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
- 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.
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.