Alignment Health AVA 001 (PPO)
Available to residents of Avery County, NC for 2027. Contract H7074, plan 001, segment 0.
- ✉ Email a copy of the plan benefit details
- Plan health benefits
- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
- Other plans in Avery County
- Plan website
- Browse the Alignment Health AVA 001 (PPO) formulary
2027 drug-by-drug coverage is not published by CMS yet. The drug lookup covers 2026, whose formulary is live.
Renewed for 2027. CMS carries this plan forward from 2026. Every NC plan’s 2026–2027 changes →
Plan details
| Monthly premium (Part C + D) | $20.00 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $20.00? |
| Monthly premium with full Extra Help (LIS) | $10.00? |
| Part B premium reduction (giveback) | None |
| In-network out-of-pocket maximum | $3,900.00? |
| In- and out-of-network out-of-pocket maximum | $6,200.00 |
| Drug deductible | $0.00 |
| Drug out-of-pocket threshold | $2,400.00 |
| Plan type | PPO? |
| Contract / plan | H7074-001-0 |
| Offered by | Alignment Health Plan |
| Parent organization | Alignment Healthcare USA, LLC |
| Formulary tiers | 6 |
| Formulary exception tier | 4? |
| Pharmacy search | www.alignmenthealthplan.com |
| Member services | (888)979-2247TTY 711 |
CMS star ratings
- Overall
- —
- Health plan (Part C)
- —
- Drug plan (Part D)
- —
Published per contract — every plan under contract H7074 shares this rating.
Plan health benefits
| Service | In-network | Out-of-network? |
|---|---|---|
| Doctor visits | ||
| Primary care doctor | $5 copay | $40 copay |
| Specialist | $20 copay(authorization and referral required) | $50 copay |
| Other health care professional | $0 copay(authorization and referral required) | 30% coinsurance |
| Additional telehealth services | $0–$20 copay | — |
| Preventive care | ||
| Medicare-covered preventive services | $0 copay | 30% coinsurance |
| Annual physical exam | $0 copay | 30% coinsurance |
| Kidney disease education | $0 copay | 30% coinsurance |
| Glaucoma screening | $0 copay | 30% coinsurance |
| Diabetes self-management training | $0 copay | 30% coinsurance |
| Diagnostic tests, labs and imaging | ||
| Diagnostic tests and procedures | $0 copay(authorization and referral required) | 30% coinsurance |
| Lab services | $0 copay(authorization and referral required) | 30% coinsurance |
| Diagnostic radiology (e.g. MRI, CT) | $150 copay(authorization and referral required) | 30% coinsurance |
| Therapeutic radiology | 20% coinsurance(authorization and referral required) | 30% coinsurance |
| Outpatient x-rays | $15 copay(authorization and referral required) | 30% coinsurance |
| Emergency and urgent care | ||
| Emergency room | $150 copay | — |
| Urgent care | $20 copay | — |
| Worldwide emergency coverage | $0 copay · $10,000 plan limit | — |
| Worldwide urgent care | $0 copay · $10,000 plan limit | — |
| Worldwide emergency transportation | Not covered | — |
| Hospital care | ||
| Inpatient hospital stay | $200 per day for days 1–6; $0 per day for days 7–90(authorization and referral required) | 10% coinsurance per stay |
| Outpatient hospital services | $165 copay(authorization and referral required) | 25% coinsurance |
| Outpatient observation | $0 copay(authorization and referral required) | 25% coinsurance |
| Ambulatory surgical center | $100 copay(authorization and referral required) | 30% coinsurance |
| Outpatient blood services | $0 copay(authorization and referral required) | 30% coinsurance |
| Skilled nursing and home health | ||
| Skilled nursing facility | $0 per day for days 1–20; $100 per day for days 21–51; $0 per day for days 52–100(authorization and referral required) | 30% coinsurance per stay |
| Home health care | $0 copay(authorization and referral required) | 30% coinsurance |
| Kidney dialysis | 20% coinsurance(authorization and referral required) | 30% coinsurance |
| Rehabilitation | ||
| Occupational therapy | $0 copay(authorization and referral required) | 30% coinsurance |
| Physical therapy and speech-language therapy | $0 copay(authorization and referral required) | 30% coinsurance |
| Cardiac rehabilitation | $0 copay(authorization and referral required) | 30% coinsurance |
| Pulmonary rehabilitation | $0 copay(authorization and referral required) | 30% coinsurance |
| Mental health and substance use | ||
| Inpatient psychiatric hospital stay | $120 per day for days 1–10; $0 per day for days 11–90(authorization and referral required) | 10% coinsurance per stay |
| Outpatient mental health, individual session | $20 copay(authorization and referral required) | 30% coinsurance |
| Outpatient mental health, group session | $20 copay(authorization and referral required) | 30% coinsurance |
| Psychiatrist, individual session | $40 copay(authorization and referral required) | 30% coinsurance |
| Psychiatrist, group session | $40 copay(authorization and referral required) | 30% coinsurance |
| Partial hospitalization | $55 copay(authorization and referral required) | 30% coinsurance |
| Intensive outpatient program | $55 copay(authorization and referral required) | 30% coinsurance |
| Outpatient substance use, individual session | $40 copay(authorization and referral required) | 30% coinsurance |
| Outpatient substance use, group session | $40 copay(authorization and referral required) | 30% coinsurance |
| Opioid treatment program | 20% coinsurance(authorization and referral required) | 30% coinsurance |
| Ambulance and transportation | ||
| Ground ambulance | $250 copay(authorization required) | 30% coinsurance |
| Air ambulance | $250 copay(authorization required) | 30% coinsurance |
| Transportation to plan-approved locations | Not covered | — |
| Medical equipment and supplies | ||
| Durable medical equipment (e.g. wheelchairs, oxygen) | 0%–20% coinsurance(authorization required) | 30% coinsurance |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) | 30% coinsurance |
| Medical supplies | 20% coinsurance(authorization required) | 30% coinsurance |
| Diabetes supplies | $0 copay(authorization required) | 30% coinsurance |
| Diabetic therapeutic shoes or inserts | 20% coinsurance(authorization required) | 30% coinsurance |
| Chiropractic, acupuncture and foot care | ||
| Chiropractic (Medicare-covered) | $0 copay(authorization and referral required) | 30% coinsurance |
| Routine chiropractic care | Not covered | — |
| Acupuncture | Not covered | — |
| Foot exams and treatment (Medicare-covered) | $0 copay(authorization and referral required) | 30% coinsurance |
| Routine foot care | Not covered | — |
| Dental? | ||
| Medicare-covered dental services | $0 copay(authorization required) | $0 copay |
| Preventive dental plan limit | $1,000 plan limit every year | — |
| Oral exams | $0 copay(authorization required, limits apply) | $0 copay |
| Cleanings | $0 copay(authorization required, limits apply) | $0 copay |
| Fluoride treatment | $0 copay(authorization required, limits apply) | $0 copay |
| Dental x-rays | $0 copay(authorization required, limits apply) | $0 copay |
| Other diagnostic dental services | Not covered | — |
| Other preventive dental services | Not covered | — |
| Restorative services (fillings, crowns) | $0 copay(authorization required) | $0 copay |
| Endodontics (root canals) | $0 copay(authorization required) | $0 copay |
| Periodontics (gum disease) | $0 copay(authorization required) | $0 copay |
| Dentures and other removable prosthodontics | $0 copay(authorization required) | $0 copay |
| Maxillofacial prosthetics | Not covered | — |
| Implants | Not covered | — |
| Bridges and other fixed prosthodontics | $0 copay(authorization required) | $0 copay |
| Oral and maxillofacial surgery | $0 copay(authorization required) | $0 copay |
| Orthodontics | Not covered | — |
| Adjunctive general services | Not covered | — |
| Vision? | ||
| Eye exam (Medicare-covered) | $0 copay | 30% coinsurance |
| Routine eye exam | $0 copay(limits apply) | 30% coinsurance |
| Eyewear after cataract surgery (Medicare-covered) | $0 copay(limits apply) | 50% coinsurance |
| Eyewear plan limit | $150 plan limit every two years | — |
| Contact lenses | $0 copay(limits apply) | 50% coinsurance |
| Eyeglasses (frames and lenses) | $0 copay(limits apply) | 50% coinsurance |
| Eyeglass lenses | $0 copay(limits apply) | 50% coinsurance |
| Eyeglass frames | $0 copay(limits apply) | 50% coinsurance |
| Eyewear upgrades | Not covered | — |
| Hearing? | ||
| Hearing exam (Medicare-covered) | $0 copay | 30% coinsurance |
| Routine hearing exam | $0 copay(limits apply) | 30% coinsurance |
| Hearing aid fitting and evaluation | $0 copay(limits apply) | 30% coinsurance |
| Hearing aids (all types) | Not covered | — |
| Hearing aids, inner ear | Not covered | — |
| Hearing aids, outer ear | Not covered | — |
| Hearing aids, over the ear | Not covered | — |
| Medicare Part B drugs | ||
| Part B insulin | 0%–20% coinsurance(authorization required, step therapy may apply) | 30% coinsurance |
| Chemotherapy and radiation drugs | 0%–20% coinsurance(authorization required, step therapy may apply) | 30% coinsurance |
| Other Part B drugs | 0%–20% coinsurance(authorization required, step therapy may apply) | 30% coinsurance |
| Other extra benefits? | ||
| Over-the-counter (OTC) allowance | Not covered | — |
| Meals after a hospital stay or for a chronic condition | Not covered | — |
| Fitness benefit | $0 copay | $0 copay |
| Health education | Not covered | — |
| Nutritional / dietary benefit | Not covered | — |
| Extra smoking and tobacco cessation counseling | Not covered | — |
| Enhanced disease management | Not covered | — |
| Telemonitoring | Not covered | — |
| Remote access technologies (web/phone, nurse line) | Not covered | — |
| Home and bathroom safety devices | Not covered | — |
| Counseling services | Not covered | — |
| In-home safety assessment | Not covered | — |
| Personal emergency response system (PERS) | Not covered | — |
| Medical nutrition therapy | Not covered | — |
| Post-discharge in-home medication reconciliation | Not covered | — |
| Re-admission prevention | Not covered | — |
| Wigs for hair loss from chemotherapy | Not covered | — |
| Weight management programs | Not covered | — |
| Alternative therapies | Not covered | — |
| Therapeutic massage | Not covered | — |
| Adult day health services | Not covered | — |
| Home-based palliative care | Not covered | — |
| In-home support services | Not covered | — |
| Support for caregivers | Not covered | — |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2027). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed; an out-of-network dash means the plan files no separate out-of-network cost for that service. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 · Preferred Generic | $0.00 |
| Tier 2 · Generic | $0.00 |
| Tier 3 · Preferred Brand | $40.00 |
| Tier 4 · Non-Preferred Drug | 40% |
| Tier 5 · Specialty Tier | 33% |
| Tier 6 · Select Care Drugs | $5.00 |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $40.00 | $40.00 | $40.00 | $120.00 | $120.00 | $120.00 |
| Tier 4: Non-Preferred Drug | 40% | 40% | 40% | 40% | 40% | 40% |
| Tier 5: Specialty Tier | 33% | 33% | 33% | n/a | n/a | n/a |
| Tier 6: Select Care Drugs | $5.00 | $5.00 | $5.00 | $0.00 | $0.00 | $0.00 |
These are the initial coverage phase amounts, as the plan filed them in its benefit package. The deductible and post-threshold phases are not stated per tier in that filing, so they are not shown here rather than being inferred; the plan's annual out-of-pocket threshold is $2,400.00.
Star rating measures
| Measure | 2027 | 2026 |
|---|---|---|
| Health Plan Customer Service | ||
| Call Center – Foreign Language Interpreter and TTY Availability · C32 | 5 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability | 5 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability |
| DD1: Drug Plan Customer Service | ||
| Call Center – Foreign Language Interpreter and TTY Availability · D01 | 5 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability | 5 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability |
| DD4: Drug Safety and Accuracy of Drug Pricing | ||
| MPF Price Accuracy · D07 | 5 out of 5 stars for MPF Price Accuracy | 5 out of 5 stars for MPF Price Accuracy |
| Medication Adherence for Diabetes Medications · D08 | 3 out of 5 stars for Medication Adherence for Diabetes Medications | not enough data |
| Medication Adherence for Hypertension (RAS antagonists) · D09 | 5 out of 5 stars for Medication Adherence for Hypertension (RAS antagonists) | 5 out of 5 stars for Medication Adherence for Hypertension (RAS antagonists) |
| Medication Adherence for Cholesterol (Statins) · D10 | 2 out of 5 stars for Medication Adherence for Cholesterol (Statins) | 5 out of 5 stars for Medication Adherence for Cholesterol (Statins) |
Measures are paired between the two years by name, not by the C/D number: CMS reuses those numbers, and in 2027 nineteen of them refer to a different measure than they did in 2026. A measure introduced for 2027 has no 2026 score to show. Published per contract — every plan under H7074 shares it.
Also available in 15 other NC counties
Benefits in plain text
Alignment Health AVA 001 (PPO) (H7074-001-0) is a 2027 PPO Medicare Advantage plan offered by Alignment Health Plan, available to residents of Avery County, NC.
The monthly premium is $20.00.
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $10.00.
Its in-network out-of-pocket maximum is $3,900.00.
The combined in- and out-of-network out-of-pocket maximum is $6,200.00.
The drug deductible is $0.00.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1 (Preferred Generic): $0.00; tier 2 (Generic): $0.00; tier 3 (Preferred Brand): $40.00; tier 4 (Non-Preferred Drug): 40%; tier 5 (Specialty Tier): 33%; tier 6 (Select Care Drugs): $5.00.
Email a copy of the plan benefit details
Plan facts come from the CMS plan Landscape file and the CMS plan benefit package (PBP) files.