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Alignment Health Balance 033 (HMO C-SNP) H3815-033 • 2027 • Los Angeles County, CA

CMS Rating: Not yet rated by CMS.
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$1499.00In-network
Part B Giveback
Not offered
Prescription Coverage
Enhanced, $0.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
Los Angeles County, CA
Local Enrollment
94 beneficiaries in Los Angeles County
Last update:

Introduction

Alignment Health Balance 033, offered by Alignment Health Plan, is a Medicare Advantage Chronic Condition Special Needs Plan (C-SNP) identified by CMS Plan ID H3815-033. The plan's Health Maintenance Organization (HMO) provider network serves its covered medical benefits, and the plan includes Medicare Part D prescription drug coverage. Its 2027 costs include a $0.00 monthly premium, $0.00 medical deductible, and $1499.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $0.00.

Eligible Medicare beneficiaries residing in Los Angeles County, California can enroll in this plan. According to CMS, 94 beneficiaries in Los Angeles County are enrolled in this plan. New members can contact the plan at (888)979-2247 (TTY 711) for help and additional plan information.

Eligibility

Alignment Health Balance 033 is a Medicare C-SNP plan for individuals with specific chronic or disabling conditions.

Special Needs Plan Type
Chronic Condition Special Needs Plan (C-SNP)
Medicare Requirement
Must have Medicare Part A and Part B
Special Needs Requirement
This plan is for individuals with chronic kidney disease.
Service Area Requirement
Must live in the plan's service area
Prescription Drug Coverage
Medicare Part D prescription drug coverage is included.

Compare Similar Plans in Los Angeles County

Compare this plan with the two most-enrolled HMO C-SNP plans available in Los Angeles County, California. Enrollment is based on CMS local enrollment data.

HMO C-SNP plan comparison for Los Angeles County, California
Plan Detail Alignment Health Balance 033 SCAN Balance Clever Care Total+
CMS Plan ID H3815-033-0 H5425-034-0 H7607-016-0
Local Enrollment 94 15,419 12,681
Monthly Premium $0.00 $0.00 $0.00
Medical Deductible $0.00 $0.00 $0.00
Maximum Out-of-Pocket $1,499.00 $199.00 $9,850.00
Part B Giveback Not offered Not offered Not offered
Primary Care $0 copay $0 copay $0 copay
Specialist $0 copay $0 copay $0 copay
Part D Deductible $0.00 $370.00 $700.00
CMS Star Rating Not yet rated Not yet rated Not yet rated
Dental $0 copay $0 copay $0 copay
Vision $0 copay $0 copay $0 copay
Hearing $0 copay $0 copay $0 copay

Plan Benefits

Alignment Health Balance 033 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 H3815-033.

You can also compare 2027 costs and coverage with last year, side-by-side: Plan H3815-033-0 Cost Compare.

Office Visits

Primary care
In-network: $0 copay
Specialist
In-network: $0 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
$0 per stay
Skilled Nursing Facility
Tier 1
$0 per day for days 1-20
$50 per day for days 21-100
Ground ambulance
In-network: $100 copay

Mental Health Services

Outpatient individual therapy
In-network: $40 copay
Outpatient group therapy
In-network: $40 copay
Inpatient psychiatric hospital care
Tier 1
$0 per stay

Rehabilitation Services

Physical therapy and speech and language therapy
In-network: $0 copay
Occupational therapy
In-network: $0 copay

Medical Equipment and Supplies

Diabetes supplies
In-network: $0 copay
Durable medical equipment
In-network: 0%-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: $15-$550 copay
Endodontics
In-network: $25-$350 copay
Restorative services
In-network: $20-$400 copay
Implant services
Not covered
Orthodontics
Not covered
Oral/Maxillofacial surgery
In-network: $25-$250 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
In-network: $0 copay

Hearing Services

Hearing exam
In-network: $0 copay
Fitting/evaluation
In-network: $0 copay
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 Balance 033 as a Part B benefit.

Prescription Drug Coverage

Alignment Health Balance 033 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.

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 Balance 033 (H3815-033-0) Prescription Drug Plan Premium Details
Part D Premium Component Amount
Basic Part D Premium:($54.80)
Supplemental Part D Premium:$54.80
Total Part D Premium:$0.00
Low-Income Premium Subsidy:$7.28
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 $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 Balance 033 may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

Alignment Health Balance 033 (H3815-033-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Preferred Generic$0.00 copay$0.00 copay
Generic$0.00 copay$0.00 copay
Preferred Brand$40.00 copay$40.00 copay
Non-Preferred Drug$100.00 copay$100.00 copay
Specialty Tier33% coinsurance33% coinsurance
Select Care Drugs$5.00 copay$5.00 copay
*Deductible does not apply.

CMS 5-Star Performance Ratings (Contract ID: H3815)

Medicare assigns star ratings to plans based on quality and performance across multiple measures, including customer service, member experience, and health outcomes. Ratings are updated annually by the Centers for Medicare & Medicaid Services (CMS) and are shown on a 1 to 5 star scale, with 5 stars representing the highest quality.

2027 Medicare Star Ratings for Contract H3815
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 Not enough data available
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 Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher CMS Version
Landscape Source Files Centers for Medicare & Medicaid Services CY2027 Landscape (202609.1)
Medicare Part C & D Performance Centers for Medicare & Medicaid Services 2027 Star Ratings Data Tables
Plan Benefits Package Centers for Medicare & Medicaid Services PBP Benefits-2027
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services 2026-09

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
CMS.gov Chronic Condition Special Needs Plans (C-SNPs) April 28, 2026
Medicare.gov Compare types of Medicare Advantage Plans April 28, 2026
AARP.org The Big Choice: Original Medicare vs. Medicare Advantage April 28, 2026

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Provenance documentation for this data is maintained under the U.S. Core Data for Interoperability (USCDI) Provenance standard.