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Our Health Plans


AlohaCare offers three health plans:
  • AlohaCare (QUEST)
  • AlohaCare Advantage (HMO) (Medicare Advantage Prescription Drug Plan)
  • AlohaCare Advantage Plus (HMO SNP) (Medicare Advantage Prescription Drug Plan for people with Medicaid. This is a Medicare Special Needs Plan.)
     
To learn more about our health plans, click on the plan name below.

Alohacare 

 
Our AlohaCare health plan is for QUEST beneficiaries. QUEST is a State program that provides health coverage through health plans for Medicaid-eligible Hawaii residents. It is a Medicaid managed care program. The State pays health plans to provide coverage for medical and behavioral health services. For more information about our QUEST plans, which includes QUEST, QUEST-Net, QUEST-ACE and BHH take a look below:

Member Handbook
QUEST-ACE and QUEST-Net

We can help if you do not speak or understand English, or if you have trouble hearing or seeing. You may ask for information in another language, such as English, Ilocano, Tagalog, Chinese or Korean, or in another way by calling us. The translation service is free.

ALOHACARE ADVANTAGE (HMO)
 

AlohaCare Advantage is a Medicare Advantage Prescription Drug plan. To enroll into our plan, you must have Medicare Part A and B, live in the State of Hawaii and NOT have End Stage Renal Disease (ESRD) at the time of enrollment. To remain enrolled into our plan, you must continue to pay you Part B premium and live in the state of Hawaii. For more information about AlohaCare Advantage, look below:
 
Provider Directory
Comprehensive Formulary
Benefits Highlight
     
To request this information be sent to you, call AlohaCare Advantage Customer Service from Oahu at 973-6395 or toll-free at 1-866-973-6395 from Oahu, Neighbor Islands or Mainland, 8 a.m. to 8 p.m., Monday through Friday, or visit us 8 a.m. to 5 p.m., Monday through Friday. (TTY/TDD users can call 1-877-447-5990.) 

Network Providers and Your Primary Care Physician (PCP)
A “network provider” is a provider that participates in our plan. This means that we have arranged with them to coordinate or provide covered services to members in our plan. As a member of AlohaCare Advantage, you must use our plan providers except in an emergent or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers neither Medicare nor AlohaCare Advantage will be responsible for the costs.
 
As a member of AlohaCare Advantage you will also choose your Primary Care Physician (PCP) within our network of providers. You must get your routine or basic care from your PCP. You PCP will also coordinate the rest of the covered services you get as a member of our plan. 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.

General Exclusions and Limitations
There are some medical services, items and drugs that aren't covered (excluded) or are covered only under specific conditions (limitations) by our plan. If you get services, items or drugs that are not covered, you must pay for them yourself. AlohaCare Advantage won't pay for exclusions and neither will the Original Medicare Plan unless they are found upon appeal to be services, items or drugs that we should have paid or covered.

For a full list of exclusions and limitations, for medical services, refer to Chapter 4, section 3 of the Evidence of Coverage.

For a description of excluded prescription drugs, refer to Chapter 5, section 8 of the Evidence of 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, click on the Low Income Premium Table.
 
If you qualify for Extra Help, you get help paying for your monthly premium, yearly deductible, prescription co-insurance and co-payments 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 getting Extra Help, call:
 
  • 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7days a week;
  • The Social Security Office at 1-800-722-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or
  • Your State Medicaid Office.
 
People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for seventy-five percent of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.
 
Additional Information
AlohaCare is a health plan with a Medicare contract with the Federal government. Our contract with CMS is renewed annually and the availability of coverage beyond the current year is not guaranteed. You may only enroll into AlohaCare Advantage only during specific times of the year. Contact our Customer Service Department for more information. Benefits, formulary, pharmacy, network premium and/or copayments/co-insurance may change on January 1. Please contact AlohaCare Advantage for details. This information may be available in alternate formats or languages. Contact AlohaCare Advantage Customer Service at 1-866-973-6395 for more information. The Medicare Prescription Drug Benefit is only available to members of AlohaCare Advantage. If you are already enrolled in a Medicare Advantage Prescription Drug Plan, you must receive your Medicare Prescription Drug Benefit through that plan. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third-party.
 
Contact Us
If you have any questions or for more information on our benefits, call AlohaCare Advantage Customer Service from Oahu at 973-6395 or toll-free at 1-866-973-6395 from Oahu, Neighbor Islands or Mainland, 8 a.m. to 8 p.m., Monday through Friday, or visit us 8 a.m. to 5 p.m., Monday through Friday. (TTY/TDD users can call 1-877-447-5990.) Our office is located at 1357 Kapiolani Blvd., Ste. 1250, Honolulu, HI 96814.
 
 
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AlohaCare Advantage Plus (HMO SNP)


AlohaCare Advantage Plus is a Medicare Advantage Prescription Drug plan. To enroll into our plan, you must have Medicare Part A and B, have full dual Medicaid coverage, live in the State of Hawaii and NOT have End Stage Renal Disease (ESRD) at the time of enrollment. To remain enrolled into our plan, you must maintain your full dual Medicaid coverage and live in the state of Hawaii. For more information about AlohaCare Advantage Plus, look below:
 
To request this information be sent to you, call AlohaCare Advantage Plus Customer Service from Oahu at 973-6395 or toll-free at 1-866-973-6395 from Oahu, Neighbor Islands or Mainland, 8 a.m. to 8 p.m., Monday through Friday, or visit us 8 a.m. to 5 p.m., Monday through Friday. (TTY/TDD users can call 1-877-447-5990.)
 
Network Providers and Your Primary Care Provider (PCP)
A “network provider” is a provider that participates in our plan. This means that we have arranged with them to coordinate or provide covered services to members in our plan. As a member of AlohaCare Advantage Plus, you must use our network providers to get all your covered services. You must use plan providers except an emergent or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers neither Medicare nor AlohaCare Advantage Plus will be responsible for the costs.

 

As a member of AlohaCare Advantage Plus you will also choose your Primary Care Physician (PCP) within our network of providers. You must get your routine or basic care from your PCP. Your PCP will also coordinate the rest of the covered services you get as a member of our plan. For example, in order for you to see a specialist, you usually need to get your PCP’s approval first; this is called getting a referral to a specialist.

General Exclusions and Limitations 
There are some medical care and services, items and drugs that aren’t covered (excluded) or are covered only under specific conditions (limitations) by our plan. If you get services, items or drugs that are not covered, you must pay for them yourself. AlohaCare Advantage Plus won’t pay for the exclusions and neither will the Original Medicare Plan unless they are found upon appeal to be services, items or drugs that we should have paid or covered.
 
For a full list of exclusions and limitation, for medical services refer to Chapter 4, section 3 of the Evidence of Coverage (EOC).

For a description of excluded prescription drugs, refer to Chapter 5, section 8 of the Evidence of 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, click on the Low Income Premium Table.
 
If you qualify for Extra Help, you get help paying for your monthly premium, yearly deductible, prescription co-insurance and co-payments 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. Premiums include coverage for both medical services and prescription drug coverage.
 
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call:

  • 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7days a week);
  • The Social Security Administration at 1-800-722-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or
  • Your State Medicaid Office.
 
People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for seventy-five percent of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.

Additional Information
AlohaCare is a health plan with a Medicare contract with the Federal government. Our contract with CMS is renewed annually and the availability of coverage beyond the current year is not guaranteed. You may enroll into AlohaCare Advantage Plus at any time of the year. Contact our Customer Service Department for more information. Benefits, formulary, pharmacy, network premium and/or copayments/co-insurance may change on January 1. Please contact AlohaCare Advantage Plus for details. This information may be available in alternate formats or languages. Contact AlohaCare Advantage Plus Customer Service at 1-866-973-6395 for more information. The Medicare Prescription Drug Benefit is only available to members of AlohaCare Advantage Plus. If you are already enrolled in a Medicare Advantage Prescription Drug Plan, you must receive your Medicare Prescription Drug Benefit through that plan. You must continue to pay your Medicare Part B premium. As a member of AlohaCare Advantage Plus, your Part B premium is paid for by the State.

Contact Us
If you have any questions or for more information on our benefits, call AlohaCare Advantage Plus Customer Service from Oahu at 973-6395 or toll-free at 1-866-973-6395 from Oahu, Neighbor Islands or Mainland, 8 a.m. to 8 p.m., Monday through Friday, or visit us 8 a.m. to 5 p.m., Monday through Friday. (TTY/TDD users can call 1-877-447-5990.) Our office is located at 1357 Kapiolani Blvd., Ste. 1250, Honolulu, HI 96814.
 
Click on this link for information regarding your AlohaCare Advantage Plus Part D Prescription Drug Benefit.

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