AlohaCare Advantage Plus (HMO SNP)
To request this information be sent to you, call Customer Service at at the numbers listed at the bottom of this webpage.
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 network providers to get all your covered services. You must use plan providers except an 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 a member of AlohaCare Advantage Plus you will 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 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.
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 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. 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 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.
People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your 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 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, 20113. 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 th numbrs below.
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