A non-government entity
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 2025, 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 out of 5 stars in 2025.
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 $31.30. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $590.00 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 $9350.00 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:
Sign up for AlohaCare Advantage Plus (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The AlohaCare Advantage Plus (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you will enter the next coverage phase. If you qualify for the low-income subsidy, your premium for Part D will be $31.30.
Additional Benefits
The AlohaCare Advantage Plus (HMO D-SNP) plan offers a variety of benefits with varying cost-sharing. Inpatient hospital services, outpatient services, and partial hospitalization have coinsurance requirements, while ambulance services have no copay. The plan also covers a range of primary care services, preventive services, hearing, vision, and dental services, with many requiring coinsurance. The plan also includes coverage for home infusion, dialysis, medical equipment, and diagnostic services, all with coinsurance. Home health services are available with no copay and no coinsurance, while skilled nursing facility benefits are covered but require prior authorization. However, certain services like cardiac rehabilitation and many "other services" are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but additional days, non-Medicare stays, and upgrades for acute and psychiatric care are not covered. You will have a copay for acute and psychiatric care, with the exact amount determined by Medicare.
Outpatient Services See details
Outpatient Services are covered by the AlohaCare Advantage Plus (HMO D-SNP) plan, including outpatient hospital services and observation services with a 20% coinsurance, and ambulatory surgical center services and outpatient substance abuse services with a coinsurance of 20%. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the AlohaCare Advantage Plus (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered with no copay and a 20% coinsurance for both ground and air ambulance services, while transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the AlohaCare Advantage Plus (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have a 20% coinsurance, while Worldwide Emergency Services has a maximum plan benefit coverage of $1,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The AlohaCare Advantage Plus (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Many of these services have a 20% coinsurance. Routine chiropractic care is not covered, and routine foot care has a 0% coinsurance.
Preventive Services See details
The AlohaCare Advantage Plus (HMO D-SNP) plan covers preventive services, including glaucoma screening, diabetes self-management training with 20% coinsurance, barium enemas, digital rectal exams, and EKG following a Welcome Visit. Annual physical exams, health education, in-home safety assessments, and several other services are not covered.
Hearing Services See details
Hearing Services are partially covered by the AlohaCare Advantage Plus (HMO D-SNP) plan. Hearing exams have a coinsurance of at most 20%, with no deductible, but routine hearing exams and fitting/evaluation for hearing aids are not covered. OTC hearing aids are covered up to $300 every year for both ears combined.
Vision Services See details
Vision services include coverage for eye exams with 20% coinsurance, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $100 per year. Routine eye exams are covered once per year, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are each covered once per year. Upgrades are also covered.
Dental Services See details
Dental services include a 20% coinsurance for Medicare dental services. Other dental services have a maximum benefit of $1500 per year and include oral exams with 2 visits per year, dental x-rays, other diagnostic dental services, prophylaxis (cleaning) with 2 visits per year, fluoride treatment with 2 visits per year, restorative services with 1 visit per year, adjunctive general services with 1 visit per year, endodontics with 1 visit every 2 years, periodontics with 1 visit every three years, prosthodontics, removable with 1 visit every 6 months, maxillofacial prosthetics with 1 visit every 7 years, prosthodontics, fixed with 1 visit per year, and oral and maxillofacial surgery with 1 visit per lifetime. Implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the AlohaCare Advantage Plus (HMO D-SNP) plan. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the AlohaCare Advantage Plus (HMO D-SNP) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered by the AlohaCare Advantage Plus (HMO D-SNP) plan. Durable Medical Equipment (DME) and diabetic supplies have a 20% coinsurance, while medical supplies also have a 20% coinsurance. Prosthetic devices and diabetic therapeutic shoes/inserts have a coinsurance between 20% and 20%. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered. The plan has no copay for these services, but you may have to pay a coinsurance of up to 20%. Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the AlohaCare Advantage Plus (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the AlohaCare Advantage Plus (HMO D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but require prior authorization. The plan does not cover additional days beyond Medicare-covered SNF stays, or non-Medicare-covered SNF stays.
Other Services See details
Other Services are not covered, including acupuncture, over-the-counter (OTC) items, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved