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AlohaCare Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AlohaCare Advantage (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 (HMO D-SNP) in 2025, please refer to our full plan details page.
AlohaCare Advantage (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 (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 (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 (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 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $24.40. 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:
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Drug Coverage
The AlohaCare Advantage (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you'll pay the costs for your drugs based on their tier, until your total drug costs reach $2000. Once you reach $2000, you will enter the next coverage phase. If you qualify for the low-income subsidy, the plan's premium is $24.40. This plan's formulary provides more details on the cost-sharing for specific drugs.
Additional Benefits
The AlohaCare Advantage (HMO D-SNP) plan offers a range of benefits with a focus on outpatient and primary care services. Many services, including outpatient services, primary care visits, and emergency services, have a 20% coinsurance. The plan also provides coverage for hearing, vision, and dental services, with specific limits and cost-sharing details. This plan includes additional benefits such as ambulance and transportation services, along with coverage for home health services with no copay or coinsurance. Home infusion, medical equipment, and diagnostic services are also covered with a coinsurance, while some services like cardiac rehabilitation and other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but additional days and non-Medicare-covered stays are not covered. The plan requires prior authorization and charges the Medicare-defined cost share.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services, both with a 20% coinsurance, while Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are covered with a coinsurance of 20%. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the AlohaCare Advantage (HMO D-SNP) plan. All ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the AlohaCare Advantage (HMO D-SNP). Emergency Services and Urgently Needed Services have a 20% coinsurance, and Worldwide Emergency Services has a maximum benefit coverage of $1,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The AlohaCare Advantage (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. Primary care physician services, physician specialist services, and physical therapy/speech-language pathology services have a 20% coinsurance. Chiropractic services, mental health specialty services, and psychiatric services have a 20% coinsurance. Podiatry services have a 20% coinsurance for Medicare-covered services and routine foot care, and no coinsurance for other services. Other health care professional services, additional telehealth benefits, and opioid treatment program services have a 20% coinsurance. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services are covered, including Medicare-covered zero dollar preventive services. Additional preventive services are partially covered, and do not include Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, Counseling Services, and In-Home Support Services.
Hearing Services See details
Hearing services are partially covered by the AlohaCare Advantage (HMO D-SNP) plan. Hearing exams are covered with a coinsurance of at most 20% and no deductible, while 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 a 20% coinsurance, and eyewear, with a combined maximum benefit of $100 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered, with a limit of one per year.
Dental Services See details
Dental services are covered, including Medicare Dental Services with 20% coinsurance. Other dental services are also covered, with a maximum benefit of $1500 every year, covering oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery. Implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. 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 under the AlohaCare Advantage (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with 20% coinsurance for covered services. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The AlohaCare Advantage (HMO D-SNP) plan covers diagnostic and radiological services. Diagnostic procedures/tests have a coinsurance of at most 20%, while lab services are not covered. Diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services each have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the AlohaCare Advantage (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 covered, but not in practice. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and the plan uses the Medicare-defined cost share for tier 1, with coinsurance details available.
Other Services See details
Other Services are not covered under the AlohaCare Advantage (HMO D-SNP) plan. Specifically, acupuncture, over-the-counter 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 are not covered.
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