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.
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 plan premium
- $0 Primary Care Provider (PCP) and Specialist visits
- $0 deductible for Part D prescription drugs
- $0 copayment for preventive health services
- 24-hour Nurse Advice Line
- Member Service Navigators for personal care coordination
- Medication Therapy Management
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 a 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.
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 coordination 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
- Making sure you get the prescriptions you need
- Coordinating services under Medicare and Medicaid
- 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. 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.
To see how much your premium would be if you qualified for Extra Help, look at the 2014 Low Income Premium Table.
To see if you qualify for Extra Help, 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 88 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.
AlohaCare Advantage Plus is a health plan with a Medicare contract and a contract with the Hawaii Medicaid program. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or copayments/ coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. The State pays the Part B premium for full-dual members who are eligible for AlohaCare Advantage Plus. 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 receive. Please contact the plan for further details.
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.