Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Medicare Advantage is an alternative way for Medicare recipients to receive health care benefits. Also known as Medicare Part C, it combines Medicare Part A and Medicare Part B into a single plan. Medicare Advantage is offered by private insurers rather than the federal government, and these companies can offer benefits not included in Original Medicare. This can include transportation to medical appointments, wellness programs and dental care. Except for hospice care, Medical Advantage plans must also offer at least the same level of coverage as Original Medicare.
Most Medicare Advantage plans also include prescription drug coverage. This means seniors don’t have to purchase a supplementary prescription drug plan. Medicare Advantage providers can set their own requirements regarding referrals, the use of in-network providers and out-of-pocket costs, but they do have to follow rules set down by the Centers for Medicare & Medicaid Services. Of the 278,558 Hawaiians eligible for Medicare about 47% were enrolled in Medicare Advantage plans, in 2020, compared to the national average of 42%.
This guide provides senior Hawaiians with an overview of Medicare Advantage plans available in their state. It also includes information on what the plans cover, who is eligible for Medicare Advantage and how to find a suitable Medicare Advantage plan.
The Top 10 Medicare Advantage Plans in Hawaii
There are several insurance companies that offer Medicare Advantage plans in Hawaii, giving Medicare-eligible residents a wide range of plan options to choose from. The table below lists the top 10 most popular Medicare Advantage providers in the state. As most providers offer multiple plans, we’ve added together enrollment numbers for each plan to determine the total number of enrollees for Hawaiian providers. We also include cost information as a range rather than an average price to account for different plans. This information was correct as of April 2022, but seniors can visit medicare.gov to get the most recent information on plans available in their area.
HMSA Akamai Advantage
Anthem Blue Cross and Blue Shield
Blue Cross Blue Shield of Michigan
How Medicare Advantage Plans Work in Hawaii
Understanding the different plan types available in Hawaii can help Medicare-eligible residents make the best choice for their health needs. Each provider can offer multiple plans, including health maintenance organization plans (HMOs), preferred provider organization plans (PPOs) and private fee-for-service plans (PFFS). Each plan type has different rules regarding prescription drug coverage, the need for a primary care physician, referrals and in-network coverage. The four most common plan types are described below.
What Medicare Advantage Plans Cover in Hawaii
All Medicare Advantage plans must offer the same benefits as Original Medicare, including hospital care, preventive screenings, mental health services and lab tests. The one exception is hospice care, which is not included in Medicare Advantage plans. Medicare Advantage plans can also offer extra benefits, such as dental care, prescription drugs and vision services. These extra benefits differ depending on the plan and provider, so seniors should check that their needs are covered before deciding on a plan.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Durable Medical Equipment
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in Hawaii
Medicare Advantage plans are available to people who meet Medicare eligibility requirements and already have Medicare Part A and Medicare Part B. To qualify for Medicare, an applicant must be a U.S. citizen or lawful immigrant who is aged 65 or older. People younger than 65 may be eligible if they have a disability. To be eligible for a specific Medicare Advantage plan, a person must live in the plan’s service area.
As with other types of health insurance, Medicare Advantage has limited enrollment periods. It’s important that seniors understand when they can enroll in or change a Medicare Advantage plan to ensure they’re health care needs are properly covered. The list below has more information about the timing of Medicare enrollments.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
Medicare Advantage Open Enrollment Period
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in Hawaii
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
Hawaii’s State Health Insurance Assistance Program (SHIP) is a federally funded program that provides free Medicare counseling. Administered through the Hawaii State Department of Health, SHIP is open to Medicare beneficiaries, their families and their caregivers, as well as those seniors who will soon be eligible for Medicare. SHIP Medicare counseling is delivered through a network of trained and vetted volunteers. SHIP volunteer counselors can give seniors information on Medicare and Medicare Advantage, as well as programs that help low-income seniors. This free MA counseling is presented via small group sessions and on a one-to-one basis through in-person meetings and phone calls.
To connect with a local SHIP volunteer counselor, seniors can call Hawaii SHIP at 1-808-586-7299 on the Island of Oahu. Seniors who reside on neighboring islands can also call the statewide number at 1-888-875-9229. They can also complete an online contact form on the SHIP Hawaii website.
The Legal Aid Society of Hawaii assists low-income seniors with issues related to Medicare Advantage. MA beneficiaries can access free and low-cost legal advice related to health insurance, and service is generally delivered through one-on-one appointments. Legal Aid counselors can also refer seniors to local resources related to Medicare.
The Legal Aid Society of Hawaii can be reached by phone at 1-808-536-4302.
Senior Medicare Patrols (SMPs Hawaii)
Senior Medicare Patrols (SMPs) are federally-funded, state-regulated volunteer groups that work to improve Medicare for seniors by preventing, detecting and reporting health care fraud, abuse and billing errors. There are more than 40 SMP volunteers in Hawaii who provide free one-on-one counseling to help beneficiaries correct Medicare billing errors. SMPs also deliver free information workshops throughout the state and make referrals to state and federal agencies when Medicare abuse or fraud is suspected.
To contact the Hawaii Senior Medicare Patrol, Oahu seniors can call 1-808-586-7281. Those who live on neighboring islands can call the statewide toll-free number at 1-800-296-9422.
Local Medicare Advantage Resources
Hawaii Aging and Disability Resource Center
Hawaii’s Aging and Disability Resource Center provides seniors and their caregivers with help finding long term supports, services and resources related to health and wellness. Funded by the State of Hawaii, as well as each county, ADRC staff can assess each seniors’ eligibility for government-funded programs, help seniors find service providers and make referrals to local resources. ADRC workers can also work with seniors and their families to develop a long-term care plan that includes coverage through a Medicare Advantage plan.
To connect with a local ADRC staff member, seniors can call the ADRC statewide phone number at 1-808-643-2372.
Hawaii County Office of Aging
The Hawaii County Office of Aging is the Area Agency on Aging for Hawaii County. The office works to plan, coordinate and administer programs and services for seniors, as well as to advocate for services that help older adults live with dignity. Seniors, adults with disabilities and their families can use the online needs assessment tool, use the eldercare search to find local resources and apply for country-funded services, such as transportation, adult day care and home-delivered meals.
To contact the Hawaii County Office of Aging, seniors can call either the Hilo or the Kona office. The contact number in Hilo is 1-808-961-8626, while the contact number for the Kona office is 1-808-323-4390.
County of Kauai Agency on Elderly Affairs (AEA)
The Country of Kauai Agency on Elderly Affairs (AEA) is the local Area Agency on Aging for Kauai. The AEA administers transportation, homemaker, personal care, respite and elderly nutrition programs for seniors aged 60 and older. The AEA also provides caregiver counseling, case management and referrals, with a focus on those seniors with low-incomes and those seniors who are socially isolated. Seniors and their caregivers can access many of AEA’s resources through Kauai’s virtual Aging and Disability Resource Center, and the AEA hosts a number of public education events throughout the year.