Medicare is a federally administered health insurance program designed to improve seniors’ access to affordable care. Beneficiaries can select between Original Medicare and Medicare Advantage to receive services and coverage. Original Medicare consists of two parts. Medicare Part A is a no-cost plan for those who have paid Medicare taxes for a decade and their spouses that covers inpatient care with a set deductible and coinsurance based on the length of stay. Medicare Part B covers outpatient medically necessary health services, such as preventative doctor’s visits, durable medical equipment or lab tests. Medicare Advantage offers similar coverage through private insurance providers, which set their own fee schedules and lists of in-network providers.
Hawaii is home to 292,356 individuals enrolled in Medicare, representing around 20% of the state population. The state spends an average of $7,472 per Medicare enrollee, significantly less than the national average of $11,910. Overall, Hawaii spent $1.088 billion on Medicare in 2021, a figure projected to continue rising by 5.4% annually through 2031.
299,154 Hawaiians are eligible for Medicare Advantage in 2023, though just 53%, or 159,605, opt for this coverage. This is slightly higher than national norms, which reveal that 48% of those eligible participate in the Medicare Advantage program. Hawaii has seen a 2.55% increase in eligible enrollees since 2022, just under the 2.66% seen nationally. 5.94% more people eligible in Hawaii enrolled, creating a 3.30% increase in the enrollment percentage from 2022 to 2023. Compared to national norms, the growth in Hawaii is on the slower side. Nationally, 9.75% more eligible individuals enrolled in Medicare Advantage, creating a 6.90% increase in enrollment percentage from 2022 to 2023.
This guide addresses Medicare coverage in Hawaii, including the options available and how seniors can customize their coverage to suit their needs. It also lists free resources for Medicare beneficiaries to assist in making informed decisions on insurance choices.
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 includes two parts: Parts A and B. Part A covers inpatient hospital care, skilled nursing, nursing home care, hospice and home health care services. Part B covers other outpatient care, preventative care, durable medical equipment and mental health. Original Medicare beneficiaries can visit any Medicare-approved medical professionals within the U.S., though in most cases, Medicare won’t cover international care. Part A coverage requires a deductible of $1,600 for the first 60 days of inpatient care, then daily coinsurance fees for the remainder of the stay. Part B has a premium based on income starting at $164.90.
Who Should Consider Original Medicare
Original Medicare may be a good option for those who:
Medicare Advantage is an alternative to Original Medicare offered by private insurance providers. All plans must provide the same Part A and Part B coverage as Original Medicare, but there is some discretion toward other benefits, such as dental and vision. Providers can also decide to limit coverage to certain in-network providers. Most Medicare Advantage Plans are structured in four types: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Special Needs Plans (SNP) Private Fee-for-Service (PFFS) plans. These plans will have maximum out-of-pocket contributions, unlike Original Medicare.
Who Should Consider Medicare Advantage
Medicare Advantage plans may be the right fit for people who:
The Top Medicare Advantage Plans in Hawaii
There are 33 total Medicare Advantage Plans available for beneficiaries living in Hawaii. The table below features the top 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 August 2023. Additional information about Hawaii’s Medicare Part C plans can be found on the Medicare Advantage Plans in Hawaii page.
|Medicare Star Rating
|Monthly Cost Range
|$0 – $55
|HMSA Akamai Advantage
|$0 – $124
|$33 – $183
|$0 – $49
|Blue Cross Blue Shield of Michigan
|$0 – $33
|Wellcare by ‘Ohana Health Plan
|$0 – $14
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:
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 2023 page.
Who Should Consider Medicare Supplement Insurance
Good candidates for Medigap may be those who:
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.
The Hawaii State Health Insurance Assistance Program (SHIP) is a state program that provides outreach and education for Medicare beneficiaries who have questions about their coverage or benefits.
SHIP’s team of Medicare-certified counselors provides free, unbiased, one-on-one counseling to beneficiaries and their family members or caregivers. It also hosts free virtual presentations on a variety of topics related to Medicare for beneficiaries to get their questions answered from the comfort of their home.
The Senior Medicare Patrol (SMP) of Hawaii is a volunteer-based organization that aims to help Medicare beneficiaries and their families avoid health care fraud, Medicare scams, billing errors, identity theft and more. The organization provides educational resources to inform the public about the dangers of Medicare fraud and the importance of keeping their information safe. Beneficiaries who think they may have been a victim of fraud or billing errors can receive free one-on-one counseling and referrals to other agencies if they need additional help to resolve their case.
The Hawaii Employer-Union Health Benefits Trust Fund (EUTF) provides medical coverage and other benefits for employees of the state of Hawaii and its counties. It offers several Medicare Advantage plans for retirees and their spouses, in addition to other plans that retirees can sign up for alongside their state-mandated Medicare Part B coverage. Retirees can contact the EUTF with questions about their retirement benefits or review the Fund’s annual Retiree Health Benefits Highlights Guide.
The Medicare Rights Center maintains a free nationwide hotline for Medicare beneficiaries to speak with trained staff and volunteers about their Medicare questions and concerns. The center’s hotline can assist with benefits enrollment, coverage questions, fraud and scam concerns, navigating the appeals process and more.
The Medicare Rights Center also provides a wealth of educational resources and Medicare information on its website through its Medicare Interactive tool. Beneficiaries in Hawaii can access the information anytime, anywhere.
The US Department Of Veteran Affairs (VA) strongly encourages eligible veterans to enroll in Medicare along with their VA health care benefits. Hawaii veterans can visit the Veterans Benefits Administration Honolulu Regional Office to get help with benefits enrollment, learn more about how the two plans can work together and receive answers to their benefits questions.
The University Hawaii Elder Law Program provides legal services for seniors who are residents of Oahu and their families. The program can assist with legal questions related to Medicare, health care decisions, wills and trusts, finances and more. All services are at no cost, although the program takes donations as well. UHELP also hosts free events throughout the year on a variety of topics under the umbrella of elder law.
The Medicare Section of Hawaii’s Office of Health Care Assurance is the governing body that licenses and oversees all Medicare facilities across the state. Its website contains a list of all Medicare facilities as well as forms that beneficiaries can use to report any complaints they may have about the care they received at a Medicare facility.
The Social Security Administration has several offices throughout Hawaii. It serves as a local resource for residents to determine eligibility, sign up for coverage and receive answers to their questions. Along with in-person appointments, the Social Security Administration provides in-depth Medicare information on its website.