Alignment Health Heroes+ (HMO) H3815-043-0 Plan Details
Alignment Health Heroes+ (HMO) H3815-043-0 Plan Details
Choosing the right Medicare Advantage plan is crucial for your healthcare needs in 2025. With Alignment Health Heroes+ (HMO) as one of the options, you can compare it side-by-side with other available plans to find the best fit for you. Whether you prefer enrolling online or seeking advice from a licensed agent, we’ve made the process simple and straightforward.
According to CMS enrollment data (May, 2025), there are approximately 1,150 members enrolled in this plan.
Alignment Health Heroes+ Overview
| Plan ID H3815-043-0 Overview | |
|---|---|
| Health Plan ID: | H3815-043-0 |
| Medicare Advantage Plan Type: | HMO |
| Plan Year: | 2025 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $5,900.00 (In-Network) |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Enhanced, $590.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | See List |
| Insured By: | Alignment Health Plan |
Plan Availability
Alignment Health Heroes+ (H3815-043-0) is available in the following locations (click to open):
Why Consider Alignment Health Heroes+ ?
With a monthly premium of $0.00, Alignment Health Heroes+ brings together hospital, medical, and prescription drug coverage in one coordinated Medicare Advantage HMO plan. It includes the core benefits of Medicare Part A and Part B, plus drug coverage to help manage your ongoing prescriptions. The annual Part D deductible is $590.00. As with most HMO plans, you’ll typically need to use in-network providers to keep costs predictable.
Primary care visits have a not covered, specialist visits come with a not covered, urgent care services carry a 20% coinsurance, and ambulance transportation is 20% coinsurance. These expenses count toward the plan’s maximum out-of-pocket (MOOP) limit of $5,900.00 . Once you reach that limit, your in-network care is covered at 100% for the rest of the year — a strong choice for anyone who wants bundled coverage and financial protection they can count on.
You’ll find this plan listed by CMS as H3815-043-0. You'll find a summary of its cost sharing below, including what you can expect to pay for primary care, specialists, urgent care, and more. Still have questions? Check the FAQ section for more details.
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Cost-Sharing Overview
With Alignment Health Heroes+ , you'll have cost-sharing expenses, which are the out-of-pocket costs for approved healthcare services. The table below provides a summary of the typical in-network out-of-pocket costs associated with plan H3815-043-0.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | Not Covered |
| Specialist: | Not Covered |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | 20% Coinsurance |
| Urgent care: | 20% Coinsurance |
| Ground ambulance: | 20% Coinsurance |
| Inpatient hospital care: | |
| Skilled Nursing Facility: |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | Not Covered |
| Routine Foot Care: | Not Covered |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | Not Covered |
| Routine chiropractic: | Not Covered |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | 20% Coinsurance |
| Outpatient group therapy: | 20% Coinsurance |
| Inpatient psychiatric hospital care: |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | 20% Coinsurance Prior Authorization Required, Referral Required |
| Occupational therapy: | 20% Coinsurance Prior Authorization Required, Referral Required |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | Not Covered |
| Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
| Prosthetics: | 20% Coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | Not Covered |
| Lab services: | Not Covered |
| Outpatient x-rays: | Not Covered |
| Diagnostic tests and procedures: | Not Covered |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered): | 20% Coinsurance |
This section details the dental services covered under your plan including, Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Medicare Covered Preventive Dental | 20% Coinsurance |
| Oral exam | |
| Dental x-rays | |
| Cleaning | |
| Periodontics | |
| Endodontics | |
| Restorative Services |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | Covered Limits may apply |
| Hearing aids | Not Covered |
| Hearing exam | Covered Limits may apply |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | |
| Routine eye exam (in-network) | Covered Limits may apply |
| Eyewear benefits | Eyeglasses: Yes Contact Lenses: Yes Eyeglass Lenses: Yes Eyeglass Frames: Yes Eyewear Upgrades: Yes |
Maximum eyewear benefit: | $500.00 Every two years |
Certain preventive services are covered 100% by Alignment Health Heroes+ as a Part B benefit.
Part D Prescription Drug Costs & Benefits
Alignment Health Heroes+ includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
| Basic Part D Premium: | $(23.40) |
|---|---|
| Supplemental Part D Premium: | $23.40 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | ${part_d_lips_amount} |
| 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 $590.00 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 Heroes+ 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 | $0.00 |
| Generic* | $10.00 | $10.00 |
| Preferred Brand* | 25.00% | 25.00% |
| Non-Preferred Drug | 25.00% | 25.00% |
| Specialty Tier | 25.00% | 25.00% |
| Select Care Drugs* | $5.00 | $5.00 |
| *Deductible does not apply. | ||
How CMS Star Ratings Guide Your Choice
The Centers for Medicare & Medicaid Services (CMS) reviews and rates Medicare Advantage (Part C) and drug plans (Part D) annually, using a 5-star system to measure aspects such as member satisfaction, preventive services, and management of chronic conditions.
Higher star ratings generally indicate better plan performance, which can be a useful factor to consider when deciding on a plan that aligns with your healthcare goals and preferences.
| CMS Measure | Star Rating |
|---|---|
| 2025 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 |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Am I Eligible for Alignment Health Heroes+ ?
You are eligible to enroll in Alignment Health Heroes+ if you meet the following conditions:
- You qualify for Medicare Part A and Part B.
- You live in the plan’s service area.
If these criteria describe your situation, you’re eligible to sign up for Alignment Health Heroes+ and take advantage of its full range of benefits.
Enrollment Periods for Alignment Health Heroes+
To ensure you don’t miss your chance to enroll in Alignment Health Heroes+ , be aware of these important enrollment periods:
- Initial Enrollment Period (IEP): Your IEP offers a seven-month window around your 65th birthday to sign up for Medicare.
- Annual Enrollment Period (AEP): The AEP, occurring from October 15 to December 7 each year, allows you to enroll in or make changes to your Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31, the MA OEP provides an opportunity to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing insurance coverage, may qualify you for a SEP, giving you a chance to make adjustments outside the standard periods.
Need help figuring out the right time to enroll? Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) to get assistance from a licensed insurance agent.
How to Sign Up for Alignment Health Heroes+
Enrolling in Alignment Health Heroes+ is easy. Choose the option that works best for you:
- Online through MedicareEnrollment.com: Visit the enrollment page and complete your enrollment through their Secure Online Enrollment Form.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent can assist you with the enrollment process and provide answers to any questions.
- Through Medicare.gov: Go to Medicare.gov, log in or create an account, and follow the instructions to join Alignment Health Heroes+ through the official Medicare website.
- Directly with Alignment Health Heroes+ : You can also enroll directly with the plan. The necessary contact details are provided below in the "Contact" section.
Remember to enroll during the correct enrollment period to ensure your coverage starts on time.
Here are some of the most frequently asked questions people have about plan ID H3815-043-0:
How much does H3815-043-0 cost per month?
For 2025, the monthly premium is $0.00, and you still pay your Part B premium to Medicare.
How high can my costs go in a worst-case year?
Your costs top out at $5,900.00 (for in-network services) in 2025; after that the plan pays 100% of covered services.
Is there a Part D deductible with this plan?
You’ll pay the first $590.00 in drug costs before coinsurance kicks in.
What’s the CMS star score for Alignment Health Heroes+ ?
For 2025, plan H3815-043-0 has a ★4.0 rating. The best rating is 5 stars.
How many people are enrolled in this plan?
CMS reports 1,150 members in the latest file.
Contact 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 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- Alignment Health Plan, http://www.alignmenthealthplan.com, Last Accessed June 1, 2025
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed 25 May, 2025
- AARP.org, "The Big Choice: Original Medicare vs. Medicare Advantage", Last Accessed 25 May, 2025
- Medicare.gov, "Explore your Medicare coverage options", Last Accessed 25 May, 2025
- CMS.gov, Landscape Source Files, Last Accessed October 15, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 15, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 15, 2024
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County, Last Accessed June 6, 2025
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