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Alignment Health AVA 001 (PPO) Medicare Advantage Plan H7074-001 • 2027 • Wake County, NC

CMS Rating: Not yet rated by CMS.
Monthly Premium
$20.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$3900.00In-network
Part B Giveback
Not offered
Prescription Coverage
Enhanced, $0.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
Wake County, NC
Local Enrollment
473 beneficiaries in Wake County
Last update:

Alignment Health AVA 001 (PPO) Introduction

Alignment Health AVA 001 is a Medicare Advantage PPO plan offered by Alignment Health Plan. It uses a Preferred Provider Organization (PPO) provider network and comes with prescription drug coverage. For the 2027 plan year it has a $20.00 monthly premium, $0.00 medical deductible, and $3900.00 in-network maximum out-of-pocket. CMS Plan ID H7074-001 identifies this plan. The 2027 Part D prescription drug deductible is $0.00.

You must live in Wake County, North Carolina to enroll in this plan. CMS reports 473 beneficiaries enrolled in this plan in Wake County. For assistance with this plan, new members can call (888)979-2247 (TTY 711).

Compare Similar Plans in Wake County

Compare this plan with the two most-enrolled PPO plans available in Wake County, North Carolina. Enrollment is based on CMS local enrollment data.

PPO plan comparison for Wake County, North Carolina
Plan Detail Alignment Health AVA 001 Blue Medicare PPO Enhanced Aetna Medicare Signature
CMS Plan ID H7074-001-0 H3404-003-2 H5521-609-0
Local Enrollment 473 4,914 3,260
Monthly Premium $20.00 $70.00 $0.00
Medical Deductible $0.00 $170 $0.00
Maximum Out-of-Pocket $3,900.00 $6,900.00 $9,850.00
Part B Giveback Not offered Not offered Not offered
Primary Care $5 copay $0 copay $0 copay
Specialist $20 copay $30 copay $60 copay
Part D Deductible $0.00 $700.00 $700.00
CMS Star Rating Not yet rated 4.5 4.0
Dental $0 copay $0 copay $0 copay
Vision $0 copay $0 copay $0 copay
Hearing $0 copay Not covered $0 copay

Want to explore more options? Browse all Medicare Advantage plans in Wake County, or compare Medicare Advantage plans across North Carolina, including premiums, out-of-pocket costs, CMS ratings, and enrollment.

Plan Benefits

Alignment Health AVA 001 has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H7074-001.

You can also compare 2027 costs and coverage with last year, side-by-side: Plan H7074-001-0 Cost Compare.

Office Visits

Primary care
In-network: $5 copay
Out-of-network: $40 copay
Specialist
In-network: $20 copay
Out-of-network: $50 copay

Preventive and Wellness Services

Annual wellness exam
In-network: $0 copay
Out-of-network: 30% coinsurance
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
Not covered
Health transportation (non-emergency)
Coming soon

Diagnostic, Lab, and Imaging Services

Diagnostic radiology services
In-network: $150 copay
Out-of-network: 30% coinsurance
Lab services
In-network: $0 copay
Out-of-network: 30% coinsurance
Outpatient x-rays
In-network: $15 copay
Out-of-network: 30% coinsurance
Diagnostic tests and procedures
In-network: $0 copay
Out-of-network: 30% coinsurance

Emergency and Urgent Care Services

Emergency room care
$150 copay
Worldwide emergency care
Coming soon
Urgent care
$20 copay
Inpatient hospital care
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
Skilled Nursing Facility
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
Ground ambulance
In-network: $250 copay
Out-of-network: 30% coinsurance

Mental Health Services

Outpatient individual therapy
In-network: $40 copay
Out-of-network: 30% coinsurance
Outpatient group therapy
In-network: $40 copay
Out-of-network: 30% coinsurance
Inpatient psychiatric hospital care
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

Rehabilitation Services

Physical therapy and speech and language therapy
In-network: $0 copay
Out-of-network: 30% coinsurance
Occupational therapy
In-network: $0 copay
Out-of-network: 30% coinsurance

Medical Equipment and Supplies

Diabetes supplies
In-network: $0 copay
Out-of-network: 30% coinsurance
Durable medical equipment
In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance
Prosthetics
In-network: 20% coinsurance
Out-of-network: 30% coinsurance

Medicare Part B Drugs

Chemotherapy
In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance
Other Part B drugs (Medicare-covered)
In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance

Dental Services

Oral exam
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Cleaning
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Periodontics
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Endodontics
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Restorative services
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Implant services
Not covered
Orthodontics
Not covered
Oral/Maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance

Vision Services

Routine eye exam
In-network: $0 copay
Out-of-network: 30% coinsurance
Contact lenses
In-network: $0 copay
Out-of-network: 50% coinsurance
Eyeglass frames only
In-network: $0 copay
Out-of-network: 50% coinsurance
Eyeglass lenses only
In-network: $0 copay
Out-of-network: 50% coinsurance
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: 50% coinsurance
Upgrades
Not covered

Hearing Services

Hearing exam
In-network: $0 copay
Out-of-network: 30% coinsurance
Fitting/evaluation
In-network: $0 copay
Out-of-network: 30% coinsurance
Prescription hearing aids
Not covered
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 AVA 001 as a Part B benefit.

Prescription Drug Coverage

Alignment Health AVA 001 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.

Alignment Health AVA 001 (H7074-001-0) Prescription Drug Plan Premium Details
Part D Premium Component Amount
Basic Part D Premium:$10.00
Supplemental Part D Premium:$$10.00
Total Part D Premium:$20.00
Low-Income Premium Subsidy:$13.25
Low-Income Premium Subsidy Paid by CMS:$10.00
Low-Income Subsidy Premium:$10.00

For more details, visit the Social Security Extra Help program .

Prescription Drug Plan Deductible

This plan has a $0.00 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 AVA 001 may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

Alignment Health AVA 001 (H7074-001-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Preferred Generic$0.00 copayComing soon
Generic$0.00 copayComing soon
Preferred Brand$40.00 copayComing soon
Non-Preferred Drug40% coinsuranceComing soon
Specialty Tier33% coinsuranceComing soon
Select Care Drugs$5.00 copayComing soon
*Deductible does not apply.

CMS 5-Star Performance Ratings (Contract ID: H7074)

Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.

2027 Medicare Star Ratings for Contract H7074
CMS Measure Star Rating
2027 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines Not enough data available
Managing Chronic (Long Term) Conditions Not enough data available
Member Experience with Health Plan Not enough data available
Complaints and Changes in Plans Performance Not enough data available
Health Plan Customer Service Not enough data available
Drug Plan Customer Service ☆☆☆☆☆
Complaints and Changes in the Drug Plan Not enough data available
Member Experience with the Drug Plan Not enough data available
Drug Safety and Accuracy of Drug Pricing Not enough data available

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 AVA 001 is available to eligible Medicare beneficiaries residing in Wake County, North Carolina, including communities such as Apex, Cary, Fuquay Varina, Garner, Holly Springs, Knightdale, Morrisville, New Hill, Rolesville, Wake Forest, Wendell, Willow Spring, Zebulon, Raleigh, and other areas throughout the county. Enrollment eligibility is based on county of residence, not city.

Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
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.

Official plan information and secondary Medicare references.
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

MedicarePlans.com operates as an independent, non-government informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.

Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.