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Medicare in Hawaii

Info on Medicare in Hawaii, including costs, plan options and more

Reviewed by: Stephanie Demus, Licensed Insurance Agent. Written by: Aaron Garcia.

Key Takeaways

  • Medicare in Hawaii is health insurance for all Americans aged 65 and older. You must be a legal U.S. citizen or have been a legal resident for five or more years.

  • Original Medicare (Parts A and B)Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). provide some hospital and medical coverage. Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). in Hawaii combines the coverage you’d get from Parts A and B and bundles them with Part DMedicare Prescription Drug Plan (Part D) is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies. and other services.

  • The price of Medicare in Hawaii starts with standard costs but comes down to your details like income and work history.

 

To many outsiders, the state of Hawaii is a single place. Locals and experienced visitors, though, understand each of the islands is unique from the others. The same can be said of Medicare in Hawaii.

Medicare isn’t a single program, but several different parts are designed to provide the health coverage you need. To get a plan that fits you, you’ll need to understand some key points. For example: Do you know which Medicare plans in Hawaii are available? Do you know how much they cost or when to enroll? Can you purchase Medicare Advantage in Hawaii?

To help answer questions like these, say aloha (the hello one) to GoHealth’s guide to Medicare in Hawaii.

How Do I Apply for Medicare in Hawaii?

Starting Medicare in Hawaii means signing up during your Initial Enrollment Period. If you’re approaching the age of 65 and ready to enroll in a Medicare plan, there are several ways to do so through the Social Security Administration (SSA).

  • Enroll online on the SSA website [1]
  • In person at your nearest SSA office [2]
  • Call the SSA at 1-800-325-0078
  • Through the Railroad Retirement Board (RRB); if you worked for a railroad, you may need to enroll in Medicare in Hawaii through the RRB. Call the RRB at 1-877-772-5772.
  • Call a GoHealth licensed insurance agent. They can review your options and help you enroll in a plan that fits your needs.

1-855-792-0088

Monday - Friday, 7 AM - 8 PM CT

 

When to enroll in Medicare

Starting with your Initial Enrollment Period, there are designated times to sign up for and change your Medicare coverage. These are known as enrollment periods. Here are the dates to keep circled on your calendar:

  • Initial Enrollment Period (IEP): seven months around the month you turn 65. If your birthday is in June, your IEP opens Mar. 1 and closes Sept. 30. Missing your IEP can leave you with costly enrollment penalties.
  • Medicare Part C & D Open Enrollment Period: Oct. 15 to Dec. 7
  • Medicare General Enrollment Period: Jan. 1 to Mar. 31
  • Medicare Advantage Open Enrollment Period: Jan. 1 to Mar. 31

Does Medicare Cover Me in Hawaii?

Medicare is health insurance, so it will cover some of your costs if you’re enrolled. To be eligible for Medicare in Hawaii, you typically must be at least 65 years old, and a legal U.S. citizen, or have been a legal resident for five or more years.

There are some situations in which you may be eligible before 65, including:

  • You’re living with End Stage Renal Disease (ESRD)
  • You’re living with Amyotrophic Lateral Sclerosis (ALS), also called Lou Gehrig’s Disease

What Are the 4 Types of Medicare?

Medicare in Hawaii comes in four parts:

Medicare Parts A and B combine to make up Original Medicare. Original Medicare beneficiaries also must enroll separately in Part D  to receive prescription drug coverage. Medicare Advantage in Hawaii is an alternative to Original Medicare that combines Parts A, B and D elements.

While it’s not considered one of the four main types, Medicare Supplement Insurance, or Medigap, can also be a valuable resource for Hawaiians. Original Medicare in Hawaii can come with high out-of-pocket costs, including copayments, coinsurance and deductibles. Medigap plans help cover these costs. Like Part D, Medigap must be added separately.

Who Qualifies for Medicaid in Hawaii?

Medicaid is not the same program as Medicare in Hawaii. The state partially provides Medicaid. Eligibility is based on income and family size. Check with the State of Hawaii to see if you’re eligible for Medicaid. [3]

Does Hawaii Have Medicare?

Yes, you can choose from Original Medicare and Medicare Advantage in Hawaii. Because Medicare is a Federal program, residents in all states and Washington D.C. can enroll in Medicare when eligible.

Is Medicare Free After You Turn 65?

Chances are, you’ll have to pay something for your health care after you turn 65. While many people believe the myth that Medicare is provided at no cost when they turn 65, there are several fees you’ll want to know about. Also, keep in mind that while some costs are standardized, what you’ll end up paying will come down to your needs, income, and which plan you choose.

In other words, you’re going to want to budget for Medicare in Hawaii. To help you get started, here’s what you can expect to pay for Original Medicare (Parts A and B) in 2021.

Medicare in HI: Part A

Premium:

  • $0 if you or your spouse worked 10 or more years
  • $259 a month if you worked between 7.5 and 10 years
  • $471 a month if you worked fewer than 7.5 years

Deductible:

  • $1,484 for each hospital benefit period

Copayments & coinsurance:

  • Hospital stays: $0 copay for Days 1-60 following deductible payment; daily charges for Days 61 and after
  • Skilled Nursing Facility: $0 for Days 1-20 (each plan period); daily charges for Days 21 and after

Medicare in HI: Part B

Premium:

  • $148.50 monthly and up (income-based)

Deductible:

  • $203 for each plan period

Copayments & coinsurance:

  • Most preventative services: $0
  • Medicare-approved services: 20% coinsurance

What Is the Average Cost of a Medicare Part D Plan?

Part D monthly premiums vary in cost, usually between $30 and $50 per month, with the average typically around $40. This monthly premium is just one of the costs associated with Part D you’ll need to know about. Here’s a quick breakdown:

PART D PREMIUM 

  • Based on plans and beneficiary needs
  • Income-based if a member qualifies for Low-Income Subsidy Benefits

PART D DEDUCTIBLE

  • Varies by plan; capped at $445 in 2021

PART D COPAYMENTS & COINSURANCE

  • It depends on plan and medications needed

How Much Money Can You Have and Still Get Medicare?

Unlike Medicaid, you don’t have to have a low income to qualify for Medicare. That means it doesn’t matter how much money you make; you can still enroll in Medicare in Hawaii. Your income may raise some of your costs, however, especially with Original Medicare and Part D.

If you have trouble affording your Medicare costs, there may be help. Medicare Savings Programs can help you pay for your out-of-pocket costs from Part B. If you need prescription drugs the Low-Income Subsidy, or Extra Help, may be able to provide financial assistance.

To see what cost-saving programs your state has to offer, give GoHealth a call. Our licensed insurance agents will review your qualifications and see if there are options that fit your needs — and your budget.

What is the Best Medicare Plan for 2021?

The answer here totally depends on what you need from a plan. Deciding between the different Medicare plans in Hawaii is a personal process, and you’ll want to consider several factors. In other words, picking a plan based on what someone else thinks is “best” can leave you without the right coverage and services. Instead, are some tools to help find a plan that works for you:

  • Weighing Original Medicare vs. Medicare Advantage in Hawaii? Learn their Pros & Cons.
  • See what others think of their plans with the Medicare Star Ratings.
  • Get impartial and honest guidance from a GoHealth licensed insurance agent. Call us today at 1-855-792-0088 (TTY: 711)

Which States Have the Best Medicare Advantage Plans?

The enrollment numbers for Medicare Advantage in Hawaii are often among the highest in the country. However, that fact doesn’t matter if you don’t find a Medicare Advantage plan that fits your needs and budget. Rather than seeing what others think is best, it’s more helpful to come up with your list. To help, here are the different kinds of Medicare Advantage in Hawaii and the differences between the plan types.

  • Private Fee-for-Service (PFFS) policies provide separate payments to your providers for each service you receive
  • Special Needs Plans (SNP) are designed for patients living with certain diseases or health conditions. [4] D-SNP plans assist dual-eligible individuals; C-SNP are for patients with chronic diseases.

Medicare in Hawaii by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 236,675 people are enrolled in Medicare in Hawaii. The total number of beneficiaries enrolled in Medicare Advantage in Hawaii is 126,872. The previous year, 122,657 enrolled in Medicare Advantage. Medicare Advantage participation in Hawaii went from 52.93% to 53.61% year over year. If you’d like to dive deeper into how Medicare in Hawaii breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of Hawaii
236,675
Beneficiaries with Part A & Part B
126,872
Medicare Advantage Beneficiaries
53.61%
Medicare Advantage Participation Rate
52.45%
% Female
47.55%
% Male
0.92
Average HCC Score
$8,228.31
Actual Per Capita Costs
11.65%
% Eligible for Medicaid
25.79%
% of Beneficiaries with an Emergency Department Visit
14.81%
Hospital Readmission Rate
31.64%
% Non-Hispanic White
1.09%
% African American
5.96%
% Hispanic
61.31%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

Hawaii Medicare Resources & Contacts

Beneficiaries spend an average of $8,228.31 each year on Medicare in Hawaii. To be certain you are not leaving anything on the table, give us a call. A GoHealth licensed insurance agent can assess your coverage or explain which Hawaii-based resources, like these, may be able to help:

Hawaii Aging and Disability Resource Center (ADRC)

1-808-768-7700

https://www.elderlyaffairs.com/

What should I know about the Hawaii ADRC?

Programs and resources for seniors, caregivers and the disabled. These can include adult day care, transportation, and much more.

Hawaii Med-QUEST

1-808-524-3370
1-800-316-8005
1-800-603-1201 (TTY)

https://medquest.hawaii.gov/

What should I know about the Med-QUEST?

Hawaii’s Medicaid program for adults, children and families with limited resources and low income

Hawaii State Health Insurance Assistance Program (SHIP)

1-808-586-7299
1-888-875-9229
1-866-810-4379 (TTY)

https://hawaiiship.org/

What should I know about the Hawaii State Health Insurance Assistance Program?

See if you can lower your out-of-pocket costs with Hawaii’s Medicare Savings Program

Hawaii Office of Veterans’ Services

1-808-433-0420

https://dod.hawaii.gov/ovs/

What Should I know about the Hawaii Office of Veterans’ Services?

File appeals, connect with your benefits and find information on other services and activities

 

Nationwide Resources

Speak with an insurance agent that is licensed in Hawaii about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in HI, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

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New to Medicare Guide

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Low Income & Medicare Guide

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