The Medicare Advantage (Medicare Part C) program lets you receive your Medicare benefits through a health plan offered by a private, Medicare-approved insurance company, rather than through Original Medicare, Part A and Part B. Medicare Advantage plans in Hawaii may offer different types of coverage, depending on the Hawaii zip code in which you live and on the plan you select. Understand what Medicare Advantage in Hawaii covers, and find out if this type Medicare plan is right for you.
How Medicare Advantage works in Hawaii
In Hawaii, Medicare Advantage is required by the government to offer at least the same hospitalization and medical benefits as Original Medicare, Part A and Part B. Many Medicare beneficiaries choose to enroll in a Medicare Advantage plan because certain plans offer additional benefits that aren’t available under Original Medicare, like routine vision, hearing, and dental services, and even fitness programs for seniors. Some Medicare Advantage plans in Hawaii also offer prescription drug coverage.
You can sign up for Medicare Advantage in Hawaii (as in other states) if you’re already enrolled or are eligible to enroll in Original Medicare, Part A and Part B. You can enroll in Original Medicare during your Initial Enrollment Period, if you’re not automatically enrolled at that time. If you don’t sign up for Medicare during your Initial Enrollment Period and you’re not automatically enrolled, you may be subject to a late-enrollment penalty. You can still enroll in Original Medicare at a later time, during the General Enrollment Period, which runs from January 1 to March 31 each year, but you might have to pay the penalty fee.
If you’re already enrolled in a Medicare Advantage plan in Hawaii, you can switch to a different Medicare Advantage plan or make other coverage changes during the Annual Election Period, also referred to as the Fall Open Enrollment Period, which runs from October 15 to December 7. Your new coverage goes into effect on January 1 of the following year. In certain situations (such as losing your health coverage or moving to a new address, for example), you may be able to enroll in or switch Medicare Advantage plans in Hawaii during Special Enrollment Periods. Special Enrollment Periods vary according to the health plan you choose and the reason you want to switch plans.
In Hawaii, you can also leave Medicare Advantage and switch back to Original Medicare, Part A and Part B, coverage during the Medicare Advantage Open Enrollment Period, which runs annually from January 1 to March 31 each year. You also can add a stand-alone Part D Prescription Drug Plan during this time if you drop your Medicare Advantage prescription drug coverage. You can also enroll into another Medicare Advantage plan.
Types of Medicare Advantage plans in Hawaii
Medicare Advantage in Hawaii generally includes the following types of plans:
- Health Maintenance Organizations (HMOs): This type of plan requires you to visit doctors, health-care providers, and hospitals listed in your plan’s network. You may also need a referral from your primary doctor to receive coverage for certain health services.
- HMO Point-of-Service (HMO-POS): An HMO-POS plan offers more flexibility than an HMO, sometimes allowing you to go out-of-network for certain health services but at a higher fee.
- Preferred Provider Organization (PPO)*: This type of plan offers even greater flexibility than an HMO-POS plan by allowing you to choose your own doctors, health-care providers, and hospitals, but possibly at a higher cost.
- Private Fee-for-Service (PFFS): A PFFS plan generally reserves the right to decide how much it will pay for your doctor, health-care provider, and hospital visits, and also determines your share of each expense.
- Medical Savings Account (MSA): An MSA plan combines a high deductible with a savings account, letting you use the account to pay for your health-care expenses.
- Special Needs Plan (SNP): Medicare SNPs are generally tailored to suit the specific health needs of each beneficiary, and they may include, among others, plans for patients with HIV/AIDS, dementia, or diabetes. SNPs are also available for those living in institutions (like nursing homes) and those who qualify for both Medicare and Medicaid.
- Medicare Advantage Prescription Drug (MAPD) plan: An MAPD plan combines health and prescription drug coverage (also available separately understand-alone Medicare Part D Prescription Drug Plans) into a single insurance plan.
With any type of Medicare Advantage plan, you’re still in the Medicare program and still need to pay your monthly Medicare Part B premium, as well as any premium the Medicare Advantage plan may charge.
Comparing Medicare Advantage plans available in Hawaii
As a Medicare beneficiary in Hawaii, you may find it useful to compare all the Medicare Advantage plans available in your area.
The availability and cost of Medicare Advantage plans generally varies depending on your state and county of residence. You may find that some Medicare Advantage plans in Hawaii offer premiums as low as $0, but always keep in mind that you must continue paying your Medicare Part B premiums, no matter which Medicare Advantage plan you choose, in order to retain your Medicare insurance coverage.
Some Medicare Advantage plans may offer additional benefits beyond what is included in Original Medicare, Part A and Part B. You may want to think about whether or not you want prescription drug coverage with your Medicare Advantage policy through a Medicare Advantage Prescription Drug plan, and which additional benefits (such as routine dental) might be important to you. It may a good idea to compare plans and choose the Medicare Advantage plan in Hawaii that suits your individual health needs.
To start comparing Medicare Advantage plans in Hawaii today, enter your zip code above for a customized list of plans available in your area. You can also enter your prescription drug needs to further customize your search and cost estimates.
View the following resources in order to learn more about Medicare in Hawaii:
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether the plan will cover an out-of-network service, you or your provider are encouraged to ask for a pre-service organization determination before you receive the service. Please call the plan’s customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.