Aloha and Welcome!
AlohaCare is a non-profit health plan founded in 1994 by Hawaii’s Community Health Centers and Queen Emma Clinics. AlohaCare is the second-largest Medicaid health plan in Hawaii.
Our passion is to serve the people of Hawaii in the true spirit of aloha. We are committed to improving the health of Hawaii's communities. We specialize in QUEST (Medicaid) health insurance to people living on Oahu, Kauai, Molokai, Lanai, Maui and Hawaii Island. We are mission driven to care for people who are underserved with specific health needs.
We provide health care coverage for Hawaii's QUEST (Medicaid) beneficiaries. AlohaCare is a health plan with a Medicare contract and provides Medicare coverage to beneficiaries in Hawaii.
AlohaCare Important Announcements
H.R.1 Federal Work Requirements
President Trump signed H.R.1 into law, which created new federal requirements for most adults between the ages of 19-64 in order to keep Med-QUEST (Medicaid) coverage.
These new work and community engagement requirements take effect January 1, 2027. Some people will not need to meet these requirements because they are exempt.
If these requirements apply to you:
- These requirements need to be met in one of the six months before your QUEST renewal month.
- These requirements apply renewals starting January 1, 2027.
- Two months before your 2027 renewal, you will receive a letter or notice from the Hawaii Department of Human Services Med-QUEST Division. The notice will explain if the state was able to verify that you meet the H.R.1 Federal Work Requirements or meet the exemptions using the state’s electronic data sources. The notice will also tell you if the state needs proof from you to verify that you meet the new requirements or an exemption.
How to Meet New Requirements* | Exemptions from the Work Requirements at Renewal* |
Work or volunteer at least 80 hours in at least one month of the six months prior to your renewal. The 80 hours can be any combination of the following activities: - Work
- Work or job training program, including college or vocational programs
- Volunteer
Other Ways to Meet Requirements - Income:
- Receive household income of $580 or more in at least one month of the six months prior to your renewal.
- Seasonal workers may use their average monthly income over six months to meet the requirement.
- School: enroll at least half time in an educational program
| These new federal work and volunteer rules DO NOT apply to: - Children (0-18)
- Older Adults (65 and older)
- People on Medicare Part A or Part B
- Pregnant people, including one year postpartum, regardless of birth outcome
- A parent, guardian, caregiver relative, or family caregiver of a dependent child who is 13 years of age and under
- A caregiver of a disabled individual
- People with disabilities (this includes physical, intellectual, or developmental disabilities that make it hard to do daily activities)
- Veterans with 100% disability rating
- People with serious health or mental health conditions or substance use problems
- People who were released from jail or prison within the last 90 days
- American Indians or Alaska Natives
- Former foster youth under 26, who were in foster care on their 18th birthday
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*Subject to change pending CMS guidance
What Can I Do Now?
- Make sure your contact information is up to date.
- Managing your Med-QUEST account online is the best way to update the information needed to help you keep your health insurance.
- The state Med-QUEST Division recommends this!
- You can report changes, complete your renewal, and upload documents online.
- You can also check your Medicaid account online 24/7.
At A Glance
When? | Starting on January 1, 2027 |
Why? | Congress passed a bill (H.R. 1) that President Trump signed into law on 7/4/25 that is requiring Medicaid programs to change eligibility rules for some adults. |
Who? | These changes only impact adults between 19-64 who are not Blind, Disabled or Pregnant. |
What? | There are two new requirements that will start in 2027: 1. For individuals described above, eligibility renewals will happen every six months instead of once per year 2. To keep Med-QUEST coverage, this adult group will need to demonstrate that they meet, or are exempt from, work and “community engagement requirements.” Unless exempt, meeting this requirements means either working or volunteering at least 80 hours per month or have a household income of at least $580 per month or are enrolled at least half-time in an educational program. |
How? | More details will become available from the state Med-QUEST Division. Until then, here are some ways QUEST members can prepare: Set up online access to your existing Med-QUEST account at mybenefits.hawaii.gov. Click here to do it now! It is fast and easy and is the best way to ensure Med-QUEST has the information it needs to help you stay enrolled. - If you work, make sure you save your paystubs.
- If you don’t have a paystub, but have proof of $580 income per month, save that evidence of income.
- If you are enrolled in an educational program at least half time, ask your school for official proof of enrollment.
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Last Updated July 8, 2026
Attention AlohaCare Advantage Plus (HMO D-SNP) and AlohaCare Advantage (HMO D-SNP) Members: Correction to the AlohaCare Winter 2025 Member Newsletter
On page 9 of the newsletter, we stated that “you should not have to pay for your medications”. This was meant for our QUEST members and not Medicare members. We apologize for any confusion this may have caused.
For plan year 2026, the AlohaCare Advantage Plus and AlohaCare Advantage formularies have Part D copays which are based on the level of Extra Help you receive. We’ve kept $0 copays for generic high blood pressure medications, generic diabetes medications and generic cholesterol medications. AlohaCare Advantage Plus members will continue to have $0 copays for formulary over the counter (OTC) drugs.
Drug copays are based on the level of Extra Help you receive until you reach the catastrophic phase, which occurs when you have spent $2100 in out-of-pocket costs, where Part D copays become $0.
For formulary information, visit the AlohaCare Formulary
AlohaCare Advantage Drug Benefits (HMO D-SNP) |
| You Pay |
Annual drug deductible | $0
Because you receive Extra Help you do not have an annual drug deductible |
Initial coverage stage
Until you’ve paid $2,100 out of pocket for Part D drugs. |
30-day, 60-day, 90-day and 100-day supply from retail pharmacies |
Tier 1 - Preferred Generic Tier 2 – Generic Tier 3 - Preferred Brand
Tier 4 - Non-preferred Drug
Tier 5 - Specialty | For generic drugs: $0, $1.60, or $5.10.
For brand drugs: $0, $4.90, or $12.65.
Copayments for drugs may vary based on the level of Extra Help you get. Refer to your “Evidence of Coverage Rider for People Who Get Extra Help Paying for Prescription Drugs” letter (also known as the Low-Income Subsidy Rider), which tells you about your level of Extra Help you receive for your drug coverage. |
Tier 6 – Select Care Drugs (generic hypertension, generic cholesterol and generic diabetes drugs) | $0 |
Up to 100-day supply from mail-order pharmacy |
Tier 1 - Preferred Generic Tier 2 - Generic Tier 3 - Preferred Brand
Tier 4 - Non-preferred Drug
Tier 5 - Specialty | For generic drugs: $0, $1.60, or $5.10.
For all other drugs: $0, $4.90, or $12.65.
Copayments for drugs may vary based on the level of Extra Help you get. Refer to your “Evidence of Coverage Rider for People Who Get Extra Help Paying for Prescription Drugs” letter (also known as the Low-Income Subsidy Rider), which tells you about your level of Extra Help you receive for your drug coverage. |
Tier 6 – Select Care Drugs (generic hypertension, generic cholesterol and generic diabetes drugs) | $0 |
Catastrophic coverage stage
After you’ve paid $2,100 out-of-pocket for Part D drugs. | Part D drug copays $0 |
Part D vaccines | $0 |
AlohaCare Advantage Plus Drug Benefits (HMO D-SNP) |
| You Pay |
Annual drug deductible | $0
Because you receive Extra Help you do not have an annual drug deductible |
Initial coverage stage
Until you’ve paid $2,100 out of pocket for Part D drugs. |
30-day, 60-day, 90-day and 100-day supply from retail pharmacies |
Tier 1 - Preferred Generic Tier 2 - Generic Tier 3 - Preferred Brand
Tier 4 - Non-preferred Drug (Generic or Brand Drug)
Tier 5 - Specialty | For generic drugs: $0, $1.60, or $5.10.
For brand drugs: $0, $4.90, or $12.65.
Copayments for drugs may vary based on the level of Extra Help you get. Refer to your “Evidence of Coverage Rider for People Who Get Extra Help Paying for Prescription Drugs” letter (also known as the Low-Income Subsidy Rider), which tells you about your level of Extra Help you receive for your drug coverage. |
Tier 6 – Select Care Drugs (generic hypertension, generic cholesterol and generic diabetes drugs) | $0 |
Formulary OTC | $0 |
Up to 100-day supply from mail-order pharmacy |
Tier 1 - Preferred Generic Tier 2 - Generic Tier 3 - Preferred Brand
Tier 4 - Non-preferred Drug (Generic or Brand Drug)
Tier 5 - Specialty | For generic drugs: $0, $1.60, or $5.10.
For all other drugs: $0, $4.90, or $12.65.
Copayments for drugs may vary based on the level of Extra Help you get. Refer to your “Evidence of Coverage Rider for People Who Get Extra Help Paying for Prescription Drugs” letter (also known as the Low-Income Subsidy Rider), which tells you about your level of Extra Help you receive for your drug coverage. |
Tier 6 - Select Care Drugs (generic hypertension, generic cholesterol and generic diabetes drugs) | $0 |
Formulary OTC | $0 |
Catastrophic coverage stage After you’ve paid $2,100 out-of-pocket for Part D drugs. | Part D drug copays $0 |
Part D vaccines | $0 |
QUESTIONS OR CONCERNS?