Medicare in Hawaii

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.

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 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:

• 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 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:

• 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 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 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 2023 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.