Medicare Advantage Plans in Hawaii

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.

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.

*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.

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.

State-Wide Medicare Advantage Resources

Local Medicare Advantage Resources