Alignment Healthcare is a Medicare Advantage (MA) plan operating in California, North Carolina, Nevada, Arizona, and Texas, with approximately 236,300 members as of year-end 2025. CMS pays Alignment a fixed monthly premium per member to cover all healthcare costs, and Alignment keeps the difference between what CMS pays and what it spends on care. What distinguishes Alignment from most MA plans is that it functions as both insurer and active care manager: over 450 clinical staff directly manage high-risk members through its Care Anywhere program, which provides in-home visits, virtual care, and proactive outreach to members with chronic conditions. Alignment sells HMO and PPO plans primarily through independent brokers and field marketing organizations. The key profitability metric is the Medical Benefit Ratio (MBR), which Alignment targets in the high 80s%. Margins improve as member cohorts mature — risk-adjusted revenue catches up to actual member health costs over time, and Care Anywhere engagement reduces medical costs. As membership scales, largely fixed SG&A costs decline as a percentage of revenue. Alignment's proprietary technology platform, AVA, ingests data from over 200 sources to give clinical and operations teams real-time visibility into member health status, driving care workflows and enabling automation across claims and care coordination. Alignment's growth strategy focuses on deepening penetration in existing markets, expanding into new counties and states, and potentially vertically integrating supplemental benefits like dental and behavioral health.