When you turn age 65 in the Aloha State (or are under age 65 and meet certain requirements), you can get health insurance through the federal government with Medicare.
Medicare plans in Hawaii include:
- Original Medicare — parts A and B
- Medicare Advantage — Part C
- Prescription drug coverage — Part D
- Medicare supplemental insurance — Medigap
It’s important to understand each part of Medicare soyou get the correct coverage.
Original Medicare is divided into two separate parts that cover different types of care: parts A and B.
Part A (inpatient care) covers:
- hospital care
- limited stays at skilled nursing facilities (SNFs)
- limited home healthcare
Most people are eligible for Medicare Part A with no premium, but you can also purchase a part A plan if needed. You’ll be responsible for paying a deductible if you’re admitted to the hospital or a SNF for care, and there may be additional costs if you stay for more than 60 days.
Part B (outpatient care) covers:
- doctors’ visits
- medical equipment (wheelchairs, walkers, etc.)
- preventive care and screenings
- lab tests and imaging
You’ll pay a monthly premium for Medicare Part B coverage, plus an annual deductible. You also pay 20 percent coinsurance for care you receive under Part B.
Premiums and deductibles are set by the Centers for Medicare and Medicaid Services (CMS). There is no out-of-pocket spending limit with original Medicare.
In addition to original Medicare, there are also options for additional or alternative coverage through private providers.
Part C (Medicare Advantage)
All these options are bundled together in a single plan to make it easier for you to get the care you need. Some Medicare Advantage plans also have a limit on how much you pay out of pocket each year.
Part D (prescription drug coverage)
You must get prescription drug coverage through a private insurance plan. If you have original Medicare and want prescription drug coverage, you need to choose a Medicare Part D plan. If you have a Medicare Advantage plan, Part D may already be included.
Medicare supplemental insurance (Medigap)
Medigap plans are private insurance plans designed to help with the portion of original Medicare costs that you pay, such as deductibles for hospital stays, coinsurance, and copays. Medigap policies cannot be used for Medicare Advantage coverage or expenses.
If you choose to enroll in a Medicare Advantage plan, you must first enroll in original Medicare parts A and B, and pay the monthly part B premium.
You may owe an additional monthly premium for Medicare Advantage plans with extra coverage or benefits, such as:
- dental, vision, and hearing
- wheelchair ramps
- delivered meals to your home
- transportation to medical appointments
You can choose from four different types of Medicare Advantageplans in Hawaii:
- Preferred Provider Organization (PPO). These plans have a network of providers and facilities where you can go for care. If you go outside the network, the care will usually cost more or will not be covered at all. You don’t need a referral from your primary care doctor to see a specialist under PPO plans.
- Health Maintenance Organization (HMO). These plans have a network of providers and facilities where you can go for care. Care outside the plan is not usually covered unless it’s for an emergency. You must choose a primary care doctor to coordinate your care, including referrals to see specialists.
- Private Fee-for-Service (PFFS). With these plans, the insurance provider negotiates its own rates with medical professionals. There are no networks, so you can choose any doctor or go to any facility, but PFFS plans are not accepted everywhere so be careful before choosing this type of plan.
- Special Needs Plan (SNP). These plans are available if you need more coordinated care management because you have a chronic or disabling condition like diabetes, dementia, kidney disease like end stage renal disease (ESRD), you meet eligibility requirements for both Medicare and Medicaid (dual eligible), or you live and receive care in a nursing home.
Medicare Advantage plans in Hawaii are offered by theseinsurance carriers:
- HMSA Akamai Advantage
- Kaiser Permanente
- Lasso Healthcare
These companies offer plans in many counties in Hawaii. However, Medicare Advantage plan offerings vary by county, so enter your specific ZIP code when searching for plans where you live
To be eligible for Medicare, Hawaii residents must be:
- 65 years old or older
- a U.S. citizen or legal resident for at least the past 5 years
You may also qualify if you are under age 65 and:
- have kidney failure (ESRD) or a kidney transplant
- receive Railroad Retirement (RRB) or Social Security Disability (SSDI) benefits
- have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease
There are specific time periods when you can enroll in Medicare and Medicare Advantage.
Initial enrollment period (IEP)
You can initially enroll in Medicare three months before you turn 65 years old. Coverage will begin the first day of your birthday month. The initial enrollment period (IEP) extends for three more months after your birthday, but if you wait until your birthday month or later, there is a delay before your coverage begins.
During IEP you can sign up for:
- Part A
- Part B
- Part C
- Part D
General enrollment: January 1 to March 31
If you don’t enroll during your IEP, you can sign up each year during general enrollment. Coverage will not begin until July 1.
During general enrollment, you can:
- sign up for parts A and B
- switch from original Medicare to a Medicare Advantage plan
Medicare open enrollment: October 15 to December 31
Every year you are able to make changes to your Medicare plans during the open enrollment period. During open enrollment you can:
- switch from a Medicare Advantage plan to original Medicare
- enroll in Medicare Advantage plan
- sign up for Part D coverage
If you didn’t sign up for Part D coverage during your IEP and you don’t have coverage through other insurance (such as an employer), you may pay a lifetime late enrollment penalty when you sign up for Part D.
Medicare Advantage open enrollment: January 1 to March 31
If you’re currently enrolled in a Medicare Advantage plan, you can choose a new plan during the Medicare Advantage open enrollment period. You can also drop your coverage during this time. During open enrollment, you can:
- change Medicare Advantage plans
- drop your Medicare Advantage plan and switch to original Medicare
Special enrollment periods (SEPs)
If you’ve lost an employer-sponsored plan or have lost coverage for another reason, you may be eligible to enroll during SEPs without waiting for open enrollment.
Think carefully about your healthcare needs before selecting a plan. If you think you may have higher healthcare costs or need additional coverage, a Medicare Advantage plan may be a better option than original Medicare.
If you’re considering a Medicare Advantage plan, review the available plans carefully for:
- a network of doctors and facilities you prefer
- affordable monthly premiums, deductibles, coinsurance, and copays
- star ratings that reflect high quality care and patient satisfaction
- Hawaii State Health Insurance Assistance Program, SHIP (808-586-7299): Assistance with Medicare for individuals, families, caregivers, and agencies
- Hawaii Employer-Union Health Benefits Trust Fund (808-586-7390): Information about Medicare for State of Hawaii, county, and city employees covered by EUTF
- Hawaii Department of Health (808-586-4400): Information about Medicare facilities in Hawaii and critical access hospitals in Hawaii for rural areas
- Medicare (800-633-4227): Contact Medicare by phone or online
Take the next steps to find and enroll in a Medicare plan in Hawaii:
- Decide whether original Medicare or a Medicare Advantage plan is best for you.
- Research available plans for Part C, Part D, and Medigap coverage.
- Set a reminder for the next enrollment period to get signed up on time.
This article was updated on November 20, 2020, to reflect 2021 Medicare information.