Medicare Plan Options
Hawaii seniors have many options when it comes to Medicare health insurance. Original Medicare provides traditional health coverage, including Part A, which covers inpatient services, and Part B, which covers outpatient and preventive care services. Hawaii residents can add prescription drug coverage or purchase other supplemental plans to reduce out-of-pocket costs. Another option is to choose one of the plans available through Hawaii’s Medicare Advantage program, which may include prescription coverage and other benefits depending on the terms of the plan.
The federal government manages the Original Medicare program, which consists of Medicare Part A and Part B. Under the terms of the program, Part A pays for hospitalization, nursing home care, hospice care, home health services, and care provided by a skilled nursing facility. Medicare Part B pays for preventive services, such as screening tests used to diagnose disease, and services or supplies that are medically necessary to diagnose or treat a medical condition. With limited exceptions, Original Medicare doesn’t cover the cost of prescription drugs. It also doesn’t cover routine dental care or routine vision care, including eyeglasses and contact lenses.
Medicare Advantage Plans
The federal government doesn’t manage Medicare Advantage plans. Instead, they’re offered by private insurance companies that agree to follow the Medicare guidelines. In addition to Part A and Part B coverage, many Medicare Advantage plans include prescription drugs. Some plans even cover routine vision or dental services not covered by Original Medicare. Out-of-pocket costs vary based on the plan selected, and private insurers are allowed to set their own requirements regarding out-of-network coverage and referrals. Medicare Advantage plans may be set up as health maintenance organizations (HMOs), special needs plans (SNPs), private fee-for-service (PFFS) plans, or preferred provider organizations (PPOs).
Medicare Prescription Drug Coverage Plans
Because Original Medicare doesn’t usually cover prescription drugs, you might purchase Medicare Part D coverage to reduce out-of-pocket medication costs. Each plan has its own formulary, which is a detailed list of drugs covered under the plan. Generic drugs usually cost the least, while specialty drugs and brand name, non-preferred drugs cost the most. Out-of-pocket costs include a monthly premium, a yearly deductible, and copayments or coinsurance payments for each medication. If you have a Hawaii Medicare Advantage plan, you may not need to purchase a Part D plan, as many Medicare Advantage plans already include prescription coverage.
Medicare Supplement Insurance Plans
Original Medicare has some gaps in coverage that may leave Hawaii seniors with higher out-of-pocket costs than expected. One way to minimize these costs is to purchase a Medicare supplement, also known as a Medigap plan. Supplemental plans help cover some of the out-of-pocket costs associated with Original Medicare, including co-payments, deductibles, and coinsurance. Medigap plans may even cover services that aren’t covered by Original Medicare, such as medical expenses incurred while traveling in other countries. Medigap premiums are paid to a private insurance company and are separate from the premiums paid for Original Medicare.
Medicare in Hawaii by the Numbers
|People enrolled in Original Medicare||Average plan cost||Annual state spending per beneficiary||Spending per beneficiary compared to the national average|
|147,055||Plan A: $0 to $471 per month*
Plan B: $148.50 per month**
*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.
Medicare Resources in Hawaii
With so many Medicare options available, it can be difficult to determine which one offers the best combination of benefits with the lowest out-of-pocket costs. But you can get help from Hawaii organizations that help seniors compare plans.
Hawaii State Health Insurance Assistance Program
Hawaii SHIP receives federal funding to help Medicare beneficiaries and their family members learn more about the services available to them. Trained volunteers answer questions regarding Original Medicare, Medigap plans, Medicare Advantage, and prescription drug coverage under Medicare Part D. The organization also offers group presentations on Medicare upon request. Seniors on the island of Oahu can call 808- 586-7299 to reach a certified counselor. Seniors living on other Hawaiian islands can call 1-888-875-9229.
Contact Information: Website | 808-586-7299
Senior Medicare Patrol Hawaii
Senior Medicare Patrol Hawaii is staffed by volunteers who ensure that Medicare isn’t billed for services not provided. The organization responds to alerts from seniors who are billed twice for the same service, receive bills for services that weren’t ordered by a medical professional, or receive bills for medical services or supplies they didn’t receive. SMP Hawaii recommends that seniors with questions about their Medicare statements contact their doctors or health plans first. If a doctor or health plan representative doesn’t provide an adequate response, seniors can call SMP Hawaii for assistance.
Contact Information: Website | 808-586-7281 on Oahu or 1-800-296-9422 on other islands
Hawaii County Office on Aging
The Hawaii County Office on Aging is the Area Agency on Aging responsible for providing information and services to residents of Hawaii County. Assistance is available to county residents aged 60 and older, their family members, and younger people with qualifying disabilities. The agency has an online assessment tool to help seniors and their caregivers locate resources to help with home repairs, activities of daily living, skilled nursing care, and treatment for chronic illnesses. Staff members are also available via telephone to answer questions and provide referrals to local programs.
Contact Information: Website | 808-643-2372
Honolulu Elderly Affairs Division
The Honolulu Elderly Affairs Division is the Area Agency on Aging for residents of Oahu. Staff members provide referrals to community programs, information about aging and disabilities, assistance applying for Medicare and other government benefits, and assistance choosing a long-term care facility. Seniors who need help comparing Medicare plans or applying for Medicare coverage can contact the agency’s Senior Helpline to connect with an experienced staff member and learn more about local resources for seniors.
Contact Information: Website | 808-768-7700
Maui County Office on Aging
As one of the Area Agencies on Aging for Hawaii, the Maui County Office on Aging provides information and referrals to seniors on the islands of Maui, Lanai, and Molokai. The agency aims to connect seniors with resources that can help them maintain their independence and dignity as they age. The Maui County Office on Aging also maintains a directory of organizations that offer Medicare Advantage plans, help applying for Medicare, and other resources of interest to seniors who qualify for Medicare coverage.
Contact Information: Website | 808-643-2372