Medicare Advantage plans in Hawaii offer comprehensive healthcare coverage that includes the same benefits as Original Medicare .
Medicare Advantage plans may also offer additional benefits such as prescription drugs, dental, and vision coverage.
Costs vary by region, and some Medicare Advantage plans have monthly premiums starting at $0.
If you’re currently enrolled in Original Medicare, you’re eligible for Medicare Advantage.
If you are eligible for Medicare and live in Hawaii, you likely have several Medicare Advantage, also known as Medicare Part C, plans to choose from. Not every plan is available in every county or ZIP code. Read on to learn about Medicare Advantage options for Hawaiians and how they may provide the coverage and services you need.
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Medicare Advantage plans offer comprehensive healthcare coverage. These plans are an alternative to Original Medicare Part A and Part B. Medicare Advantage plans provide the same coverage as Original Medicare and often feature additional benefits.
Coverage can include:
- Inpatient hospital coverage, with at least the same coverage as Medicare Part A.
- Outpatient coverage, providing the same benefits as Medicare Part B.
- Preventative services.
- Screenings, lab work and X-rays.
- Additional benefits such as dental and vision coverage.
- Fitness program membership.
- Prescription drug coverage, similar to Part D coverage.
As of 2024, there are 40 Medicare Advantage plans available in Hawaii, and all residents who are eligible for Medicare have access to at least one of these plans.
Medicare Advantage plans are offered by private insurance agencies. Unlike Original Medicare, which is federally funded, Medicare Advantage plans are local. Each city or county provides unique plans with your healthcare needs in mind.
You can choose from several types of Medicare Advantage plans.
Health Maintenance Organizations (HMOs)
HMOs are the most common type of Medicare Advantage plan. When you enroll in an HMO plan, you’ll select a primary care physician as your main healthcare contact. Whenever you want to see a specialist, you’ll need a referral from your primary care physician in order to see another in-network provider.
HMOs offer low monthly premiums, and they’re an excellent option for anyone with no complex health concerns.
Preferred Provider Organizations (PPOs)
PPOs are another popular Medicare Advantage plan option. These plans offer more flexibility since you don’t need to choose a primary physician. You can visit specialists without a referral, and you have more flexibility in selecting out-of-network providers.
PPOs may have higher premiums, and may be a good choice for those who access care from multiple providers.
Private Fee-for-Service plans (PFFSs)
PFFSs aren’t as widely available as HMOs and PPOs. Private Fee-for-Service plans let you access care from any provider, in- or out-of-network. These plans give you the most flexibility, and you can visit any care provider that agrees to accept your plan coverage.
PFFSs have the highest monthly premiums, and they’re perfect for anyone who wants to manage their care.
Special Needs Plans (SNPs)
SNPs are designed to offer comprehensive coverage to individuals with certain health conditions. You may qualify for an SNP if you have a chronic condition such as:
- Autoimmune disorder
- Cardiovascular disorder
- Chronic heart failure
- End-stage renal disease
Older adults eligible for both Medicare and Medicaid or who live in a long-term care facility may also qualify for a SNP.
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Since Medicare Advantage plans are administered by private insurance agencies, costs vary. The average monthly premium for a Medicare Advantage plan in Hawaii was $47.01 in 2024. All Medicare-eligible residents have access to at least one plan with $0 monthly premiums.
You may have to pay coinsurance or copayments when you access healthcare services. However, Medicare Advantage plans have a cap on out-of-pocket spending. Once you reach your yearly spending limit, you won’t pay anything for covered services for the remainder of the plan year.
If you’re enrolled in Original Medicare, you’re eligible for a Medicare Advantage plan. Medicare beneficiaries receive a Medicare ID Card with their personal Medicare number. Once you have your Medicare number, it’s easy to switch to a Medicare Advantage plan.
To be eligible for Original Medicare in Hawaii, you must either be a US citizen or have been a legal resident for five or more years. One of the following must also be true:
- You’re over 65.
- You’re under 65 and you have a qualifying condition such as end-stage renal disease or Amyotrophic Lateral Sclerosis (ALS, or Lou Gehrig’s disease).
- You’ve received Social Security disability benefits for 24 months.
When to Enroll in a Medicare Advantage Plan
Ready to enroll in a Medicare Advantage plan? Timing is everything. There are only a few times during the year you can switch from Original Medicare to Medicare Advantage.
- The best time to enroll in a Medicare Advantage plan is during your Initial Enrollment Period (IEP). IEP is a seven-month window that starts three months before the month you turn 65 and ends three months after your birthday month. If you enroll in Original Medicare at the beginning of your IEP, you’ll have more than enough time to switch to a Medicare Advantage plan during the same period.
- You can also switch to a Medicare Advantage plan during Medicare’s Open Enrollment Period from October 15 to December 7 every year. This is sometimes referred to as Annual Enrollment.
- Certain life events can also trigger a Special Enrollment Period (SEP). If, for example, you move outside the plan coverage area or lose healthcare coverage, you will be granted an SEP that allows you to enroll in a new Medicare Advantage plan.
How to Enroll in Medicare Advantage Plans in Hawaii
All you need is your Original Medicare number to enroll in a Medicare Advantage plan. Once you have your information, you can contact the Medicare Advantage plan provider of your choice and switch to a plan that gives you comprehensive coverage.
If you need help shopping for Medicare Advantage plans and benefits in your area, give GoHealth a call. Our licensed insurance agents at GoHealth can help you learn more about your plan options and find a plan that’s right for you.
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Most Medicare Advantage plans in Hawaii include prescription drug coverage. Rather than enrolling in Original Medicare and adding Part D coverage, you can get it all in a Medicare Advantage Plan.
Each Medicare Advantage plan has a unique list of covered medications. This list, called a formulary, gives you detailed information about which meds the plan includes and exactly how much you’ll pay in copayments. Before enrolling in a Medicare Advantage plan, check the formulary and make sure your medications are on the list.
A licensed insurance agent at GoHealth can help you weigh your options by finding Medicare Advantage plans in your area and comparing formularies. Call today for advice you can trust.
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