Alignment Health Platinum 012 (HMO) Medicare Advantage Plan H5296-012 • 2027
- 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
- See List
- Total Enrollment
- 0 beneficiaries
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.
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.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay | Coming soon |
| Specialist | In-network: $15 copay | Coming soon |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay | Coming soon |
| Telehealth benefit | In-network: $0-$20 copay | Coming soon |
| Routine chiropractic | Not covered | Coming soon |
| Fitness benefits | Coming soon | Coming soon |
| Health education | Not covered | Coming soon |
| Counseling services | Not covered | Coming soon |
| Over-the-counter drug benefits | In-network: $0 copay | Coming soon |
| Health transportation (non-emergency) | Coming soon | Coming soon |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $0 copay | Coming soon |
| Lab services | In-network: $0 copay | Coming soon |
| Outpatient x-rays | In-network: $0 copay | Coming soon |
| Diagnostic tests and procedures | In-network: $0 copay | Coming soon |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $150 copay | Coming soon |
| Worldwide emergency care | Coming soon | Coming soon |
| Urgent care | $0 copay | Coming soon |
| Inpatient hospital care | Tier 1 $275 per day for days 1-5 $0 per day for days 6-90 $0 per stay |
Coming soon |
| Skilled Nursing Facility | Tier 1 $20 per day for days 1-20 $178 per day for days 21-100 |
Coming soon |
| Ground ambulance | In-network: $225 copay | Coming soon |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $35 copay | Coming soon |
| Outpatient group therapy | In-network: $35 copay | Coming soon |
| Inpatient psychiatric hospital care | Tier 1 $275 per day for days 1-5 $0 per day for days 6-90 $0 per stay |
Coming soon |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $10 copay | Coming soon |
| Occupational therapy | In-network: $35 copay | Coming soon |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay | Coming soon |
| Durable medical equipment | In-network: 20% coinsurance | Coming soon |
| Prosthetics | In-network: 20% coinsurance | Coming soon |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance | Coming soon |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance | Coming soon |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay | Coming soon |
| Dental x-rays | In-network: $0 copay | Coming soon |
| Cleaning | In-network: $0 copay | Coming soon |
| Periodontics | In-network: $0 copay | Coming soon |
| Endodontics | In-network: $0 copay | Coming soon |
| Restorative services | In-network: $0 copay | Coming soon |
| Implant services | Not covered | Coming soon |
| Orthodontics | Not covered | Coming soon |
| Oral/Maxillofacial surgery | In-network: $0 copay | Coming soon |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay | Coming soon |
| Contact lenses | In-network: $0 copay | Coming soon |
| Eyeglass frames only | In-network: $0 copay | Coming soon |
| Eyeglass lenses only | In-network: $0 copay | Coming soon |
| Eyeglasses (frames & lenses) | In-network: $0 copay | Coming soon |
| Upgrades | Not covered | Coming soon |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay | Coming soon |
| Fitting/evaluation | In-network: $0 copay | Coming soon |
| Prescription hearing aids | In-network: $195-$1750 copay | Coming soon |
| OTC hearing aids | Not covered | Coming soon |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Coming soon |
| Home-based palliative care | Not covered | Coming soon |
| Personal emergency response system | Coming soon | Coming soon |
| Weight management programs | Not covered | Coming soon |
| Wigs for chemotherapy-related hair loss | Coming soon | Coming soon |
| Alternative therapies | Not covered | Coming soon |
| Massage therapy | Not covered | Coming soon |
| Home/bathroom safety devices | Not covered | Coming soon |
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.
Plan Availability
Alignment Health Platinum 012 (H5296-012-0) is available in the following locations:
North Carolina Counties Served
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About Alignment Health Platinum 012 (HMO)
Is there a monthly premium for this plan in 2027?
The 2027 monthly premium is $0.00. The Medicare Part B premium is paid separately.
What is the in-network MOOP for plan H5296-012?
For 2027, the in-network maximum out-of-pocket is $3500.00. The plan pays 100% of covered in-network services beyond this amount.
What is the star rating for plan H5296-012 in 2027?
CMS rates this plan at ★4.5 out of 5 stars for 2027.
What is the total enrollment for plan H5296-012?
Total enrollment is 0 beneficiaries based on the latest CMS data.
What is the prescription drug deductible for 2027?
The plan’s Part D deductible is $225.00, applied to covered prescription drug costs.
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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