Hawaii—home to beautiful beaches, stunning scenic views, and fantastic Medicare options
From Honolulu to Hilo, Hawaii is famous for its spectacular beaches and natural attractions. Whether you’re Hawaiian or a resident of Hawaii, you’ll be happy to know an array of top-rated Medicare health plans are available to you.
With so many Medicare options, it can be hard to narrow them down. In this article, we’ll walk you through everything you need to know about getting Medicare coverage in Hawaii. We’ll also guide you through choosing the best plan for you. Let’s get started.
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In this article
How Much Does Medicare Cost in Hawaii?
The cost of Medicare in Hawaii will vary depending on the type of plan(s) you enroll in. The costs for Medicare Part A, Part B, and Part D are standardized by the federal government and updated annually.
Medigap and Medicare Advantage plans, on the other hand, are offered by private insurance companies and have various price points based on their extent of coverage. Other factors, such as your location, age, gender, and income, may also affect the cost of certain Medigap and Medicare Advantage plans.
Remember, regardless of what plan type you choose, your total Medicare costs are not limited to the monthly premium you pay. There are other associated costs to keep in mind when choosing a Medicare plan, like:
- Deductibles: This is the amount of money you must pay out of pocket before your coverage kicks in. Once you meet your deductible, your insurance plan will begin to pay for covered medical costs.
- Coinsurance payments: These payments are typically a small percentage of medical costs that you pay out of pocket. After meeting your plan’s deductible, your insurance plan will pay a percentage of the medical costs, leaving you responsible for paying the remainder. For example, an insurance plan may cover 80 percent, leaving the insured to pay for the remaining 20 percent of medical costs.
- Co-pays: This is similar to coinsurance, but instead of a percentage, the insured is responsible for a predetermined flat fee for specific medical services or prescriptions.
It’s important to read an insurance plan in full because a plan with the lowest monthly premium may not necessarily be the cheapest. If you anticipate frequent doctor visits, then a plan with a low monthly premium and high deductible may not be as cost-efficient as a plan with a higher monthly premium and zero deductible. Before signing up for a plan, it’s important to carefully review your needs and weigh all the pros and cons.
The Cost of Original Medicare in Hawaii
Original Medicare, which is made up of Medicare Part A and Part B, has standardized costs across the United States. Each year, the cost of Original Medicare increases at approximately 7.6 percent. The Centers of Medicare & Medicaid Services publishes the updated costs every year.
In 2021, this is what you can expect to pay for Original Medicare:
- Medicare Part A: Most Medicare beneficiaries do not have to pay a monthly premium for Medicare Part A. To qualify for a premium-free Part A plan, you are required to have at least 40 work credits (which equates to roughly 10 years of work). If you don’t meet this requirement, you can still enroll in a Medicare Part A plan with a monthly premium of $259 if you have 30 work credits or $475 if you have fewer than 30 work credits.
- Medicare Part B: Part B works on a sliding scale. For most beneficiaries, the Medicare Part B premium costs $148.50 per month. If you make over $88,000 as an individual or over $176,000 as a married couple, you can expect a higher monthly premium. People with low income may be eligible for a lower monthly premium through state Medicaid or the federal Extra Help program. The annual deductible for Part B is $203. After that amount has been met, Part B will cover 80 percent of covered medical costs and the insured will be responsible for 20 percent of medical costs.
If you qualify for a premium-free Part A plan, then Original Medicare can be affordable. If not, the costs begin to add up and become quite expensive. In these cases where Medicare costs may be difficult to manage, beneficiaries may benefit from enrolling in a Medicare Supplement Plan, also known as Medigap.
The Cost of Medigap Plans in Hawaii
Medigap is supplemental insurance that helps pay for deductibles, co-payments, and coinsurance. There are 10 different types of Medigap plan options, each designated by the letter A, B, C, D, F, G, K, L, M, or N.
Since Medigap is not a government program and is offered by private insurance companies, there is not a standard cost across the board for each type of Medigap program. For example, you might find a Medigap Plan G offered by one insurer that costs $124 a month. Another Medigap Plan G with the same exact coverage may be offered by another insurer for $189 a month.
Several factors, such as business practices, care agreements, and overhead costs, contribute to a Medigap plan’s monthly premium. Keep in mind that the lower monthly premium may not always be worth it. For example, let’s say you narrow down your options to a Medigap Plan G offered by Company A and Company B. Company B’s monthly premium is $20 more, but they also offer friendlier customer service and respond to all inquiries much faster than Company A. In this instance, even though Company B may cost a little bit more, they may be the better choice to avoid potential stress and headaches.
The Cost of Medicare Advantage in Hawaii
Hawaii Medicare Advantage plans at a glance:
Remember that while all Medicare Advantage plans have to cover what is in Original Medicare, not all MA plans will offer the same additional benefits. Take care in shopping around for a Medicare Advantage plan that works best for your personal needs. You can search for and compare Medicare Advantage plans in your area with this tool.
Medicare Advantage Plans serve as a more comprehensive alternative to Original Medicare. These plans are offered by approved private insurance companies and provide Part A, Part B, and Part D coverage, along with supplemental Medicare benefits like dental, hearing, and vision.
The Cost of Prescription Drug Plans in Hawaii
Hawaii prescription drug plans at a glance:
Medicare prescription drug plans (PDPs), also known as Medicare Part D, help cover the cost of medications prescribed by a doctor. With prescription medications becoming more costly every year, a PDP can provide substantial savings to some beneficiaries.
PDP pricing follows a formulary—tiered pricing system. Tier 1 is the least expensive and covers generic drugs. Tier 4 is the most expensive, covering specialty drugs.
When possible, it’s best to choose plans that include your medications in Tier 1 or Tier 2. This may not be possible if you take a specialty drug, a new drug, or have a preference for a certain brand.
If you need to take an expensive medication for a special health condition, you may be eligible for a more cost-effective Special Needs Plan.
Cost of Special Needs Plans in Hawaii
Hawaii Special Needs Plans at a glance:
You are dual-eligible for Medicare and Medicaid.Special Needs Plans (SNPs) are similar to Medicare Advantage plans but are designed for people with special health or financial circumstances. For eligibility, you must meet one of the following criteria:
- You have been diagnosed with a chronic condition like HIV/AIDS, cancer, dementia, chronic heart failure, ALS, or ESRD.
- You need to live in a long-term care institution, such as a nursing home, skilled nursing facility, or inpatient psychiatric facility.
Although these plans are offered by private insurance companies, they are regulated by the Centers for Medicare & Medicaid Services.
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What Is Medicare?
Medicare is a federal health insurance program that was founded in 1966. It was initially designed for senior citizens in the United States, who were often left behind and unable to seek medical treatment. Most people over the age of 65 were denied access to medical insurance due to the number of health issues experienced in older age.
With Medicare, this all changed. The program helped provide healthcare coverage to senior citizens. And over the years, it has expanded to help more groups of people who may have trouble finding or affording health insurance—like those with disabilities and those diagnosed with end-stage renal disease.
Run by the Centers for Medicare & Medicaid Services, the Medicare program is funded by Social Security and Medicare taxes that U.S. citizens pay on their income, by the federal budget, and through the premiums that Medicare recipients pay.
Medicare is made up of a few parts, with each focusing on a different aspect of health coverage:
- Medicare Part A covers inpatient care, which includes hospital stays, skilled nursing facilities, rehabilitation centers, and hospice care. It’s also known to many as “Hospital Insurance” and is the first half of Original Medicare.
- Medicare Part B covers most routine healthcare services, like doctor visits, outpatient care, medical supplies, and preventative health services. Part B is the second half of Original Medicare.
- Medicare Part C is an alternative option to Original Medicare. Also known as “Medicare Advantage,” Part C covers everything that Original Medicare covers but typically comes with additional benefits. These benefits may include dental, vision, and hearing aid coverage.
- Medicare Part D is a prescription drug coverage plan. Medicare Part D plans are optional and work with Medicare Part A, Part B, and Part C.
- Medicare Supplement Insurance is an additional insurance plan you can use to supplement Original Medicare. Also known as “Medigap,” this plan covers some expenses like deductibles, co-payments, and/or coinsurance.
Who Qualifies for Medicare in Hawaii?
To qualify for Medicare in Hawaii, you need to be an American citizen or a permanent resident during the last five consecutive years. If you meet this condition, then you qualify for Medicare coverage once you turn 65.
If you are under the age of 65, there are a few circumstances where you may be eligible for Medicare, which include:
- Being diagnosed with end-stage renal disease (ESRD)
- Being diagnosed with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease.
- Receiving Social Security, Railroad Retirement Board, or disability benefits for 24 consecutive months or more.
How Do I Choose Between Original Medicare and Medicare Advantage?
Choosing between Original Medicare and a Medicare Advantage plan may be one of the biggest decisions you’ll make. There isn’t one universally correct answer to which is better. Some beneficiaries may want a plan that covers a specific list of healthcare providers they have developed relationships with. Other beneficiaries may be more concerned with monthly premium costs.
Regardless of what your priorities are, we’ve covered the essential advantages and disadvantages of each option to help you with this decision.
How Do I Apply for Original Medicare in Hawaii?
Applying for Original Medicare in Hawaii is simple—even automatic in some cases. Hawaii residents who are receiving Social Security benefits may be automatically enrolled for Medicare once they are eligible. But no matter your circumstance, it is always highly recommended to check on the status of your enrollment as you approach your 65th birthday.
If you are not automatically enrolled and do not sign up for Medicare during your Initial Enrollment Period (which starts three months before your 65th birthday and ends three months after your 65th birthday), then you risk your monthly premiums increasing in cost.
It’s easy to check on your enrollment status and sign up. You can apply:
- Online at medicare.gov.
- Over the phone by calling the Social Security Administration at 1 (800) 772-1213; TTY users can call 1 (800) 325-0778.
- In person at your local Social Security office.
- Mailing in a paper application.
How Do I Apply for Medicare Advantage in Hawaii?
If you’ve decided that a Medicare Advantage plan works best for you, you still need to make sure to enroll in Original Medicare Part A and Part B during your Initial Enrollment Period. This is the only way to receive your Medicare number, which is required to apply for a Medicare Advantage plan. During the Medicare Open Enrollment Period, which is every year from October 15 to December 7, you can switch your coverage to your desired Medicare Advantage plan.
What’s the Best Medicare Advantage Plan in Hawaii?
The “best” Medicare Advantage plan will depend entirely on your needs, your preferences, and your budget.
- Your needs: How frequently do you visit the doctor? Do you have special health conditions that require specific coverage? Do you need a lot of prescription medications or specialized medication? These are just some of the questions you should consider when addressing your medical needs. The best Medicare Advantage plan will cover your unique needs.
- Your preferences: Do you prefer contacting customer service over the phone or online? Read customer reviews to get a feel for the insurance company‘s customer service, and take note of the method of communication they are known for. If you prefer to talk to a person over the phone, a great online portal might not matter to you as much as it does to someone else. Also, do you have certain healthcare providers that you prefer seeing or certain prescription drug brands you prefer? These are the types of preferences you should consider when choosing a plan.
- Your budget: The best plan shouldn’t be a financial burden to you. When comparing Medicare Advantage plans, remember to consider not just your monthly premium but also other out-of-pocket costs, such as deductibles, coinsurance, and co-payments.
Once you identify the features most important to your needs, you can narrow down the options. Finding the best Medicare Advantage plan for you is easy with Insurify. It takes just a couple of minutes to search for plans. Type in your ZIP code, and you’ll instantly be matched with plans that you can compare with a few clicks of your mouse.
FAQ: Hawaii Medicare
What is the cost of Medicare when you turn 65?
The total cost will depend on the type(s) of Medicare plans you choose. If you choose Original Medicare (Part A and Part B) and qualify for a premium-free Part A plan, you should expect to pay at least $148 per month. Your monthly premium may go up if your income exceeds a certain threshold or if you choose to enroll in Medigap or a prescription drug plan. If you choose a Medicare Advantage plan, which typically costs more than Original Medicare, you will need to compare the plans available to your local area.
Does Medicare cover me in Hawaii?
Yes. Medicare coverage is available in all 50 states. If you are an American citizen or permanent resident of the last five consecutive years and are 65 years or older (or meet a special condition if you are under the age of 65), then Medicare will cover you in Hawaii.
Which Medicare Advantage plans are offered in Hawaii?
There are 20 Medicare Advantage plans offered to Hawaii residents. To see all the Medicare Advantage plans available in Hawaii, you can enter your ZIP code here.
Which is better in Hawaii: Humana or United Health Medicare supplemental insurance?
The answer depends entirely on your personal preferences and needs. Humana has many initiatives and benefits offered to veterans, such as their "Humana Honors" Medicare Advantage plan. United Healthcare is known to offer more comprehensive additional benefits. To figure out which Medicare supplemental insurance is best, make sure to carefully compare your options.
Conclusion: Compare Hawaii Medicare Plans Before You Buy
Now that you’re armed with the knowledge of how Medicare works and the different types of coverage plans available, the next step is taking the time to evaluate your personal needs, preferences, and budget. Getting clear on these criteria will help you make an informed decision that works in your favor.
When you’re ready to begin comparing plans, remember that the Insurify Medicare comparison tool is here to make your life easier. Simply enter your ZIP code to unlock all the Medicare coverage options available in your area. Try it today!
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