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.