Medicare in Hawaii

Hawaii regulations ensure that Medicare beneficiaries under age 65 can purchase Medigap plans

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At a glance: Medicare health insurance in Hawaii

How many Hawaiians are enrolled in Medicare?

2020 Medicare enrollment datesAs of November 2018, 267,831 Hawaii residents were enrolled in Medicare. That’s nearly 19 percent of the state’s total population, which is very similar to the percentage of the total United States population enrolled in Medicare.

Most people become eligible for Medicare when they turn 65, but Medicare coverage is also available to people who are disabled. Nationwide, 84 percent of Medicare beneficiaries are eligible due to being at least 65 years old, while the other 16 percent are eligible due to disability.

Hawaii has the smallest percentage of disabled Medicare beneficiaries in the country – just 9 percent of Medicare beneficiaries in Hawaii are eligible as a result of a disability (this is tied with the Virgin Islands), while the other 91 percent are eligible due to their age.

Medicare Advantage in Hawaii

In Hawaii in 2017, 45 percent of Medicare beneficiaries were enrolled in private Medicare Advantage plans — as opposed to 33 percent of Medicare beneficiaries nationwide. The remaining 55 percent of the state’s Medicare beneficiaries had coverage under Original Medicare.

Hawaii has five counties, and the availability of Medicare Advantage plans varies by county. In Honolulu County in 2019, Medicare beneficiaries can select from among 19 different Medicare Advantage plans. But in tiny Kalawao County (which had just 88 residents as of 2017), there are only six Medicare Advantage plans available (it’s noteworthy that in some low-population areas in other states — including the entire state of Alaska — there are no Medicare Advantage plans available at all, but plans are available throughout Hawaii).

As of 2019, there’s a Medicare Advantage open enrollment period (January 1 to March 31) during which people who are already enrolled in Medicare Advantage plans can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.

Medigap in Hawaii

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its own.

As of 2019, there are 14 insurers offering Medigap plans in Hawaii.

Medigap plans are standardized under federal rules, although states can add their own regulations. Hawaii’s Medigap regulations are available here.

The state also requires (see §16-12-6.2) all Medigap insurers to offer all plans on a guaranteed-issue basis (and without adjusting premiums based on medical underwriting) to any enrollee during the six-month window that begins when the person is enrolled in Medicare Part B. This applies regardless of age in Hawaii. Federal law grants a six-month guaranteed-issue open enrollment window, but only when people are enrolled in Part B and also age 65. So Hawaii’s law extends the same protections to people who are under 65 and eligible for Medicare as a result of a disability. As noted above, however, Hawaii has the nation’s lowest percentage of Medicare beneficiaries who are eligible due to a disability.

The majority of the states have adopted rules to ensure at least some access to Medigap plans for enrollees under the age of 65, but as is the case in most of them, Hawaii does not prohibit insurers from charging higher premiums for Medigap enrollees under age 65. Medical underwriting cannot be used for Medigap plans during the first six months that a person has Medicare Part B, but insurers can have higher standard rates for these enrollees.

Medicare Part D in Hawaii

Original Medicare does not cover outpatient prescription drugs. But Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D plan.

For 2019 coverage, insurers are offering 24 stand-alone Part D plans in Hawaii, with premiums ranging from $14 to $80 per month.

As of November 2018, there were 71,138 Hawaii Medicare beneficiaries covered by stand-alone Part D prescription drug plans. Another 118,456 beneficiaries had Part D coverage integrated with their Medicare Advantage coverage (most Medicare Advantage plans include Part D coverage; stand-alone Part D plans are usually used to supplement Original Medicare, since it never includes prescription coverage).

Medicare spending in Hawaii

As of 2016, per-beneficiary Medicare spending in Hawaii was the lowest in the nation, at $6,441. Nationwide, the average was $9,533 (and on the high end, per-beneficiary spending exceeded $11,000 in Florida, Texas, and Louisiana). That’s according to data that were standardized to account for regional differences in payment rates, but the data did not include costs under Medicare Advantage, and Hawaii has a larger-than-average share of its Medicare population enrolled in Medicare Advantage plans.

You can read more about Medicare in Hawaii in our state Medicare guide. You can also contact the Hawaii State Health Insurance Assistance Program with questions related to Medicare coverage in Hawaii.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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