Hawaii Medicare Guide

Our licensed Hawaii Medicare Advisors make it easier to get to know your Medicare options and enroll in the plan that gets you the most value. Kick things off by scheduling a free consultation or calling us today at (888) 604-0055. 

Below, you’ll find key information about the options available in Hawaii to help you make informed Medicare decisions.

Use this table of contents to jump to specific sections:

• A Snapshot of Medicare in Hawaii

• Medicare Eligibility and Enrollment Steps

• Hawaii Medicare Advantage Plans

• Hawaii Medicare Supplement Plans

• Hawaii Medicare Part D (Prescription Drug) Plans

• Get help paying for Medicare in Hawaii

A Snapshot of Medicare in Hawaii

There are roughly 300,00 Medicare beneficiaries in Hawaii, making up 20% of the total population. 15% of Hawaii Medicare beneficiaries are also on Medicaid. 

Enrollment in Medicare Advantage vs. Original Medicare in Hawaii

When you first get Medicare, you enroll in Original Medicare (Parts A & B). Medicare beneficiaries have a choice between staying on Original Medicare or switching to Medicare Advantage. In Hawaii, there’s about a 50/50 split for Medicare Advantage vs. Original Medicare.

Those on Original Medicare can add a Medicare Supplement plan to their insurance coverage to significantly reduce their out-of-pocket costs. Choosing between Original Medicare and Medicare Advantage is a personal choice based on your health and financial situation. Speak with one of our licensed Hawaii Medicare Advisors to get personalized advice tailored to you.

Hawaii Medicare Eligibility and Enrollment Steps

Medicare eligibility is the same nationwide. If you’re a US citizen and meet one of the following conditions, you are eligible for Medicare:

• You’re 65 or older

• You have certain disabilities, like End-Stage Renal Disease or ALS

Three key steps for Hawaii Medicare enrollment:

1. Enroll in Original Medicare (Part A & Part B)

2. Choose your supplemental coverage

   • Medicare Supplement (Medigap)

   • Medicare Advantage (Part C)

   • Part D (drug coverage)

3. Set yourself up for success by finding doctors, sharing your plan information with your pharmacy, and accessing additional benefits that come with your coverage.

Hawaii Medicare Advantage Plans

Medicare Advantage (also known as Medicare Part C) plans replace Original Medicare. They must legally provide the same amount of coverage as Original Medicare and often include additional benefits, including:

• Dental, vision, and hearing benefits

• Prescription coverage

• Flex cards to use for things like groceries and over-the-counter medications

• Fitness perks

• Transportation services

Be careful in choosing a Hawaii Medicare Advantage plan specifically for these added benefits. You want to be sure your healthcare needs are met first. This includes being sure your preferred doctors are in-network and your prescriptions are covered. You should also know about the disadvantages that come with Medicare Advantage, including:

• Networks are limited

• Preauthorization requirements are common

• Your out-of-pocket costs will be higher than if you’re on Original Medicare with an added Medigap plan

Half of Medicare beneficiaries choose to enroll in one of the 24 Medicare Advantage plans available in Hawaii. Plan pricing and availability may vary by county. For example, Honolulu County has 20 Medicare Advantage plans available from eight insurance carriers and Maui County has 18 plans available from six carriers (in 2023). To hear about Medicare Advantage plans available in your county, schedule a free consultation with one of our licensed Hawaii Medicare agents or call us today at (888) 604-0055. 

Hawaii Medicare Supplement Plans

Original Medicare covers about 80% of the costs of covered services, leaving the remaining 20% (your coinsurance) for you to pay. Many people on Original Medicare choose to enroll in a Medicare Supplement (Medigap) plan to reduce their out-of-pocket costs, pay less for treatments, and get better financial predictability. 

The advantages that come with Medigap plans counter the big drawbacks of Medicare Advantage plans. The most important differentiators are:

• You can see any doctor that accepts Medicare (about 90% of doctors nationwide)

• You don’t need prior authorization for covered services

• Your out-of-pocket costs are significantly reduced, regardless of which of the ten plan types you choose

Medigap Plan G is the most comprehensive type of Medigap plan. It covers almost all of your out-of-pocket costs (you just have to meet your Part B deductible). Our lead advisor, Ari Parker often shares a story about his mother who, without a Plan G, would have had to spend $8,000 on her knee surgery. Because she had enrolled in a Plan G, she reached the 2022 Part B deductible ($233) and didn’t owe a penny more. 

When you enroll in a Medicare Supplement plan matters a lot! It’s best to enroll in a Supplement during your Medigap Open Enrollment Period, which occurs during the first six months that you have Medicare Part B coverage. During this period, you have a guaranteed issue right, which means you cannot be denied acceptance into any Medigap plan and insurance carriers cannot charge you more—regardless of your medical history. If you choose to enroll in a Medigap plan later, insurance companies can ask you questions about your age and health and may deny you coverage. Learn more about Medigap enrollment and additional guaranteed issue periods here.

Hawaii Part D (Prescription Drug) Plans

Original Medicare doesn’t include prescription coverage, which is why we have Medicare Part D (prescription drug coverage). Medicare beneficiaries can secure prescription drug coverage by either enrolling in a Medicare Advantage plan that includes it or enrolling in a stand-alone Part D plan. Hawaii has a total of 20 stand-alone Part D plans available, but the number available to you is based on your county. The exact number of plans available to you will be based on your zip code. 

Take note of all of your prescriptions and dosages before comparing drug plans to ensure you get the best value. If you aren’t currently taking any prescriptions, we generally recommend to still enroll in one of the cheaper Part D plans to avoid the Part D penalty. 

Get help paying for Medicare in Hawaii

Medicaid, Medicare’s Extra Help Program, and Social Security Income Benefits provide financial assistance for Medicare beneficiaries with low income and resources.

Medicaid

Medicaid is a jointly administered federal and state program that provides health coverage assistance with certain categories of individuals, including those who are aged, blind, or disabled. Medicaid programs are operated by each state and eligibility requirements are based on low income and resources. Hawaii created the Med-QUEST Division to run the state’s Medicaid program. 

For those who are eligible, the QUEST Integration program provides several benefits, including vision, hearing, and behavioral health services. 

Medicare Savings Programs

Hawaii Medicare Savings Programs are run by the state Medicaid office to provide assistance with medicare costs for four groups of Medicare beneficiaries:

1. Qualified Medicare Beneficiaries (QMB)

2. Specified Low Income Medicare Beneficiary (SLMB)

3. Qualifying Individual-1 (QI-1)

4. Qualified Disabled and Working Individual (QDWI)

Learn about eligibility and benefits for each group here.

Medicare Extra Help Program

Extra Help is a federal program that helps low-income individuals with Part D costs. If you meet any of the following conditions, you’ll qualify for Extra Help automatically:

• You receive full Medicaid coverage from Hawaii

• Hawaii helps pay your Part B premium

• You get Supplemental Security Income (SSI) benefits

If you don’t automatically qualify for Extra Help, you can learn more about eligibility here. If you need help, you can speak with one of our Hawaii Medicare Advisors who can help you with the application process.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

• You are 65 and older, blind, or have a disability

• You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.

Medicare overwhelms many people, and that’s why we’re here to help! Our licensed Hawaii Medicare Advisors can walk you through your options, compare pricing and benefits, and help you enroll in the right coverage for your specific health and financial needs. Get started today! Schedule a free consultation or give us a call at (888) 604-0055.