As a Medicare beneficiary living in Hawaii, you may be able to choose to participate in the optional Medicare Part D program by enrolling in a Medicare plan that includes prescription drug coverage. Original Medicare (Part A and Part B) generally doesn’t cover prescription drugs in most cases. Medicare plans that include prescription drug coverage in Hawaii may have different costs, depending on the insurance company offering the plan, and on your place of residence and zip code. Plans generally require you to pay a monthly premium, annual deductible, and copayment or coinsurance. Familiarize yourself with Medicare Part D, and learn how to find a Medicare plan that includes prescription drug coverage that may work for your health needs.
How Medicare plans that include prescription drug coverage work in Hawaii
Medicare plans that include prescription drug coverage are offered by private insurance companies that contract with Medicare. This coverage is available either as a stand-alone Medicare Part D Prescription Drug Plan to work alongside your Original Medicare coverage, or through a Medicare Advantage Prescription Drug plan.
Medicare plans that include prescription drug coverage have formularies, or lists of covered prescription drugs. A formulary divides prescription drugs into tiers, which are categories, each with a different cost. The lowest tier includes the least expensive prescription drugs, while the highest tier lists the more costly medications. In certain cases, your doctor or health provider may decide that a prescription drug in a higher tier is necessary to treat your medical condition instead of a similar prescription drug on a lower tier. If so, you or your doctor can ask your plan for a tiering exception to lower the cost-sharing for your higher-tier prescription drug. Please note that a formulary may change at any time, and your plan will notify you when necessary.
Medicare plans that include prescription drug coverage in Hawaii, as in all states, generally include both brand-name and generic prescription drugs in their formularies. Generic prescription drugs, according to Medicare.gov, are copies of brand-name prescription drugs, using similar active ingredients. The difference for you is that generic prescription drugs usually cost substantially less than brand-name prescription drugs. In cases where your specific generic prescription drug is not available, you may be able to substitute a similar generic prescription drug rather than paying more for a brand-name prescription drug, but make sure you discuss all medication details and substitution options with your doctor or health-care provider.
How can I enroll in a Medicare plan that includes prescription drug coverage in Hawaii?
Before enrolling in a Medicare plan that includes prescription drug coverage, make sure you understand the eligibility requirements and the enrollment windows.
- In order to enroll in a stand-alone Medicare Part D Prescription Drug Plan, you must be enrolled or eligible to enroll in Original Medicare (Part A and Part B). If you prefer an alternative way to receive your Original Medicare benefits (except for hospice care, which is still covered by Medicare Part A), you may be able to enroll in a Medicare Advantage Prescription Drug plan. You must have both Medicare Part A and Part B to enroll in a Medicare Advantage Prescription Drug plan, and live within the plan’s local area.
- In Hawaii, as in the rest of the United States, you may enroll in Medicare Part D during the seven-month period starting three months before the month you turn 65, including your birthday month, and continuing three months after that month. This is your Medicare Initial Enrollment Period. If you’re enrolled in Medicare due to a disability, your Initial Enrollment Period generally starts three months before your 25th month of disability, includes that month, and continues for three more months.
- You may enroll in a Medicare Advantage Prescription Drug plan during your Initial Coverage Election Period. This period is usually the same as your Medicare Initial Enrollment Period, unless you delay enrollment in Medicare Part B.
- If you miss your Initial Enrollment or Initial Coverage Election period, you may enroll in (or change) a Medicare plan that includes prescription drug coverage during the Annual Election Period, from October 15 to December 7 each year. This applies to Medicare Advantage Prescription Drug plans and stand-alone Medicare Part D Prescription Drug Plans. You can make other changes during that period, including (but not limited to) returning to Original Medicare coverage.
- If you’re enrolled in a Medicare Advantage plan and decide to switch back to Original Medicare, you can do so during the annual Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31, and you have until March 31 to add an optional stand-alone Medicare Part D Prescription Drug Plan to your coverage or change to another Medicare Advantage plan.
It’s very important for you to know that if you go without creditable prescription drug coverage for 63 consecutive days or more after your Initial Enrollment Period ends, you may be subject to a lifetime late-enrollment penalty for Medicare Part D if you ever decide to add this coverage. In Hawaii and the rest of the United States, this late-enrollment penalty is calculated using 1% of the national base beneficiary premium, and the number of full months you were eligible for Medicare Part D but didn’t join. This amount is then added to your plan’s monthly premium. The national base beneficiary premium may increase each year, which means your late-enrollment penalty may also increase annually.
Don’t forget that you need to stay enrolled in Medicare Part A. If you’re enrolled in Medicare Part B, you have to continue paying your Medicare Part B premium in order not to lose your health coverage, regardless of whether or not you decide to enroll in Medicare Part D.
Types of Medicare plans that include prescription drug coverage in Hawaii
As a Medicare beneficiary in Hawaii, you may have access to various Medicare plans that include prescription drug coverage.
One way to participate in Medicare Part D is to enroll in a Medicare Advantage Prescription Drug plan With Medicare Advantage (Medicare Part C), you get at least the same coverage as Original Medicare, only you get it through a private insurance company instead of directly through Medicare. Some Medicare Advantage plans include extra benefits like fitness plans.
When comparing Medicare plans that include prescription drug coverage in Hawaii, you may want to consider your personal medication needs, since prescription drug formularies vary among plans–as do costs.
You’ll want to review your Medicare plan that includes prescription drug coverage at the end of every year to be aware of any changes to your coverage. Your plan will send you an Annual Notice of Change and an Evidence of Coverage notice every fall. Medicare plans that include prescription drug coverage in Hawaii, as in the rest of the United States, are allowed to change their premiums, copayments, deductibles, and prescription drug formularies annually. This means that your current plan may not be the one best suited to your health needs in the coming year.
For additional information about Medicare in Hawaii, follow these links: