Medicare in Hawaii

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

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At a glance: Medicare enrollment in Hawaii

How many Hawaiians are enrolled in Medicare?

As of July 2020, 280,006 Hawaii residents — nearly 20 percent of the state’s population — were enrolled in Medicare.

For most Americans, filing for Medicare is part of turning 65. But Medicare coverage is also available to people under the age of 65 who have been receiving disability benefits for at least two years, or who have ALS or end-stage renal disease. Nationwide, 85 percent of Medicare beneficiaries are eligible due to being at least 65 years old, while the other 15 percent are under 65.

Hawaii has the smallest percentage of disabled Medicare beneficiaries of any state in the country – just 9 percent Hawaii’s Medicare beneficiaries are under 65 and eligible due to a disability (if we also include U.S. territories, just 8 percent of the Virgin Islands’ Medicare beneficiaries are under 65). The other 91 percent of Hawaii’s Medicare beneficiaries are eligible due to their age.

Medicare Advantage in Hawaii

In Hawaii in 2018, 45 percent of Medicare beneficiaries were enrolled in private Medicare Advantage plans — as opposed to 34 percent of Medicare beneficiaries nationwide. The remaining 55 percent of the state’s beneficiaries had Medicare coverage enrollment under Original Medicare.

Hawaii has five counties, and the availability of Medicare Advantage plans varies by county. In Honolulu County in 2020, Medicare beneficiaries can select from among 20 different Medicare Advantage plans. But in tiny Kalawao County (which had just 86 residents as of 2019), 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).

Medicare Advantage enrollment is available when a person is first eligible for Medicare, and there’s also an annual enrollment period in the fall when beneficiaries can enroll in Medicare Advantage plans if they choose to do so. And there is another window — the Medicare Advantage open enrollment period (January 1 to March 31) — during which people who are already enrolled in Medicare Advantage can switch their Medicare Advantage enrollment to a different 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 2020, there are 13 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, Medicare in Hawaii has the nation’s lowest percentage of 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 unlike most of them Hawaii also prohibits Medigap insurers from charging higher premiums for people under the age of 65, based on their disability. So while it’s common to see under-65 Medigap policies sold in other states with premiums that are well above the age-65 premiums, that’s not the case in Hawaii.

Hawaii Medicare Part D

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

For 2020 coverage, insurers are offering 25 stand-alone Medicare Part D plans in Hawaii, with premiums ranging from $13 to $87 per month.

As of mid-2020, there were 72,585 people with Medicare in Hawaii who had prescription coverage under stand-alone Medicare Part D plans. Another 128,545 beneficiaries had Medicare Part D coverage integrated with their Medicare Advantage plans, so the majority of Part D coverage in Hawaii is provided via Medicare Advantage plans as opposed to stand-alone Medicare Part D plans (most Medicare Advantage plans include Part D coverage; stand-alone Medicare Part D plans are usually used to supplement Original Medicare, since it never includes prescription coverage).

Medicare Part D enrollment is an option when a person first submits their Medicare application in Hawaii, or when they lose access to other creditable drug coverage (eg, they retire and lose the drug coverage that they had from their employer). The annual open enrollment period that runs from October 15 to December 7 each year is also an opportunity for Medicare beneficiaries to sign up for a Part D plan or switch to a different Part D plan.

Medicare spending in Hawaii

As of 2018, per-beneficiary spending on Medicare in Hawaii was the lowest in the nation, at $6,971. Nationwide, the average was $10,096 (and on the high end, per-beneficiary spending exceeded $11,000 in Florida, Texas, Mississippi, Oklahoma, 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.

Medicare in Hawaii: Resources for Medicare beneficiaries and caregivers

Questions about Medicare eligibility in Hawaii or Medicare enrollment in Hawaii? You can contact the Hawaii State Health Insurance Assistance Program with questions related to Medicare in Hawaii.

The state of Hawaii’s Employer-Union Health Benefits Trust Fund also has an overview of Medicare.


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 healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

 

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