AlohaCare Advantage Plus (HMO SNP)
AlohaCare Advantage Plus is a Medicare Advantage Prescription Drug plan. Our plan is available to Medicare beneficiaries who live in our service area. Our service area includes the islands of: Oahu, Maui, Hawaii, Kauai, Molokai and Lanai.
Your Benefits
AlohaCare Advantage Plus is a plan that is specifically designed to meet the special needs of individuals who are currently enrolled in Medicare and have full benefit Medicaid coverage. Some of your benefits include:
- $0 premium. You must continue to pay your Part B premium. The State pays the Part B premium if you have full benefit Medicare coverage.
- Primary Care Provider (PCP) and Specialist visits
- $0 deductible for Part D prescription drugs
- Member Service Navigators for personal care coordination
Limitations, copayments and restrictions may apply. For a complete listing of benefits, see your Summary of Benefits.
Network Providers and Your Primary Care Provider (PCP)
A “network provider” is a provider that participates in our plan. As a member of AlohaCare Advantage Plus, you must use our plan providers except in emergent or urgent care situations. If you obtain routine care from out-of-network providers neither Medicare nor AlohaCare Advantage Plus will be responsible for the costs.
As our member, you have choosen your Primary Care Provider (PCP) within our network of providers. You must get your routine or basic care from your PCP. Your PCP will coordinate the rest of the covered services you receive as a member. For example, in order for you to see a specialist, you usually need to get you PCP's approval first; this is called getting a referral to a specialist.
Prior Authorizations
For certain medical services and medications, you must first receive approval from AlohaCare Advantage Plus before the medical services and medications are covered under your plan. You, your representative or your doctor can initiate the authorization request to AlohaCare Advantage Plus. We will notify you and your doctor of our decision. In some cases, your medications and medical services are covered with a prior authorization.
Member Service Navigators
As an AlohaCare Advantage Plus member, you receive personal care coodination from one of our Member Service Navigators. Our Member Service Navigators make sure you get the health care you need, such as:
- Helping you choose your PCP
- Setting up doctor’s appointments
- Going with you to your doctor appointments
- Making sure you get the prescriptions you need
- Answering questions about our plan and how you maintain your Medicaid coverage
Low Income Subsidy or “Extra Help”
If you have limited income and resources, you may be able to get Extra Help. Generally, your premium will be lower once you receive Extra Help from Medicare.
To see how much your premium would be if you qualified for Extra Help, look at the
2012 Low Income Premium Table.
If you qualify for Extra Help, you get help paying for your monthly premium, yearly deductible, prescription coinsurance and copayments and experience no gap in coverage. Premiums include coverage for both medical services and prescription drug coverage. This does not include any Medicare Part B premium you may have to pay.
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help or if you would like to inquire about your LIS status or level, call:
- 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;
- The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or
- Your State Medicaid Office.
Transition of Care
Under certain circumstances, AlohaCare Advantage Plus can offer a temporary supply of a drug to our members who have a level of care change. For more information about our transition process, see page 95 of your Evidence of Coverage.
Rights upon Disenrollment
Ending your membership with AlohaCare Advantage Plus may be voluntary (your own choice) or involuntary (not your own choice). You might leave our plan because you have decided that you want to leave. There are also limited situations where we are required to end your membership. For example, if you move permanently out of the geographic service area we cover. We cannot ask you to leave our plan because of your health.
If you leave our plan, it may take some time for your membership to end. While you are waiting for your membership to end, you are still a member and must continue to get your care and/or prescription drugs as usual through our plan.
You have the right to make a complaint if we end your membership in our plan. If we end your membership in our plan we will tell you our reasons in writing and explain how you may file a complaint against us if you want to.
Additional Information
AlohaCare Advantage Plus is a Coordinated Care plan with a Medicare Advantage contract but without a contract with the HAwaii Medicaid program. Our plan may not be available to you the following contract year because by law, we can choose to not renew our contract with CMS or reduce our service area. CMS may also refuse to renew the contract, thus, resulting in a termination or non-renewal.
The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information, contact the plan. Benefits, formulary, pharmacy, network premium and/or copayments/co-insurance may change on January 1, 2013. This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, copayments, coinsurance and deductibles may vary based on the level of Extra Help that you may receive. Contact the plan for further details. This information is available in alternate formats or languages. For more information, contact AlohaCare Advantage Plus at the numbers below.
Contact Us
If you have any questions or for more information on your benefits, call Customer Service
at 973-6395 or toll-free at 1-866-973-6395, 8 a.m. to 8 p.m., 7 days a week. TTY users should call 1-877-447-5990.
Click on this link for information regarding your AlohaCare Advantage Plus Part D Prescription Drug Benefit.