Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H7074-801

Medicare Plan

Alignment Health Plan Retiree Options (PPO) · Alignment Health Plan · Local PPO · Mountains and Piedmont Regions

Full CMS plan ID: H7074-801-000

H7074-801-000 is the full CMS identifier for the H7074-801 Medicare plan. Common searches include H7074 801 and H7074801.

Historical 2026 record. Benefits and service areas shown apply to that year.

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

Alignment Health Plan Retiree Options (PPO)

H7074-801-000 Mountains and Piedmont Regions Local PPO Employer-only

At-a-glance

Quick view

01

In-network

Inpatient hospital

Days 1–5 $150 / day
Days 6–90 $0 / day
Total of listed copays · 5 charged days $750
02

Emergency transport

Ambulance

Ground · in-network$250 copay
Air · in-network$250 copay
03

Emergency services

Emergency room

$85 copay

04

Medical maximum

Maximum out-of-pocket

In-network$4,201
Combined in + out$8,000
05

Skilled care at home

Home health

In-networkCost share not reported
Out-of-networkCost share not reported
06

Monthly cost

Premium & giveback

Part C premiumNot reported
Consolidated C + DNot reported

Plan details

All plan benefits

Medical care3 benefits

Primary care physician

In-network$5 copay
Out-of-networkCost share not reported

Specialist

In-network$35 copay
Out-of-networkCost share not reported

Preventive care

In-networkCost share not reported
Out-of-networkCost share not reported
Diagnostics & imaging4 benefits

Diagnostic procedures & tests

In-networkCost share not reported
Out-of-networkCost share not reported

Laboratory services

In-networkCost share not reported
Out-of-networkCost share not reported

X-rays & standard imaging

In-network$150 copay
Out-of-networkCost share not reported

MRI, CT & PET imaging

In-network20% coinsurance
Out-of-networkCost share not reported
Urgent & hospital care6 benefits

Urgent care

In-networkCost share not reported
Out-of-networkNot separately reported

Emergency room

In-network$85 copay
Out-of-networkNot separately reported

Ground ambulance

In-network$250 copay
Out-of-networkCost share not reported

Air ambulance

In-network$250 copay
Out-of-networkCost share not reported

Outpatient hospital

In-network$195 copay
Out-of-networkCost share not reported

Outpatient surgery / ASC

In-networkCost share not reported
Out-of-networkCost share not reported
Recovery & therapy5 benefits

Home health

In-networkCost share not reported
Out-of-networkCost share not reported

Skilled nursing facility

In-networkCost share not reported
Out-of-networkNot separately reported

Cardiac & pulmonary rehabilitation

In-networkCost share not reported
Out-of-networkCost share not reported

Occupational therapy

In-networkCost share not reported
Out-of-networkCost share not reported

Physical & speech therapy

In-networkCost share not reported
Out-of-networkCost share not reported
Behavioral health2 benefits

Mental health services

In-network$55 copay
Out-of-networkCost share not reported

Substance use treatment

In-network$40 copay
Out-of-networkCost share not reported
Specialty care2 benefits

Podiatry

In-networkCost share not reported
Out-of-networkCost share not reported

Chiropractic

In-networkCost share not reported
Out-of-networkCost share not reported
Supplemental benefits7 benefits

Dental

In-networkCost share not reported
Out-of-networkCost share not reported

Vision

In-networkCost share not reported
Out-of-networkCost share not reported

Hearing

In-networkCost share not reported
Out-of-networkCost share not reported

Transportation

Not reported in this CMS export

Not reported in this CMS export

Fitness & wellness

In-networkCost share not reported
Out-of-networkCost share not reported

Over-the-counter allowance

Not reported in this CMS export

Not reported in this CMS export

Meals

In-networkCost share not reported
Out-of-networkCost share not reported
Plan costs & rulesCoverage overview

Premium & Part B giveback

Part C premium not reported · Part B giveback not separately reported

Maximum out-of-pocket (MOOP)

In-network$4,201
Combined in + out$8,000

Medical deductibles

In-networkNot reported
Out-of-networkNot reported

Network & referrals

Local PPO · Referrals: Not required · Out-of-network coverage: Yes

Prescription drugs0 tiers

Part D deductible

This plan is not present in the public CMS Landscape release

Using this plan

Understand H7074-801-000

Plain-language context built from this plan’s 2026 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.

Plan at a glance

A quick read on this plan

Alignment Health Plan Retiree Options (PPO) is a 2026 Local PPO offered by Alignment Health Plan in Mountains and Piedmont Regions. The CMS record indicates out-of-network coverage, although member costs may differ from in-network care. The plan record does not require referrals. Its listed inpatient copay stages total $750 across 5 charged days.

Common benefit costs

What you may pay

These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.

Routine care

Primary care physician
$5 copay
Specialist
$35 copay
Laboratory services
Cost share not reported

Separate visits or services; costs are not added together.

Tests & outpatient care

Diagnostic procedures & tests
Cost share not reported
MRI, CT & PET imaging
20% coinsurance
Outpatient hospital
$195 copay

The service setting and billing details can change what you pay.

Emergency & hospital care

Emergency room
$85 copay
Listed inpatient stages
$750 total

5 charged inpatient days are included in the calculated total. Actual costs depend on the care received and plan rules.

Helpful context

Terms worth knowing

Maximum out-of-pocket (MOOP)

This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.

Availability

Who can enroll

Service area
Mountains and Piedmont Regions (NC)
Plan type
Local PPO
Contract / plan
H7074-801
Coverage year
2026

Enrollment is limited to people eligible through the sponsoring employer or group. Confirm eligibility and the exact service area with the plan before enrolling.

Supplemental coverage

Extra benefits reported

Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.

DentalCost share not reported
VisionCost share not reported
HearingCost share not reported
Fitness & wellnessCost share not reported
MealsCost share not reported

Plan-specific answers

Frequently asked questions

Where is H7074-801-000 available?

Alignment Health Plan Retiree Options (PPO) is listed for Mountains and Piedmont Regions (NC). Enrollment is limited to people eligible through the sponsoring employer or group.

What is the in-network maximum out-of-pocket limit for H7074-801-000?

The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $4,201. Prescription drug spending generally does not count toward this medical limit.

What does an emergency room visit cost on H7074-801-000?

The plan record lists $85 copay.

Does H7074-801-000 report extra benefits?

Yes. CMS reports dental, vision, hearing, fitness & wellness, meals. See the detailed benefit rows and official plan documents for limits and conditions.

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release; county identity is sourced from segment-level Landscape rows and stable codes are enriched from the aligned MA contract service-area release where matched. Quick-reference values should be confirmed in 2026 official plan documents.

PBP benefits ↗ Landscape data ↗ County service area ↗

Plan context

Where H7074-801-000 fits

Full CMS plan ID
H7074-801-000
Contract
H7074
Base plan code
H7074-801
Segment
000
Carrier
Alignment Health Plan
Plan type
Local PPO
Service area
Mountains and Piedmont Regions (NC)

County/service-area foundation

CMS service-area entries

These named entries come from a CMS contract-level service-area file. They describe the contract's published geography and must not be treated as proof that every segment has identical county-level rules.

  • Avery, NC
  • Buncombe, NC
  • Chatham, NC
  • Davidson, NC
  • Davie, NC
  • Forsyth, NC
  • Guilford, NC
  • Henderson, NC
  • Johnston, NC
  • Madison, NC
  • McDowell, NC
  • Mitchell, NC

4 additional service-area entries are retained in the data record.

Same CMS contract

H7074-001-000 Alignment Health AVA (PPO) Mountains and Piedmont Regions · Local PPO H7074-802-000 Alignment Health Plan Retiree Options (PPO) Mountains and Piedmont Regions · Local PPO H7074-803-000 Alignment Health Plan Retiree Options (PPO) Mountains and Piedmont Regions · Local PPO H7074-804-000 Alignment Health Plan Retiree Options (PPO) Mountains and Piedmont Regions · Local PPO

About this code

What H7074-801-000 identifies

H7074-801-000 is a Contract Year 2026 Medicare plan segment code. Searches written as H7074-801, H7074 801, or the compact full CMS ID H7074801000 refer to this plan or its base plan code.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.