Beginning January 1, 2027, new federal requirements will change how health coverage works for many people who are eligible for both Medicare and Medicaid. This change, known as health plan alignment, is designed to make healthcare simpler and improve coordination between benefits and services.
If you have both Medicare and QUEST (Medicaid) coverage, it is important to understand what these changes mean for you and whether you need to take any action before the end of 2026.
What Is Health Plan Alignment?
Health plan alignment means that individuals who are enrolled in both Medicaid and a Medicare Dual Eligible Special Needs Plan (D-SNP) will be required to have both coverages through the same health plan beginning January 1, 2027.
The goal of this change is to create a more seamless healthcare experience by improving coordination between Medicare and Medicaid services. When both coverages are managed through the same organization, members can experience more streamlined care, easier navigation of benefits, and better support for their health needs.
Who Will Be Affected?
This change affects people who:
- Have QUEST (Medicaid) coverage.
- Are enrolled in a Medicare Dual Eligible Special Needs Plan (D-SNP).
- Currently receive their Medicare and Medicaid coverage from different health plans.
If your Medicare and Medicaid coverage are already with the same health plan, you do not need to make any changes.
Why This Change Matters
Health plan alignment is intended to help individuals receive more coordinated care by bringing Medicare and Medicaid benefits together under a single health plan. This can help reduce confusion about coverage, improve communication among care teams, and make it easier for members to access the services they need.
As the transition approaches, members should carefully review any communications they receive from their health plan or Med-QUEST and understand the options available to them.
AlohaCare Members
If You Want to Keep AlohaCare for Your QUEST (Medicaid) Coverage
Members who currently have AlohaCare QUEST (Medicaid) coverage but receive their Medicare D-SNP through another health plan can choose to align their Medicare coverage with AlohaCare by enrolling in AlohaCare Advantage Plus (HMO D-SNP) by September 30, 2026.
AlohaCare Advantage Plus offers:
- A dedicated team to support your health and well-being.
- Over-the-counter allowance funds for health-related items.
- Benefits such as dental, vision, Native Hawaiian healing services, and more.
Learn more about AlohaCare Advantage Plus (HMO D-SNP) and how to enroll.
If You Want to Keep Your Current Medicare D-SNP
Members who prefer to stay with their current Medicare D-SNP plan do not need to take action to change their Medicare coverage. Instead, their QUEST (Medicaid) health plan will be changed to match their Medicare D-SNP, with the new health plan becoming effective January 1, 2027.
Need help? AlohaCare members can contact us.
At AlohaCare, Your Health is in Caring Hands
AlohaCare is a nonprofit health plan created in 1994 by Hawaiʻi’s community health centers and Queen Emma Clinics. We support people of all ages who qualify for government-funded health plans. We are proud to be the second largest Medicaid and Medicare health plan in Hawaiʻi, serving families across the state.