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AlohaCare Advantage Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AlohaCare Advantage Plus (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on AlohaCare Advantage Plus (HMO D-SNP) in 2026, please refer to our full plan details page.
AlohaCare Advantage Plus (HMO D-SNP) is a HMO D-SNP plan offered by AlohaCare available for enrollment in 2025 to people living in State of Hawaii. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that AlohaCare Advantage Plus (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
AlohaCare Advantage Plus (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about AlohaCare Advantage Plus (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For AlohaCare Advantage Plus (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $43.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.50. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The AlohaCare Advantage Plus (HMO D-SNP) plan features an annual prescription drug deductible of $615. Under this plan, members pay a 25% coinsurance at standard pharmacies and standard mail order for Tier 1 preferred generics, Tier 2 generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs. Tier 5 specialty drugs also carry a 25% coinsurance for a one-month supply at standard pharmacies. Conversely, Tier 6 select care drugs are covered with no copay for one-month, two-month, and three-month supplies filled at standard pharmacies or through standard mail order. This cost-sharing structure ensures predictable costs for essential medications under the AlohaCare Advantage Plus (HMO D-SNP) plan.
Additional Benefits
The AlohaCare Advantage Plus (HMO D-SNP) offers robust coverage where essential services like inpatient hospital stays, home health care, and skilled nursing facilities require no copay and no coinsurance. For outpatient hospital visits, specialist care, emergency services, and durable medical equipment, members typically pay no copay and a 20% coinsurance. The plan also covers up to 24 one-way transportation trips per year to plan-approved locations with no copay and no coinsurance. In addition to medical care, members receive dental coverage up to a $1,500 annual limit and an over-the-counter allowance of $100 per month with no copay or coinsurance. However, routine vision exams, glasses, routine hearing exams, and hearing aids are not covered under this plan. Diagnostic hearing exams and diagnostic radiological services are covered, but standard cardiac rehabilitation and laboratory services are excluded.
Inpatient Hospital See details
AlohaCare Advantage Plus (HMO D-SNP) partially covers inpatient hospital services with no copay and no coinsurance, though prior authorization is required. Covered acute and psychiatric stays follow Original Medicare guidelines, but additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
AlohaCare Advantage Plus (HMO D-SNP) covers outpatient services—including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services—with no copay and a 20% coinsurance. Prior authorization is required for most of these outpatient services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered under AlohaCare Advantage Plus (HMO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the AlohaCare Advantage Plus (HMO D-SNP) plan, with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation is partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
AlohaCare Advantage Plus (HMO D-SNP) covers emergency and urgent care services with a 20% coinsurance and no copay, with cost-sharing counting toward the deductible and emergency coinsurance waived if admitted to the hospital within three days. Worldwide emergency and urgent care are covered with no copay and no coinsurance up to a $1,000 limit, though worldwide emergency transportation is not covered.
Primary Care See details
AlohaCare Advantage Plus (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and 20% coinsurance, though prior authorization is required for some benefits. Routine podiatry is covered with no copay and no coinsurance for up to four visits per year, while routine chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by AlohaCare Advantage Plus (HMO D-SNP), offering no copay and no coinsurance for Medicare-covered zero-dollar preventive services, kidney disease education, and remote access technologies. Some services, such as diabetes self-management training (which has a 20% coinsurance and no copay) and digital rectal exams, require prior authorization, while other benefits like annual physical exams and fitness programs are not covered.
Hearing Services See details
AlohaCare Advantage Plus (HMO D-SNP) covers diagnostic hearing exams with no copay, no coinsurance, and no deductible. However, routine hearing exams, fitting and evaluation services, and all prescription or over-the-counter hearing aids are not covered.
Vision Services See details
Vision services under AlohaCare Advantage Plus (HMO D-SNP) are technically covered with no copay, no deductible, and a 20% coinsurance, but the benefit is not covered in practice because routine eye exams, contact lenses, and eyeglasses are not covered.
Dental Services See details
AlohaCare Advantage Plus (HMO D-SNP) covers Medicare dental services with no copay and 20% coinsurance, and other dental services with no copay and no coinsurance up to a $1,500 annual limit. This benefit is partially covered, as fluoride treatments, other preventive dental services, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
AlohaCare Advantage Plus (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Associated Medicare Part B drugs, including chemotherapy, radiation, and other drugs, carry a coinsurance of 0% to 20%, while insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the AlohaCare Advantage Plus (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
AlohaCare Advantage Plus (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for these covered benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by AlohaCare Advantage Plus (HMO D-SNP), as lab services are not covered. Covered services, including diagnostic procedures, therapeutic and diagnostic radiological services, and outpatient X-rays, require prior authorization and have no copay and a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by AlohaCare Advantage Plus (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered in practice by AlohaCare Advantage Plus (HMO D-SNP), as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered and require a 20% coinsurance and no copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by AlohaCare Advantage Plus (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required and additional days beyond the Medicare-covered limit are not covered. This benefit also allows for admission without a prior three-day inpatient hospital stay.
Other Services See details
AlohaCare Advantage Plus (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance, up to a $100 monthly limit that carries forward. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered under this plan.
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