TURNING 65 IN HAWAIʻI? HERE’S WHAT YOU NEED TO KNOW

Turning 65 is an important milestone. It also marks the time when most Hawaiʻi

residents become eligible for Medicare.

Unfortunately, Medicare isn’t always as simple as people expect. Between enrollment

deadlines, employer coverage, prescription drug plans, and Hawaiʻi’s unique healthcare

landscape, making the wrong decision can lead to unnecessary costs or penalties.

The good news? A little planning goes a long way.

Here are some of the most important things Hawaiʻi residents should know when

approaching Medicare eligibility.

1. Medicare Doesn’t Always Happen Automatically

Many people assume Medicare enrollment happens automatically when they turn 65.

That is sometimes true, but not always.

If you are already receiving Social Security benefits, you will generally be enrolled

automatically in Medicare Part A and Part B.

However, if you are not yet collecting Social Security, you may need to actively enroll

yourself.

Missing your enrollment window can result in delays in coverage and potential late

enrollment penalties.

2. Know Your Initial Enrollment Period

Your Initial Enrollment Period (IEP) begins three months before your 65th birthday

month, includes your birthday month, and continues for three months afterward.

This seven-month window is often your first opportunity to enroll in Medicare.

Waiting too long can create coverage gaps and may result in permanent penalties for

certain parts of Medicare.

Planning ahead is always easier than fixing a mistake later.

3. Still Working? Your Employer Size Matters

This is one of the most misunderstood Medicare topics in Hawaiʻi.

Many Hawaiʻi residents continue working past age 65 and are covered by employer-

sponsored health insurance.

Because Hawaiʻi has one of the nation’s strongest employer healthcare systems through the Hawaiʻi Prepaid Health Care Act, many employees assume they can simply

keep their work coverage and ignore Medicare.

Sometimes that’s true.

Sometimes it’s not.

The key factor is often the size of your employer.

Generally speaking:

• Employers with 20 or more employees typically allow eligible employees to remain on their employer health plan while delaying Medicare Part B without penalty.

• Employers with fewer than 20 employees may require Medicare to become your

primary coverage at age 65.

If Medicare should be primary and you fail to enroll when eligible, you may discover that

your employer plan pays less than expected, potentially leaving you responsible for

significant medical bills.

Because every situation is different, it is important to review your employer coverage

before making any Medicare decisions.

4. Medicare Part A Is Often Free

Most individuals qualify for premium-free Medicare Part A because they paid Medicare

taxes during their working years.

Part A primarily covers hospital-related services.

Even people who continue working sometimes choose to enroll in Part A at age 65

because there is often no monthly premium.

However, there are situations where enrolling in Part A may affect eligibility to contribute

to a Health Savings Account (HSA).

This is another area where personalized guidance can be valuable.

5. Don’t Forget Prescription Drug Coverage

Prescription drug coverage is another area where timing matters.

If you delay enrolling in Medicare drug coverage and do not have other creditable

prescription coverage, you may face a late enrollment penalty in the future.

The penalty can continue for as long as you have Medicare drug coverage.

Before declining any Medicare-related coverage, make sure you understand how your

current prescription benefits compare.

6. Hawaiʻi Healthcare Networks Matter

Unlike many parts of the mainland, Hawaiʻi has a unique healthcare environment.

Provider networks, physician groups, hospitals, and island-specific healthcare resources can all play an important role when selecting coverage.

The right Medicare plan for someone living on Oʻahu may not be the best fit for

someone on Maui, Kauaʻi, or Hawaiʻi Island.

Choosing a plan should involve more than simply comparing premiums.

7. Don’t Make This Decision Alone

Every year we meet individuals who missed deadlines, misunderstood employer

coverage rules, or selected a plan that wasn’t the best fit for their healthcare needs.

Most of these mistakes could have been avoided with a simple conversation

beforehand.

Medicare is not one-size-fits-all.

The right choice depends on your employment status, healthcare providers,

prescriptions, travel habits, budget, and long-term goals.

Need Help Navigating Medicare? Premier Benefit Consultants has helped thousands of Hawaiʻi residents understand their Medicare options and make informed decisions.

If you’re approaching age 65 and would like personalized guidance, we’re here to help.

Visit the PBC Medicare Knowledge Center for additional educational resources or

contact us through PBCHawaii.com to schedule a complimentary consultation.

Medicare is complicated enough. You don’t have to figure it out alone.

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ABOUT PREMIER BENEFIT CONSULTANTS

Premier Benefit Consultants (PBC) is an independent Hawaiʻi-based Medicare agency

contracted with every Medicare Advantage plan available in Hawaiʻi. Since 2008, PBC

has helped thousands of Hawaiʻi residents understand their Medicare options and make

informed healthcare decisions.

Whether you’re turning 65, retiring, moving, or reviewing your current coverage, our

team is committed to providing unbiased guidance and personalized service.

Visit PBCHawaii.com to learn more or schedule a complimentary consultation.