescription drug coverage. For the 2027 plan year, the monthly premium is $0.00, the medical deductible is $0.00, and the in-network maximum out-of-pocket is $3500.00. The plan is identified by CMS Plan ID H5296-012. The 2027 Part D prescription drug deductible is $225.00.
Enrollment in this plan requires residence in Rowan County, North Carolina. CMS enrollment data reports 0 plan members in Rowan County. New members can call the plan directly at (888)979-2247 (TTY 711) for assistance.
Compare Similar Plans in Rowan County
Compare this plan with the two most-enrolled HMO plans available in Rowan County, North Carolina. Enrollment is based on CMS local enrollment data.
| Plan Detail | Alignment Health Platinum 012 | HealthSpring Preferred Savings | HealthSpring Preferred |
|---|---|---|---|
| CMS Plan ID | H5296-012-0 |
H9725-015-1 |
H9725-009-1 |
| Local Enrollment | 0 | 877 | 835 |
| Monthly Premium | $0.00 | $0.00 | $0.00 |
| Medical Deductible | $0.00 | $150 | $0.00 |
| Maximum Out-of-Pocket | $3,500.00 | $6,750.00 | $3,900.00 |
| Part B Giveback | Not offered | −$179.00 reduction | −$5.00 reduction |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $15 copay | $45 copay | $20 copay |
| Part D Deductible | $225.00 | $600.00 | $400.00 |
| CMS Star Rating | 4.5 | 3.0 | 3.0 |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Want to explore more options? Browse all Medicare Advantage plans in Rowan County, or compare Medicare Advantage plans across North Carolina, including premiums, out-of-pocket costs, CMS ratings, and enrollment.
Plan Benefits
Cost-sharing for Alignment Health Platinum 012 includes out-of-pocket expenses for covered healthcare services. The following tables provide a summary of typical in-network out-of-pocket costs for plan H5296-012.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H5296-012-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
- Specialist
- In-network: $15 copay
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
- Telehealth benefit
- In-network: $0-$20 copay
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- In-network: $0 copay
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $0 copay
- Lab services
- In-network: $0 copay
- Outpatient x-rays
- In-network: $0 copay
- Diagnostic tests and procedures
- In-network: $0 copay
Emergency and Urgent Care Services
- Emergency room care
- $150 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $0 copay
- Inpatient hospital care
- Tier 1
$275 per day for days 1-5
$0 per day for days 6-90
$0 per stay - Skilled Nursing Facility
- Tier 1
$20 per day for days 1-20
$178 per day for days 21-100 - Ground ambulance
- In-network: $225 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $35 copay
- Outpatient group therapy
- In-network: $35 copay
- Inpatient psychiatric hospital care
- Tier 1
$275 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $10 copay
- Occupational therapy
- In-network: $35 copay
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
- Durable medical equipment
- In-network: 20% coinsurance
- Prosthetics
- In-network: 20% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
- Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
- Dental x-rays
- In-network: $0 copay
- Cleaning
- In-network: $0 copay
- Periodontics
- In-network: $0 copay
- Endodontics
- In-network: $0 copay
- Restorative services
- In-network: $0 copay
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: $0 copay
Vision Services
- Routine eye exam
- In-network: $0 copay
- Contact lenses
- In-network: $0 copay
- Eyeglass frames only
- In-network: $0 copay
- Eyeglass lenses only
- In-network: $0 copay
- Eyeglasses (frames & lenses)
- In-network: $0 copay
- Upgrades
- Not covered
Hearing Services
- Hearing exam
- In-network: $0 copay
- Fitting/evaluation
- In-network: $0 copay
- Prescription hearing aids
- In-network: $195-$1750 copay
- OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- Not covered
Certain preventive services are covered 100% by Alignment Health Platinum 012 as a Part B benefit.
Prescription Drug Coverage
Alignment Health Platinum 012 includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $0.00 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $13.25 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $225.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Alignment Health Plan starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Alignment Health Platinum 012 may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | $45.00 copay | Coming soon |
| Non-Preferred Drug | 40% coinsurance | Coming soon |
| Specialty Tier | 30% coinsurance | Coming soon |
| Select Care Drugs | $5.00 copay | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H5296)
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 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 |
Contact Information for Alignment Health Plan
- Website
- Alignment Health Plan Plan Page
- Providers
- Alignment Health Plan Providers Page
- Formulary
- Alignment Health Plan Formulary Page
- Pharmacy
- Alignment Health Plan Pharmacy Page
- 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
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Advantage Plan Availability
Alignment Health Platinum 012 is available to eligible Medicare beneficiaries residing in Rowan County, North Carolina, including communities such as Cleveland, Woodleaf, China Grove, Gold Hill, Landis, Mount Ulla, Rockwell, Salisbury, Spencer, and other areas throughout the county. Enrollment eligibility is based on county of residence, not city.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Alignment Health Plan (official source) | http://www.alignmenthealthplan.com | October 4, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Explore your Medicare coverage options | 25 May, 2025 |
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