AlohaCare Fact Sheet
• Founded in 1994 by Hawaii’s Community Health Centers
• Third largest health plan in Hawaii
Unique Health Plan
• Mission driven
• Community governed
• Contracts exclusively with the State and Federal governments to provide health care for Medicaid and Medicare beneficiaries
Health Plan Membership
• Nearly 70,000 health plan members of which more than 1,000 are Medicare members
• Health plan members live on Oahu, Maui, Kauai, Molokai, Lanai and the Big Island
Physician Network
• Partners with more than 3,300 physicians and other health care providers
Financial
• Annual revenue more than $151 million
• Ranked 55th among the top 250 businesses in Hawaii by Hawaii Business Magazine
• Non-profit health plan
Team
• More than 170 employees
• Offices on Oahu, and the Big Island
Community Commitment
• AlohaCare Believes in Me Scholarship
• AlohaCare Community Conscience Award
• AlohaCare Children’s Art Contest
• AlohaCare Thanks, Doc!
• Healthy Hawaii Teen Video Contest
Associations
• America’s Health Insurance Plan (AHIP) organization
• Hawaii Association of Health Plan (HAHP) organization
Accreditation
• URAC accredited for QUEST line of business
Medicaid Fact Sheet
What is Medicaid?
Medicaid is a health program funded by both federal and state governments and is designed for children, low-income families, elderly and disabled people Individuals must qualify for Medicaid by meeting certain eligibility requirements most often including income requirements
Two Parts of Medicaid
The Hawaii Medicaid program provides services in two ways:
1. State Fee-for-Service
Hawaii’s Medicaid Fee-for-Service program is health insurance specifically for aged, blind, and disabled Medicaid beneficiaries. Historically, the State would pay physicians and other health care providers directly for the medical services they render to Medicaid-eligible beneficiaries. More than 37,000 Hawaii Medicaid beneficiaries are covered through this program.
In October 2007, the State of Hawaii released a request for proposal to move this Medicaid population into private health plans through the QUEST Expanded Access program. The State plans to award two private health plans this contract.
2. QUEST
Hawaii’s QUEST program is health insurance specifically for children, adults, and families that meet certain income requirements. The State contracts with health plans like AlohaCare to cover the health services of these Medicaid QUEST beneficiaries. As a result, health plans like AlohaCare pay physicians and other health care providers directly for the medical services they render to Medicaid-QUEST members. There are more than 160,000 Medicaid QUEST beneficiaries in Hawaii.
Medicare Fact Sheet
What is Medicare?
• Medicare is a health insurance program funded by the federal government
• Medicare beneficiaries must meet one of the eligibility requirements.
- People age 65 years or older
- People of all ages with certain disabilities
- People of all ages with End Stage Renal Disease
The Many Parts of Medicare
Medicare is divided into different Parts.
Part A: Hospital Insurance
Part A helps with hospital costs for eligible beneficiaries including inpatient care, critical access care and skilled nursing facilities. Most beneficiaries will not have to pay a premium for Part A because of the Medicare taxes they paid while they worked over the years.
Part B: Medical Insurance
Part B does typically require a premium each month that is paid to the government. Part B provides medical insurance to help cover additional costs such as doctor’s services and outpatient care. It also picks up coverage where Part A leaves off.
Part C: Medicare Advantage Plans
Beneficiaries that have Medicare Parts A and B are eligible to receive all their Medicare benefits through a Medicare Advantage plan through Part C. Medicare Advantage plans can provide a plan that encompasses Part A, Part B and/or Part D.
Part D: Prescription Drug Insurance
Part D is the newest area to Medicare. Part D provides prescription drug coverage that is available to all Medicare-eligible beneficiaries. Part D is set-up to protect beneficiaries from paying high, out-of-pocket drug costs now and in the future. Health plans provide the coverage to beneficiaries through a drug plan. If beneficiaries do not enroll in a drug plan when they’re first eligible, they may have to pay a penalty if they enroll at a later date. Part D was introduced in January 2006 as a result of the Medicare Modernization Act.