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.
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:
2013 Summary of Benefits
2013 Benefit Highlights
2013 Provider & Pharmacy Directory
2013 Comprehensive Formulary
2013 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 2013 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.
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.
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.