Medicare Plan Lookup Official CMS data · Contract Year 2027
CMS 2027 data

2027 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.

2027

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

● CMS 2027 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
Out-of-network

Tier 1: 40% coinsurance

Point of service

Not separately reported

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$4,451
Combined in + out$8,000
05

Skilled care at home

Home health

In-network$0 cost share
Out-of-network$0 cost share
06

Monthly cost

Premium & giveback

Part C premiumNot reported
Consolidated C + DNot reported

CMS reports no Part B premium reduction for this plan.

Plan details

All plan benefits

Medical care3 benefits

Primary care physician

In-networkPrimary Care Physician Services: $5 copay
Out-of-network7a: $0 cost share

Specialist

In-networkPhysician Specialist Services: $35 copay
Out-of-network7d: $0 cost share

Preventive care

In-networkAnnual Physical Exam: $0 cost share; Kidney Disease Education Services: $0 cost share; Glaucoma Screening: $0 cost share; Diabetes Self-Management Training: $0 cost share; Digital Rectal Exams: $0 cost share; EKG following Welcome Visit: $0 cost share
Out-of-network14b: $0 cost share; 14d: $0 cost share; 14e1: $0 cost share; 14e2: $0 cost share; 14e4: $0 cost share; 14e5: $0 cost share; 14a: $0 cost share
Diagnostics & imaging4 benefits

Diagnostic procedures & tests

In-networkDiagnostic Procedures/Tests: $0 cost share
Out-of-network8a1: $0 cost share

Laboratory services

In-networkLab Services: $0 cost share
Out-of-network8a2: $0 cost share

X-rays & standard imaging

In-networkOutpatient X-Ray Services: $15 copay
Out-of-network8b3: $0 cost share

MRI, CT & PET imaging

In-networkDiagnostic Radiological Services: $150 copay
Out-of-network8b1: $0 cost share
Urgent & hospital care6 benefits

Urgent care

In-networkUrgently Needed Services: $0 cost share
Out-of-networkNot separately reported

Emergency room

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

Ground ambulance

In-network$250 copay
Out-of-network$0 cost share

Air ambulance

In-network$250 copay
Out-of-network$0 cost share

Outpatient hospital

In-networkOutpatient Hospital Services: $195 copay
Out-of-network9a1: $0 cost share; 9a2: $0 cost share

Outpatient surgery / ASC

In-networkAmbulatory Surgical Center (ASC) Services: $0 cost share
Out-of-network9b: $0 cost share
Recovery & therapy5 benefits

Home health

In-network$0 cost share
Out-of-network$0 cost share

Skilled nursing facility

In-networkSkilled nursing facility: Tier 1: $0 / day for days 1–20; $160 / day for days 21–51; $0 / day for days 52–100
Out-of-networkSkilled nursing facility: Tier 1: 40% coinsurance

Cardiac & pulmonary rehabilitation

In-networkCardiac Rehabilitation Services: $0 cost share; Intensive Cardiac Rehabilitation Services: $0 cost share; Pulmonary Rehabilitation Services: $0 cost share; SET for PAD Services: $0 cost share; 3-1(NMC): Not applicable; 3-2(NMC): Not applicable; 3-3(NMC): Not applicable; 3-4(NMC): Not applicable
Out-of-network3-1: $0 cost share; 3-2: $0 cost share; 3-3: $0 cost share; 3-4: $0 cost share

Occupational therapy

In-networkOccupational Therapy Services: $0 cost share
Out-of-network7c: $0 cost share

Physical & speech therapy

In-networkPhysical Therapy and Speech-Language Pathology Services: $0 cost share
Out-of-network7i: $0 cost share
Behavioral health2 benefits

Mental health services

In-networkPartial Hospitalization Program: $55 copay; Individual Sessions for Mental Health Specialty Services: $0 cost share; Group Sessions for Mental Health Specialty Services: $0 cost share; Individual Sessions for Psychiatric Services: $40 copay; Group Sessions for Psychiatric Services: $40 copay; Inpatient psychiatric hospital: Tier 1: $120 / day for days 1–10; $0 / day for days 11–90; $250 per stay
Out-of-network5a: $0 cost share; 7e1: $0 cost share; 7e2: $0 cost share; 7h1: $0 cost share; 7h2: $0 cost share; Inpatient psychiatric hospital: Tier 1: 40% coinsurance

Substance use treatment

In-networkIntensive Outpatient Program Services: $0 cost share; Individual Sessions for Outpatient Substance Abuse: $40 copay; Group Sessions for Outpatient Substance Abuse: $40 copay
Out-of-network5b: $0 cost share; 9c1: $0 cost share; 9c2: $0 cost share
Specialty care2 benefits

Podiatry

In-networkPodiatry Services: $0 cost share; 7f(NMC): Not applicable
Out-of-network7f: $0 cost share

Chiropractic

In-networkChiropractic Services: $0 cost share
Out-of-network7b: $0 cost share
Supplemental benefits7 benefits

Dental

In-networkMedicare Dental Services: $0 cost share
Out-of-network16a: $0 cost share

Vision

In-networkEye Exams: $0 cost share; Routine Eye Exams: $0 cost share; Other Eye Exam Services: Not applicable; Eyewear: $0 cost share; Contact Lenses: $0 cost share; Eyeglasses (lenses and frames): $0 cost share; Eyeglass lenses: $0 cost share; Eyeglass frames: $0 cost share; Upgrades: Not applicable
Out-of-network17a: $0 cost share; 17a1: $0 cost share; 17b: $0 cost share; 17b1: $0 cost share; 17b2: $0 cost share; 17b3: $0 cost share; 17b4: $0 cost share

Hearing

In-networkHearing Exams: $0 cost share; Routine Hearing Exams: $0 cost share; Fitting/Evaluation for Hearing Aid: $0 cost share; Prescription Hearing Aids (all types): Not applicable; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable
Out-of-network18a: $0 cost share; 18a1: $0 cost share; 18a2: $0 cost share

Transportation

Not applicable
In-network10b(NMC): Not applicable
Out-of-networkNot separately reported

Fitness & wellness

In-networkFitness Benefit: $0 cost share
Out-of-network14c4: $0 cost share

Over-the-counter allowance

In-networkOver-the-Counter (OTC) Items: $0 cost share
Out-of-network13b: $0 cost share

Meals

Not applicable
In-networkMeal Benefit: Not applicable
Out-of-networkNot separately reported
Plan costs & rulesCoverage overview

Premium & Part B giveback

Part C premium not reported · CMS reports no Part B premium reduction for this plan.

Maximum out-of-pocket (MOOP)

In-network$4,451
Combined in + out$8,000

Medical deductibles

In-networkNot reported
Out-of-networkNot reported

Annual health deductible

$0

Combined network deductible

Not separately reported

Part D premium

Not reported

Network & referrals

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

Prescription drugs0 tiers

Part D deductible

Plan-specific drug deductible not published

Using this plan

Understand H7074-801-000

Plain-language context built from this plan’s 2027 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 2027 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
Primary Care Physician Services: $5 copay
Specialist
Physician Specialist Services: $35 copay
Laboratory services
Lab Services: $0 cost share

Separate visits or services; costs are not added together.

Tests & outpatient care

Diagnostic procedures & tests
Diagnostic Procedures/Tests: $0 cost share
MRI, CT & PET imaging
Diagnostic Radiological Services: $150 copay
Outpatient hospital
Outpatient Hospital Services: $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.

Part B premium reduction (“giveback”)

A giveback may reduce the amount you pay toward Medicare Part B; it is not usually paid to you as cash. The CMS record notes: CMS reports no Part B premium reduction for this plan.

Availability

Who can enroll

Service area
Mountains and Piedmont Regions (NC)
Plan type
Local PPO
Contract / plan
H7074-801
Coverage year
2027

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.

DentalMedicare Dental Services: $0 cost share
VisionEye Exams: $0 cost share; Routine Eye Exams: $0 cost share; Other Eye Exam Services: Not applicable; Eyewear: $0 cost share; Contact Lenses: $0 cost share; Eyeglasses (lenses and frames): $0 cost share; Eyeglass lenses: $0 cost share; Eyeglass frames: $0 cost share; Upgrades: Not applicable
HearingHearing Exams: $0 cost share; Routine Hearing Exams: $0 cost share; Fitting/Evaluation for Hearing Aid: $0 cost share; Prescription Hearing Aids (all types): Not applicable; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable
Over-the-counter allowanceOver-the-Counter (OTC) Items: $0 cost share
Fitness & wellnessFitness Benefit: $0 cost share

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 2027 CMS record lists an in-network medical maximum out-of-pocket limit of $4,451. 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, over-the-counter allowance, fitness & wellness. See the detailed benefit rows and official plan documents for limits and conditions.

Source trail

Official CMS, Contract Year 2027

Plan identity and benefits come from CMS PBP data. Benefits and drug cost sharing come from the approved annual PBP tabular extract and its CMS dictionary. Premiums and drug deductibles are cross-checked with the annual Landscape. Geography comes from annual PlanArea and PlanRegionArea records, including exact segments and partial-county or employer/group qualifiers. Quick-reference values should be confirmed in current 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

Service areas come from the annual CMS PlanArea and PlanRegionArea tables for this exact contract, plan, and segment. Partial-county and employer/group qualifiers remain part of the coverage area. Regional PPO county entries use the matching annual Landscape expansion of the CMS region.

  • 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.

Exact county navigation

These links are limited to named counties tied to this exact medical plan segment. Partial-county entries remain labeled for verification.

Show 16 county links

Same CMS contract

H7074-001-000 Alignment Health AVA 001 (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 2027 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.