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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 2026, 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 3.5 out of 5 stars in 2026.
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 $44.40. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $3.60. 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 (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic, Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, you will pay a 25% coinsurance for one-, two-, or three-month supplies filled at standard pharmacies and standard mail order. Tier 5 specialty drugs also require a 25% coinsurance for a one-month supply at standard pharmacies. In contrast, Tier 6 select care drugs offer excellent savings with no copay for one-, two-, or three-month supplies filled at standard pharmacies or standard mail order. Reviewing these coinsurance and copay details can help you determine your potential out-of-pocket medication costs under this plan.
Additional Benefits
The AlohaCare Advantage (HMO D-SNP) plan offers comprehensive medical coverage with no copay for most services, though many outpatient and specialist care categories require a 20% coinsurance. Key benefits like inpatient hospital stays, skilled nursing facility care, and home health services are covered with no copay and no coinsurance. For outpatient services, emergency care, primary and specialist visits, and durable medical equipment, members will typically pay no copay and a 20% coinsurance. Additional benefits include diagnostic hearing exams and home infusion services with no copay or coinsurance, alongside a monthly $75 over-the-counter allowance. The plan also covers up to 24 one-way transportation trips per year and select preventive dental care up to $750 annually with no copay or coinsurance. However, routine vision and hearing services, including routine eye exams and hearing aids, are not covered under this plan.
Inpatient Hospital See details
AlohaCare Advantage (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, although prior authorization is required. This benefit is partially covered because additional days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
AlohaCare Advantage (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for most of these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered by AlohaCare Advantage (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
AlohaCare Advantage (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
AlohaCare Advantage (HMO D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, with the emergency coinsurance waived if you are admitted to the hospital within three days. Worldwide emergency and urgent services are partially covered with no copay and no coinsurance up to a $1,000 maximum, though worldwide emergency transportation is not covered.
Primary Care See details
AlohaCare Advantage (HMO D-SNP) covers primary care, specialist, therapy, telehealth, and mental health services with no copay and 20% coinsurance. Podiatry services are covered with no copay and 0% to 20% coinsurance, but chiropractic services are not covered.
Preventive Services See details
AlohaCare Advantage (HMO D-SNP) partially covers preventive services, offering Medicare-covered preventive care, kidney disease education, and remote access technologies with no copay and no coinsurance. However, some services like diabetes self-management training require a 20% coinsurance, and several benefits including annual physical exams, fitness benefits, and health education are not covered.
Hearing Services See details
Hearing services are covered by AlohaCare Advantage (HMO D-SNP), offering diagnostic hearing exams with no copay, no coinsurance, and no deductible. However, routine hearing exams, hearing aid fittings, over-the-counter (OTC) hearing aids, and all prescription hearing aid types—including inner ear, outer ear, and over-the-ear—are not covered.
Vision Services See details
Vision services are covered under the AlohaCare Advantage (HMO D-SNP) plan with no copay, featuring a 20% coinsurance for eye exams and no coinsurance for eyewear. Although some services are covered, routine eye exams, other eye exam services, contact lenses, eyeglasses, and upgrades are not covered in practice.
Dental Services See details
AlohaCare Advantage (HMO D-SNP) partially covers dental services, offering Medicare-covered dental care with no copay and 20% coinsurance, and select preventive services with no copay and no coinsurance up to a $750 annual limit. However, fluoride, restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under AlohaCare Advantage (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B drugs, such as chemotherapy, radiation, and insulin, carry a coinsurance of 0% to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the AlohaCare Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
AlohaCare Advantage (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for these services, and there are no restrictions on preferred vendors or manufacturers.
Diagnostic and Radiological Services See details
AlohaCare Advantage (HMO D-SNP) partially covers diagnostic and radiological services with prior authorization required, offering these benefits with no copay but a 20% coinsurance. Covered services include diagnostic procedures, diagnostic and therapeutic radiological services, and outpatient X-rays, while lab services are not covered.
Home Health Services See details
AlohaCare Advantage (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
AlohaCare Advantage (HMO D-SNP) covers cardiac rehabilitation services with no copay, though the benefit is only partially covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered under the $0 copay and instead require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by AlohaCare Advantage (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered because additional days beyond the Medicare-covered limit are not covered, but the plan does allow admission without a prior three-day inpatient hospital stay.
Other Services See details
AlohaCare Advantage (HMO D-SNP) partially covers other services, providing an over-the-counter (OTC) benefit with no copay and no coinsurance for up to $75 monthly that carries forward if unused. Acupuncture, meal benefits, and highly integrated dual-eligible services are not covered under this plan.
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