Alignment Health AVA (PPO)

North Carolina Medicare Advantage Plan (2024 Plan)

Monthly Premium

Your Cost

by Alignment Health Plan

Additional Coverage

HearingVisionDental

Overall Government Star Rating

No Rating (new plan)

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Plan Name

Alignment Health AVA (PPO)

Insurance Carrier

Alignment Health Plan

Plan Type

Medicare Advantage Plan With Part D Prescription Drug Coverage

Network Type

PPO

Alignment Health AVA (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in North Carolina and offered by the health insurance company Alignment Health Plan. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium

Annual Deductible

Max Out-of-Pocket

$2,899

Primary doctor visit

$5 copay per visit

Specialist visit

$20 copay per visit

ER visit

$85 copay per visit (always covered)

Ambulance

$250 copay

Alignment Health AVA (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $5,750 In and Out-of-network $2,899 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Alignment Health AVA (PPO) are defined below.

Yes

Part D Prescription Drug Coverage

Yes

Dental

Yes

Vision

Yes

Hearing

Alignment Health AVA (PPO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Alignment Health AVA (PPO) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Alignment Health AVA (PPO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit

Limited coverage

Over the counter drug benefits

Not covered

In-home support services

Not covered

Home and bathroom safety devices

Not covered

Meals for short duration

Not covered

Annual physical exams

Limited coverage

Telehealth

Limited coverage

Monthly Premium

Health Portion of Premium

Drug Portion of Premium

Health Plan Deductible

Health Plan Max Out-of-Pocket

$5,750 In and Out-of-network
$2,899 In-network

Nationwide Coverage included

Hearing Coverage included

Yes

Vision Coverage included

Yes

Dental Coverage included

Yes

Doctor Lookup Link

http://www.alignmenthealthplan.com

Plan Link

http://www.alignmenthealthplan.com

Doctor Services

Primary doctor visit

In-network: $5 copay per visit
Out-of-network: $40 copay per visit

Specialist visit

In-network: $20 copay per visit
Out-of-network: $50 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures

In-network: $0 copay
Out-of-network: 30% coinsurance

Lab services

In-network: $0 copay
Out-of-network: 30% coinsurance

Diagnostic radiology services (like MRI)

In-network: $150 copay
Out-of-network: 30% coinsurance

Outpatient x-rays

In-network: $15 copay
Out-of-network: 30% coinsurance

Emergency care

$85 copay per visit (always covered)

Urgent care

$20 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage

In-network: $200 per day for days 1 through 6
$0 per day for days 7 through 90
Out-of-network: 10% per stay

Outpatient hospital coverage

In-network: $165 copay per visit
Out-of-network: 25% coinsurance per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$100 per day for days 21 through 51
$0 per day for days 52 through 100
Out-of-network: 30% per stay

Preventive services

In-network: $0 copay
Out-of-network: 30% coinsurance

Ambulance

Ground ambulance

In-network: $250 copay
Out-of-network: 30% coinsurance

Therapy services

Occupational therapy visit

In-network: $0 copay
Out-of-network: 30% coinsurance

Physical therapy & speech & language therapy visit

In-network: $0 copay
Out-of-network: 30% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist

In-network: $40 copay
Out-of-network: 30% coinsurance

Outpatient individual therapy with a psychiatrist

In-network: $40 copay
Out-of-network: 30% coinsurance

Outpatient group therapy visit

In-network: $0 copay
Out-of-network: 30% coinsurance

Outpatient individual therapy visit

In-network: $0 copay
Out-of-network: 30% coinsurance

Opioid treatment services

Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)

In-network: 0-20% coinsurance per item
Out-of-network: 30% coinsurance per item

Prosthetics (like braces, artificial limbs)

In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item

Diabetes supplies

In-network: $0 copay
Out-of-network: 30% coinsurance per item

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

Tiers	Initial coverage phase	Gap coverage phase¹	Catastrophic coverage phase
Preferred Generic	$0.00 copay	$0.00 copay	$0 copay
Generic	$0.00 copay		$0 copay
Preferred Brand	$40.00 copay		$0 copay
Non-Preferred Drug	$100.00 copay		$0 copay
Specialty Tier	33%		$0 copay
¹ For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

Part B Drugs

Chemotherapy drugs

In-network: 0-20% coinsurance
Out-of-network: 30% coinsurance

Other Part B drugs

In-network: 0-20% coinsurance
Out-of-network: 30% coinsurance

Hearing

Hearing exam

In-network: $0 copay
Out-of-network: 30% coinsurance

Fitting/evaluation

In-network: $0 copay
Out-of-network: 30% coinsurance

Hearing aids - Inner ear

Not covered

Hearing aids - Outer ear

Not covered

Hearing aids - Over the ear

Not covered