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Our Health Plans


AlohaCare offers three health plans:
  • AlohaCare QUEST
  • AlohaCare Advantage (HMO) 
  • AlohaCare Advantage Plus (HMO SNP)   
     
To learn more about our health plans, click on the plan name below.

Alohacare QUEST

 
AlohaCare provides health care coverage for Hawaii’s QUEST beneficiaries. QUEST is a state program that provides Medicaid-eligible Hawaii residents with health care coverage. Beneficiaries include low-income residents, including children and pregnant women.

AlohaCare offers:
  • Customer service staff who know our local island communities
  • A large provider network so you can choose your doctors
  • Care Coordinators to make sure you get the services you need
  • Prevention programs to help you and your family stay healthy
  • Dedicated staff who care for your well-being

QUEST Eligibility Requirements
Visit the Med-QUEST website to learn more about the eligibility requirements.

Your Primary Care Provider (PCP)
You will choose a Primary Care Provider (PCP) for your care. Your PCP is your personal doctor who you will see first for most of your health care needs. Your PCP will coordinate the rest of your services. This helps your PCP provide you with the best care by knowing your health care needs and services your receive.

Language Assistance
We can help if you do not speak or understand English. We can also help you if you have trouble hearing or seeing. You may ask for information in another language, such as Ilocano, Vietnamese, Chinese or Korean, or in another way. TTY assistance is available by calling 1-877-447-5990. For more information, see our Language Assistance flyer.

Contact Us
Oahu: 973-0712
Neighbor Island/Oahu (toll-free): 1-877-973-0712
TTY: 1-877-447-5990
info@alohacare.org
 

 


 

ALOHACARE ADVANTAGE (HMO)
 

AlohaCare Advantage 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 offers you Medicare Parts A, B and D coverage with affordable cost sharing. Some of our benefits include:

  • $0 plan premium 
  • $0 to $5 copayment for each office visit to your Primary Care Provider (PCP)
  • $20 copayment for each office visit to your Specialist (PCP referral required)
  • $0 deductible for Part D prescription drugs
  • $0 copayment for prevnetive health services
  • 24-hour Nurse Advice Line

Limitations, copayments and restrictions may apply. For a complete listing of benefits, see the Summary of Benefits.

For more information about AlohaCare Advantage, look below:

2014 Summary of Benefits
2014 Provider & Pharmacy Directory
2014 Comprehensive Formulary
2014 Plan Rating

Network Providers and Your Primary Care Providers (PCP)
A “network provider” is a provider that participates in our plan. As a member of AlohaCare Advantage, 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 will be responsible for the costs.
 
As a member of AlohaCare Advantage you will choose your Primary Care Provider (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 our member. 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 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.

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.
       
Additional Information
AlohaCare Advantage is a health plan with a Medicare contract. 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 of each year. You must continue to pay your Part B premium.   
 
Contact Us
If you have any questions or for more information about our 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. Our office is located at 1357 Kapiolani Blvd., Suite 1250, Honolulu, HI 96814. Visit us Monday through Friday, 8 a.m. to 5 p.m.
 
 
 

H5969_400614_1 CMS Approved 02122014

 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 plan premium
  • 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
 
Limitations, copayments and restrictions may apply. For a complete listing of benefits, see your Summary of Benefits.

For more information about AlohaCare Advantage Plus, look below:

2014 Summary of Benefits
2014 Provider & Pharmacy Directory
2014 Comprehensive Formulary
2014 Plan Rating
 
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. 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.
  • Your State Medicaid Office.

 


Additional Information
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.

Contact Us
If you have any questions or for more information on our benefits, call Customer Service from 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. Our office is located at 1357 Kapiolani Blvd., Suite 1250, Honolulu, HI 96814. Visit us Monday through Friday, 8 a.m. to 5 p.m.


Click on this link for information regarding your AlohaCare Advantage Plus Part D Prescription Drug Benefit.

 
H5969_400614_1 CMS Approved 02122014