Medicare in Hawaii

The Aloha State is home to 278,558 residents enrolled in Medicare, a federal health insurance program for people over 65 and people with specific long-term disabilities or end-stage kidney disease. Medicare Part A and Part B are part of Original Medicare. Medicare Part A is at no cost to individuals who paid Medicare payroll taxes for at least a decade and their spouses. It covers inpatient care in hospitals, skilled nursing facilities, hospices and some home health care. The standard Medicare Part B premium amount is $170.10 in 2022. While Part A focuses on inpatient care, Medicare Part B covers outpatient medically necessary health services such as doctor’s visits and laboratory tests. 

Medicare beneficiaries represent 19% of Hawaii’s population. The state spends an average of $7,208 on each enrollee per year, which is lower than the nationwide average of $10,536 per enrollee. In total, Hawaii spends about $1 billion on Medicare each year. The state’s total annual Medicare expenditure has increased by 7.8% over the last two decades. 

Of the 278,558 Hawaiians enrolled in Medicare in 2020, 131,102 enrolled in Medicare Advantage Plans. Also called Medicare Part C, Medicare Advantage Plans are private health insurance that covers everything included in Medicare parts A and B and usually includes additional benefits for dental, vision and prescription drug coverage (known as Medicare Part D). 

This guide covers the specifics of Medicare in Hawaii, including what options are available and how residents can customize their coverage with the added benefits of Medicare Advantage Plans, the prescription drug coverage of Medicare Part D or the cost savings of supplementary Medigap plans. It also includes a list of free resources available to Medicare beneficiaries and their families to help them make informed health care decisions.

Options for Medicare Coverage in Hawaii

While many seniors and people with certain disabilities in Hawaii may feel that Original Medicare satisfies their health insurance needs, others may have different coverage priorities. Medicare isn’t a one-size-fits-all program, and beneficiaries can tailor their plans to fit their individual needs. Medicare Advantage Plans, Medicare Part D and Medigap supplementary plans give Hawaii’s residents the ability to expand upon Original Medicare coverage.

Original Medicare (Parts A & B)

Original Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Advantage is also known as Medicare Part C. It’s a private health insurance alternative to Original Medicare. Medicare Advantage plans cover all of the same services as Medicare parts A and B, and most plans offer prescription drugs (Part D). Many Advantage plans also offer additional coverage benefits for dental, vision,and wellness programs. The four types of Medicare Advantage plans are Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee For Service (PFFS) plans and Special Needs Plans (SNPs). Each differs when it comes to factors like coinsurance, deductibles and eligibility. Unlike Original Medicare, all Advantage plans have an annual out-of-pocket maximum. 

Who Should Consider Medicare Advantage

Medicare Advantage plans may be the right fit for people who:

• Want a plan that covers vision and dental services 
• Want to limit out of pocket expenses 
• Are overall healthy and qualify for lower premiums
• Don’t mind needing physician referrals or prior authorizations
• Are okay with being limited to a predetermined number of in-network physicians 
• Are fine with a managed care plan

The Top 10 Medicare Advantage Plans in Hawaii

There are 33 total Medicare Advantage Plans available for beneficiaries living in Hawaii. The table below features the top 10 most popular plans by enrollment. There is additional information about what types of plans they offer and how much enrollees pay for coverage for each plan provider listed. The information in the table is current as of April 2022. Additional information about Hawaii’s Medicare Part C plans can be found on the Medicare Advantage Plans in Hawaii page. 

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2022 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Hawaii

Hawaii residents can take advantage of various free resources provided by the state or federal government to help them navigate the ins and outs of Medicare. Beneficiaries and their families can contact the agencies and departments below to learn more about Medicare benefits, research plans available in their area, enroll in coverage and get help with costs and logistics.