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Our Health Plans


AlohaCare offers three health plans:
  • AlohaCare (QUEST)
  • AlohaCare Advantage (HMO) (Medicare Advantage Prescription Drug Plan)
  • AlohaCare Advantage Plus (HMO SNP) (Medicare Advantage Prescription Drug Plan for people with Medicaid coverage.)
  
To learn more about our health plans, click on the plan name below.

Alohacare 

 
Our AlohaCare health plan is for QUEST beneficiaries. QUEST is a State program that provides health coverage through health plans for Medicaid-eligible Hawaii residents. It is a Medicaid managed care program. The State pays health plans to provide coverage for medical and behavioral health services. For more information about our QUEST plans, which includes QUEST, QUEST-Net, QUEST-ACE and BHH take a look below:

Member Handbook
QUEST-ACE and QUEST-Net

We can help if you do not speak or understand English, or if you have trouble hearing or seeing. You may ask for information in another language, such as English, Ilocano, Tagalog, Chinese or Korean, or in another way by calling us. The translation service is free.

 

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 premium. You must continue to pay your Part B premium. 
  • $2 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

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:
 

2012 Summary of Benefits
H5969_ACA101107_1_FINAL CMS Approved 08252011


2012 Benefit Highlights
H5969_ACA401040_1_FINAL CMS Approved 08312011


2012 Provider/Pharmacy Directory
H5969_104403_1_FINAL File & Use 09212011


2012 Comprehensive Formulary
H5969_ACA500307_2_FINAL File & Use 09072011


2012 Coverage Decisions, Appeals and Grievances
H5969_900031_1 CMS Approved 08022011


2012 Plan Rating
H5969_900402_1 File & Use 10222011


 
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. 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, look at 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.
 
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 is a health plan with a Medicare contract. 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, 2013. This information is available in alternate formats or languages. For more information, contact AlohaCare Advantage at the numbers below.
 
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_400612_1 01172012

 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 premium. You must continue to pay your Part B premium. The State pays the Part B premium for individuals with full benefit Medicare coverage. 
  • Primary Care Provider (PCP) and Specialist visits
  • Preventive Services
  • $0 deductible for Part D prescription drugs
  • 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:

2012 Summary of Benefits
H5969_ACAP101701_2 CMS Approved 10192011


2012 Benefits Highlight
H5969_ACAP401040_1 CMS Approved 08312011


2012 Provider/Pharmacy Directory
H5969_104403_1_FINAL File & Use 09212011


2012 Comprehensive Formulary
H5969_500307_2_FINAL File & Use 09072011


2012 Coverage Decisions, Appeals and Grievance Processes
H5969_900031_1 CMS Approved 08022011


2012 Plan Rating
H5969_900402_1 File & Use 10222011


 
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. 

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_400612_1 01172012