Medicare Advantage Plans in Hawaii

Fact Checked
Published: June 25, 2021

In the United States, the federal government manages the Original Medicare program, which provides a basic level of health coverage to eligible adults. Medicare Advantage covers many of the same services, but it gives you the freedom to choose one of several plans, all of which are offered by private insurers. Every Medicare Advantage Plan offers at least the same amount of coverage as Original Medicare, ensuring you get the care you need as you get older.





  • In 2019, there were 20 Medicare Advantage Plans available in Hawaii.
  • 45% of the total Medicare population in Hawaii was enrolled in Medicare Advantage Plans as of 2018.
  • In 2018, Original Medicare spent an average of $6,971 per beneficiary in Hawaii, which is 31% lower than the national average.
  • Available Medicare Advantage Plans range from six to 20 across Hawaii’s five counties.

Plan availability depends on where you live and how many insurance companies have been approved to offer Medicare Advantage Plans in the state. If you decide to enroll in Medicare Advantage, you’ll be able to compare multiple plans and determine which one offers the best combination of price and coverage. In some cases, it makes sense to pay a higher premium to get a plan with a lower deductible or better coverage for the services you need.

Medicare Advantage Plans in Hawaii

Types of Medicare Advantage Plans

If you join Hawaii’s Medicare Advantage program, you’ll be able to choose from several types of plans. All of them cover basic hospital care, preventive services, and outpatient care provided by doctors and other health professionals. Your out-of-pocket costs will depend on which type of plan you select and how often you need medical care. HMOs, PPOs, PFFS plans, and SNPs are some of your options.

Health Maintenance Organizations (HMO)

Health maintenance organizations control costs by setting up networks of providers who agree to charge lower rates for plan members. Except in an emergency, you can’t go to a provider outside the network unless you’re willing to cover the full cost yourself. You may also have to choose a primary care provider (PCP), which is a doctor, physician assistant, or nurse practitioner who manages your care and determines when you need to see specialists.

Preferred Provider Organizations (PPO)

Preferred provider organizations have networks of participating providers, but they’re a little more flexible than HMOs. It costs less to see an in-network provider, but you can usually see an out-of-network provider if you’re willing to pay a higher percentage of the cost. Most PPO plans have no PCP requirement, so there’s no need to ask for referrals if you need specialist care. This is especially helpful if you need to see a specialist outside of the PPO network.

Private Fee-For-Service Plans (PFFS)

Private-fee-for-service plans also have networks of participating providers. If you receive care from one of these providers, it costs less than if you were to receive out-of-network care. The providers in a PFFS network agree to accept a set fee for each of their services, and they also agree to treat plan members. You can keep seeing your current provider as long as they agree to follow the terms of the plan.

Special Needs Plans (SNP)

Special needs plans aren’t available to everyone, as they’re restricted to individuals with chronic health conditions. For example, you may qualify for a special needs plan if you have some type of cancer. Each SNP is designed for people with a particular condition, ensuring that members have access to the services they need to keep their health problems in check. If you join an SNP, you may be assigned a care coordinator to help you access health-related resources.

Enrollment and eligibility for Medicare Advantage Plans in Hawaii

Eligibility

To enroll in Medicare Advantage, you must be eligible for Original Medicare and not have Medigap (Medicare Supplement Insurance) coverage. Original Medicare is available to adults aged 65 and older, people with end-stage renal disease (kidney failure), and younger people who’ve received Social Security Disability benefits for at least 24 months.

Enrollment Periods

In most cases, you must sign up for Medicare Advantage during your initial enrollment period, the open enrollment period, or the Medicare Advantage open enrollment period.

  • Your seven-month-long initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday month. It may take several months for your coverage to take effect, so it’s best to sign up as early as possible.
  • The open enrollment period is when you can switch Medicare Advantage Plans or join the Medicare Advantage program. It runs from October 15th to December 7th each year. If you enroll by the final day of the open enrollment period, your coverage will start on January 1st.
  • Medicare Advantage open enrollment allows you to switch Medicare Advantage Plans or leave the Medicare Advantage program and enroll in Original Medicare. It runs from January 1st to March 31st each year.

Under certain circumstances, you may qualify for a special enrollment period during the year. For example, if you previously qualified for an SNP and no longer meet the eligibility requirements, you may be able to sign up for a different plan during a special enrollment period.

Prescription drug coverage

If you choose a PFFS plan, it may not cover prescription medications as other Medicare Advantage Plans do. To ensure you have adequate coverage, consider buying a Medicare prescription supplement (Part D). Medicare Part D is a supplementary plan that covers the cost of prescription medications, reducing your expected out-of-pocket costs. If you sign up for Part D, you’ll pay a monthly premium and a copay for each of your medications.

Medicare Advantage Resources in Hawaii

Picking a Medicare Advantage plan is one of the most important decisions you’ll ever make. If you don’t fully understand the options, don’t enroll until you speak with someone who can explain the pros and cons of each type of coverage and recommend a plan that will work for your needs. Hawaii has several organizations available to answer questions related to Medicare and help you with enrollment, including the Hawaii Aging and Disability Resource Center, Senior Medicare Patrol Hawaii, and the Hawaii State Health Insurance Assistance Program.

Hawaii Aging and Disability Resource Center

The Hawaii Aging and Disability Resource Center helps older adults and residents with disabilities access the resources they need to remain independent. If you’re worried about paying your Medicare premiums or copays, contact the ADRC to speak with an experienced staff member. ADRC staff will ask questions about your health and financial situation to determine if you qualify for any of Hawaii’s income-based assistance programs. Staff members can also refer you to other organizations if needed.

Contact Information: Website | 808-643-2372

SMP Hawaii

Senior Medicare Patrol Hawaii exists to prevent Medicare fraud and help Medicare beneficiaries and their caregivers understand how to identify fraudulent practices. Each island has trained counselors available to teach you how to read Medicare statements, help you compare plans, and show you how to spot signs of fraud. The organization also offers presentations titled “Guard Your Card,” “Basics of Medicare,” and “Take Charge! Help Prevent Medicare Fraud and Abuse.” If you suspect fraud, call SMP Hawaii to speak with a trained counselor about your concerns.

Contact Information: Website | 808-586-7281

Hawaii State Health Insurance Assistance Program

Hawaii SHIP offers information and support to Medicare-eligible residents and their loved ones. If you find all the options confusing, you can attend one of Hawaii SHIP’s educational events to learn more about Medicare coverage, eligibility requirements, and enrollment options. SHIP counselors give group presentations, attend state health events, and provide one-on-one counseling to ensure Hawaii residents know how to compare Medicare plans and avoid Medicare-related scams and fraud. Call SHIP to speak with someone who can offer unbiased advice tailored to your situation.

Contact Information: Website | 888-875-9229

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