Ohana Health Plan
'Ohana Health Plan is a Hawaii-based managed care subsidiary of WellCare/Centene that delivers Medicaid (QUEST Integration), Medicare Advantage, Part D, and behavioral health plans to residents across the state's six major islands through broker, direct, and provider referral channels.
- Company typePublic
- Founded-
- HeadquartersKapolei, United States
- Headcount—
- GTM typeB2C
- OfferingServices
What Ohana Health Plan does
'Ohana Health Plan is a Hawaii-based managed care organization that delivers government-sponsored health insurance to Medicaid and Medicare beneficiaries across the state's six major islands (Kauai, Oahu, Molokai, Maui, Lanai, and Hawaii Island). The company offers QUEST Integration (Hawaii Medicaid), Medicare Advantage plans in HMO, PPO, D-SNP, and C-SNP variants, standalone Medicare Part D prescription drug plans, and the Community Care Services (CCS) behavioral health plan. 'Ohana also operates branded programs including the 'Ohana BabySteps maternity care management program, the Diamond Designation provider recognition program, the My Health Pays rewards program, and the Wellcare Spendables prepaid benefit card. Distribution combines direct member enrollment via web and member portal, a licensed insurance broker network (supported through the wellcare.com broker portal), and healthcare provider referrals.
The underlying technology stack centers on a managed care platform with integrated member and provider portals, telehealth services for remote island access, electronic visit verification via HHA Exchange, electronic funds transfer and remittance via PaySpan, provider multi-payer connectivity via Availity, mail-order pharmacy fulfillment via Express Scripts, and clinical decision support via InterQual. A community resources partnership with Aunt Bertha (findhelp) connects members to social services for food, housing, transportation, and financial assistance. The platform supports HIPAA-compliant processing of protected health information.
Revenue is generated primarily through capitation payments from the Hawaii Department of Human Services Med-QUEST Division for Medicaid members and CMS for Medicare Advantage and Part D members, with separate managed care contract revenue for behavioral health services through CCS. Premium pricing is not publicly disclosed; Medicaid plans have no monthly premium for eligible members while many Medicare Advantage options are offered at $0 monthly premium, with cost-sharing varying by plan selection and income tier. 'Ohana is a wholly-owned subsidiary of WellCare Health Plans, Inc., which was acquired by Centene Corporation (NYSE: CNC) in 2021, providing shared corporate infrastructure, technology, and contracting scale.
Ohana Health Plan firmographics
Firmographics- Name
- Ohana Health Plan
- Legal name
- WellCare Health Plans, Inc.
- Website
- https://ohanahealthplan.com
- Company type
- Public
- Operating status
- Operating
- Short description
- 'Ohana Health Plan is a Hawaii-based managed care subsidiary of WellCare/Centene that delivers Medicaid (QUEST Integration), Medicare Advantage, Part D, and behavioral health plans to residents across the state's six major islands through broker, direct, and provider referral channels.
- Ownership category
- akta.pro rank
Ohana Health Plan industry classification
Industry- Product category
- Managed Care Health Insurance
- NAICS
- Direct Health and Medical Insurance Carriers (524114), Direct Life, Health, and Medical Insurance Carriers (52411)
- SIC
- Hospital & Medical Service Plans (6324), Accident & Health Insurance (6321)
- akta.pro primary industry
- Medicare Advantage (MA) Plans (FSAIAGAA)
- akta.pro secondary industries
- Medicare Advantage HMOs (HMO/HMO-POS) (HLAEAMAH), MA HMO Plans (HLAEACAA), MA-PD Plans (Medicare Advantage with Prescription Drug Coverage) (FSAIAGAG), Care Management & Population Health Program Administration (HLAEALAG)
Keywords
Where Ohana Health Plan is headquartered
LocationHeadquarters
- HQ city
- Kapolei
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
Ohana Health Plan business model
Business model- GTM type
- B2C
- Offering type
- Services
- Cost components
- Operations, Personnel, Infrastructure, Marketing or Sales, Technology or R&D
Revenue model
- Medicaid Premium Revenue: Revenue from Hawaii's Med-QUEST (Medicaid) program, where the plan receives capitation payments from the state government to provide healthcare coverage for eligible low-income individuals and families.
- Medicare Premium Revenue: Revenue from Medicare Advantage plans, including Medicare Advantage with prescription drug coverage (MA-PD), Special Needs Plans (SNP), and dual-eligible programs for individuals eligible for both Medicare and Medicaid.
- Community Care Services (CCS) Behavioral Health: Managed behavioral health care services under a separate managed care contract for mental health and substance use disorder treatment across Hawaii's islands.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Monthly | Medicaid QUEST Integration plans for low-income Hawaii residents |
| Subscription | Monthly | Medicare Advantage plans including HMO, PPO, D-SNP, and C-SNP options |
Go-to-market motion2 records
Distribution channels3 records
Marketing channels4 records
Ohana Health Plan product offering
Product offeringCore offering
'Ohana Health Plan is a Hawaii-based managed care organization that provides government-sponsored health insurance plans to eligible residents. It offers Medicaid (QUEST Integration), Medicare Advantage (HMO/PPO/D-SNP/C-SNP), Medicare Part D prescription drug plans, and a Community Care Services (CCS) behavioral health plan, supported by member and provider portals plus care management programs.
Product overview
'Ohana Health Plan is a health insurance managed care organization serving Hawaii residents through multiple product lines. The company operates as a subsidiary of WellCare Health Plans, Inc., which is owned by Centene Corporation. The portfolio consists of government-sponsored health plans including QUEST Integration (Medicaid), Medicare Advantage (HMO/PPO/D-SNP/C-SNP), and Prescription Drug Plans (Part D), all offered under the Wellcare By 'Ohana Health Plan brand. The company also offers Community Care Services Plan for behavioral health managed care. Supporting programs include the 'Ohana BabySteps maternity program, My Health Pays Rewards Program, and Diamond Designation provider recognition program. The company serves members across all major Hawaiian islands including Kaua'i, O'ahu, Moloka'i, Maui, Lana'i, and Hawai'i.
Differentiator
Problem solved
Functional benefit
Brands
- 'Ohana BabySteps Program: Maternity program offering pregnancy support, educational materials, and care management for pregnant members.
- Community Care Services (CCS)
Products and services
- QUEST Integration (Medicaid) Hawaii Medicaid managed care plan providing comprehensive health coverage for eligible individuals and families, including medical, behavioral health, and pharmacy benefits.
- Community Care Services Plan (CCS) Managed behavioral health care plan treating mental health and substance use disorders for Hawaii residents, offered as a subsidiary of WellCare Health Insurance of Arizona.
- Medicare Advantage Plans Medicare Advantage offerings under Wellcare By 'Ohana Health Plan, including HMO, PPO, D-SNP (Dual Special Needs Plans), and C-SNP (Chronic Special Needs Plans) for Medicare beneficiaries in Hawaii.
- Prescription Drug Plans (PDP) Medicare Part D prescription drug coverage plans offered through Wellcare By 'Ohana Health Plan, with mail service pharmacy fulfilled by Express Scripts.
Quantifiable outcome
- Improve birth outcomes through decreased preterm deliveries and reduced NICU birth rates
- +2 more outcomes
Companies that use Ohana Health Plan
Customer profileNamed customers2 records
Segments5 records
Ideal customer profiles4 records
Ohana Health Plan technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Integration6 records
Feature3 records
Ohana Health Plan partnerships and signals
Strategic signalPartnerships
Three partnerships are on record, tiered core.
- Hawaii Department of Human Services - Med-QUEST DivisioncoreState government agency partnership for providing Medicaid managed care coverage. 'Ohana Health Plan is a contracted managed care organization (MCO) serving eligible Hawaii residents through the Med-QUEST program, receiving capitation payments in exchange for providing comprehensive healthcare services.
- WellCare Health Insurance of Arizona, Inc.coreParent company subsidiary relationship. 'Ohana CCS is offered by 'Ohana Health Plan and is a subsidiary of WellCare Health Insurance of Arizona, Inc., which is part of the WellCare/Centene corporate family providing government-sponsored healthcare plans.
- Centene CorporationcoreParent company. Centene Corporation is the parent organization of WellCare Health Plans, Inc., which operates 'Ohana Health Plan. Centene specializes in government-sponsored healthcare programs serving millions of members nationwide.
Scale indicators2 records
Recent moves6 records
Expansion highlights4 records
Ohana Health Plan competitors and assessment
Company assessmentBroad incumbents
- Elevance Health: Large diversified managed care insurer with extensive Medicaid and Medicare businesses across states, comparable in business model to Ohana at scale.
- Humana: Major Medicare Advantage and dual-eligible insurer nationally, overlapping with Ohana's MA-PD, D-SNP, and C-SNP offerings.
- Centene Corporation: Parent company and the largest U.S. Medicaid managed care insurer; operates the same government-sponsored model at national scale, of which Ohana is a subsidiary brand.
- CVS Health / Aetna: National insurer with sizeable Medicare Advantage and Medicaid managed care lines, competing in the same government-sponsored insurance category.
Direct peers
- Molina Healthcare: National managed care organization focused on Medicaid, Medicare, and dual-eligible members via government contracts, mirroring Ohana's capitated business model.
- UnitedHealthcare Community Plan (Hawaii): National insurer's Medicaid/Medicare managed care arm operating in Hawaii, competing for the same QUEST and Medicare Advantage populations Ohana serves.
Others
- Ohana Health Plan (Kaiser Foundation Health Plan competitor set): Placeholder omitted; retained slot reflects the concentrated Hawaii market where relevant direct competitors are limited to a handful of local plans.
Regional players
- AlohaCare: Hawaii-based nonprofit Medicaid (QUEST Integration) and Medicare D-SNP managed care plan; directly competes with Ohana for the same government-sponsored members in Hawaii.
- Kaiser Permanente Hawaii: Integrated payer-provider offering Medicaid and Medicare Advantage plans in Hawaii, competing for the same member base as Ohana.
- Hawaii Medical Service Association (HMSA): Hawaii's largest health insurer offering QUEST Medicaid and Medicare plans; the dominant local incumbent competing directly with Ohana across the islands.
Market position
Strengths4 records
Weaknesses4 records
Competitive moat5 records
Key risks6 records
Key highlights6 records
Customer concentration
Ohana Health Plan social profiles
Digital presenceOhana Health Plan compliance and trust
Trust signalCompliance1 record
Ohana Health Plan financial estimates
Financial estimateRevenue estimate
Valuation estimate
Ohana Health Plan leadership team
Management profileNumber of profiles
Profiles1 record
Ohana Health Plan subsidiaries and ownership
Company hierarchySubsidiaries2 records
Ohana Health Plan funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Ohana Health Plan M&A and investment
M&A and investmentM&A
Investments1 record
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Ohana Health Plan
What does Ohana Health Plan do?
'Ohana Health Plan is a Hawaii-based managed care organization that provides government-sponsored health insurance plans to eligible residents. It offers Medicaid (QUEST Integration), Medicare Advantage (HMO/PPO/D-SNP/C-SNP), Medicare Part D prescription drug plans, and a Community Care Services (CCS) behavioral health plan, supported by member and provider portals plus care management programs.
Is Ohana Health Plan a public or private company?
Ohana Health Plan is a public company. It is classified as corporate owned and is currently operating.
When was Ohana Health Plan founded?
Ohana Health Plan was founded in -1.
Where is Ohana Health Plan based?
Ohana Health Plan is headquartered in Kapolei, United States, in the North America region.
How does Ohana Health Plan make money?
Three revenue lines are on record. Medicaid Premium Revenue is the primary driver. The others are medicare Premium Revenue and community Care Services (CCS) Behavioral Health.
Who are Ohana Health Plan's main competitors?
Broad incumbents on record are Elevance Health, Humana, Centene Corporation and CVS Health / Aetna. Direct peers are Molina Healthcare and UnitedHealthcare Community Plan (Hawaii). Ohana Health Plan (Kaiser Foundation Health Plan competitor set) is listed as an others. Regional players are AlohaCare, Kaiser Permanente Hawaii and Hawaii Medical Service Association (HMSA).
Does Ohana Health Plan have an API?
No public API is recorded for Ohana Health Plan.
What industry is Ohana Health Plan in?
Ohana Health Plan's product category is Managed Care Health Insurance. Its primary akta.pro industry code is FSAIAGAA, Medicare Advantage (MA) Plans, with a secondary code of HLAEAMAH, Medicare Advantage HMOs (HMO/HMO-POS). Its NAICS code is 524114 and its SIC code is 6324.