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Medicare in Hawaii

October 6, 2016

Medicare health insurance can play an important role in the lives of Hawaii residents who have reached the retirement age of 65. The “parts” of Medicare include Original Medicare, Part A and Part B; Medicare Part C (Medicare Advantage); and Medicare Part D (prescription drug coverage).

You may also be eligible for Medicare in Hawaii (as in all states) before the age of 65. If you’ve been receiving disability benefits from the Social Security Administration (SSA) or Railroad Retirement Board (RRB) for at least 24 months in a row, you might be enrolled in Medicare Part A and Part B automatically. You might also qualify for Medicare if you have amyotrophic lateral sclerosis (ALS) or end-stage renal disease (ESRD).

Original Medicare for Hawaii beneficiaries

Original Medicare consists of two parts: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Medicare beneficiaries in Hawaii, as in other states, are usually automatically enrolled in Medicare; this happens when you’re already receiving Social Security or Railroad Retirement Board benefits when you turn 65 or have a qualifying disability, as described above. If you have ESRD before age 65, you might qualify for Medicare, but you need to enroll manually.

If you’re not automatically enrolled, you can enroll in Original Medicare during the seven-month Medicare Initial Enrollment Period which begins three months before the month you turn 65, includes your birthday month and ends three months after that month. You can also enroll in Original Medicare during the General Enrollment Period, which takes place every year from January 1 to March 31. However, if you miss your Initial Enrollment Period and end up enrolling in Medicare at a later date, you might have to pay higher monthly premiums. This is the Medicare late enrollment penalty.

Medicare beneficiaries in Hawaii, like those in other states, can generally enroll in Medicare Part A without paying a monthly premium. If you’ve worked for at least 10 years (40 quarters) while paying Medicare taxes, Part A is generally premium-free.

Medicare Part A includes the following health coverage:

  • Hospital care
  • Skilled nursing facility care
  • Nursing home care
  • Hospice care
  • Limited home health services

Medicare Part B, also part of Original Medicare, provides medical insurance and charges a monthly premium. Under Medicare Part B, Hawaii beneficiaries, like those of other states, can receive services and supplies such as (but not limited to):

  • Clinical research
  • Ambulance services
  • Durable medical equipment
  • Mental health (inpatient, outpatient, and partial hospitalization)
  • Second opinion before surgery
  • Limited outpatient prescription drugs

Medicare plan options in Hawaii

Medicare beneficiaries in Hawaii may have several coverage choices through the Medicare plan options described below.

These plans are offered by private insurance companies that contract with Medicare.

The Medicare Advantage (Medicare Part C) program offers an alternative way to get your Original Medicare (Part A and Part B) benefits. Medicare Advantage plans include your Medicare Part A and Part B benefits (except hospice care, which is covered under Part A). There may be a Medicare Advantage plan in your area that has additional coverage, such as routine dental, vision, or hearing benefits.

If you seek health and prescription drug coverage through a single Medicare plan, you may be able to enroll in a Medicare Advantage Prescription Drug plan. You need to be enrolled in Medicare Part A and Part B to qualify for any Medicare Advantage plan. Please note that even if you sign up for a Medicare Advantage plan or a Medicare Advantage Prescription Drug plan, you have to continue paying the Medicare Part B premium, in addition to any premium your plan provider charges, to maintain your Medicare insurance coverage. To learn more, read about Medicare Advantage plans in Hawaii.

Medigap (Medicare Supplement) plans are also offered by private insurance companies and can help you pay your out-of-pocket costs for services covered under Medicare Part A and Part B. You can find out more about Medigap plans in Hawaii.

Original Medicare includes limited prescription drug coverage and doesn’t cover most medications you would take at home. You can add this benefit through a stand-alone Medicare Part D Prescription Drug Plan. In Hawaii, as in every state, Medicare Prescription Drug Plans may have different costs, but may require payment of a monthly premium, annual deductible, and copayment or coinsurance. These stand-alone Medicare Part D Prescription Drug Plans work alongside Original Medicare. For more information, read about Medicare Part D in Hawaii.

As a Hawaii resident, you may have access to various Medicare plan options, depending on the county in which you live. A resident of Honolulu in Honolulu County may have different Medicare plan offerings than a resident of Hilo in Hawaii County. Considering the variety of Medicare plans in Hawaii, you may want to customize your search for plans based on your own health and prescription needs. To get started, just enter your zip code where indicated on this page. 

Hawaii resources for Medicare beneficiaries

There are a number of resources that are designed to help Medicare beneficiaries in Hawaii with Medicare-related issues and concerns. Here is a resource that may be helpful to you:

 

Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.