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What Does Medicare in Hawaii Look Like?

Hawaii Medicare plans are an important part of how kama'aina access health care. As of August 2022, 293,951 residents of Hawaii - 20% of the state’s population — were enrolled in Medicare.

Medicare is a federal health program and all beneficiaries have access to Part A (hospital) and Part B (medical) benefits. While there are many similarities about Medicare from state to state, there are differences in the particular private plans available and the numbers of people enrolled in them.

What Does Medicare in Hawaii Look Like?

Medicare beneficiaries can choose to receive their benefits directly from the federal government by enrolling in Original Medicare along with a Part D plan for prescription drugs and a Medigap plan to cover out-of-pocket costs. Alternatively, beneficiaries may choose to enroll in a Medicare Advantage plan that typically includes prescription drug coverage and coverage for additional services such as hearing, dental, and vision.

How many residents of Hawaii are enrolled in Medicare Advantage plans?

Across the country, less than half of Medicare beneficiaries (46%) are enrolled in Medicare Advantage plus but Hawaii is among a handful of states where the majority of Medicare beneficiaries (52%) have chosen Advantage plans.

Medicare Advantage plan options vary from county to county with larger counties typically having more plans to choose from. For example, Honolulu County has over 1 million residents and 26 different Medicare Advantage plan options while Kalawao County has only 82 residents and eight Medicare Advantage plan options. Contact a local Medicare insurance agent to discuss your options.

At Premier Benefit Consultants, we help kupuna enroll in Medicare Advantage plans all over Hawaii and we are proud to be the only insurance agency in Hawaii contracted with EVERY Medicare Advantage plan!

Medigap enrollment in Hawaii

Medigap plans are used to supplement Original Medicare. They cover some or all of the out-of-pocket costs for coinsurance and deductibles that beneficiaries would otherwise have to pay if they were only enrolled in Original Medicare.

As of 2022, there are 11 insurers offering Medigap plans in Hawaii. Because Medigap plans are standardized under federal rules, you can expect each insurer to offer the same 10 plans. What varies from company to company is the price.

Note: States can add their own regulations on top of federal regulations. Click here to learn more about Hawaii’s Medigap policies.

Under §16-12-6.2, Hawaii requires all Medigap insurers to offer all Medigap plans on a guaranteed-issue basis (without charging higher premiums to applicants with pre-existing health conditions based on medical underwriting) to any enrollee during the six-month window that begins when the person is enrolled in Medicare Part B. This is important because the federal law only requires insurers to offer plans on a guaranteed-issue basis to people aged 65 and older while Hawaii’s law extends the same protections to people who are under 65 and eligible for Medicare as a result of a disability.

Medicare Part D enrollment in Hawaii

Prescription drugs for use outside of the hospital setting are not covered by Original Medicare. Medicare beneficiaries have two main options for prescription drug coverage:

1. Original Medicare with a standalone Part D prescription drug plan

As of August 2022, there were 70,951 people with Medicare in Hawaii who were covered by stand-alone Medicare Part D plans. Note: this number also includes people enrolled in the small percentage of Advantage plans that do not include Part D.

2. Medicare Advantage plan that includes Part D coverage

An additional 146,225 beneficiaries had Medicare Part D coverage through their Medicare Advantage plans, which makes Advantage plans with integrated prescription drug coverage the main source of Part D coverage in Hawaii.

Local Medicare agents are up to date on all state and federal laws about Medicare and can help guide you in making the best decisions for your Medicare coverage.

Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. We are the only insurance agency in Hawaii contracted with EVERY Medicare Advantage plan, which means we are able to offer unbiased advice; all at no cost to our clients.

At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.

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