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Medicare in Hawaii

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

Photo credit: Ryan Ozawa | Flickr

Key takeaways

Medicare options

Medicare, a healthcare insurance program for older and disabled Americans, operates under the guidance of the Centers for Medicare and Medicaid (CMS). CMS is part of the federal Department of Health and Human Services (HHS).

Medicare beneficiaries can choose to receive their benefits directly from the federal government via Original Medicare — along with supplemental coverage for prescriptions and out-of-pocket costs — or enroll in private Medicare Advantage plans.

Original Medicare includes Medicare Parts A and B. Medicare Part A (also called hospital insurance) helps pay for inpatient stays, like at a hospital, skilled nursing facility, or hospice center. Medicare Part B (also called medical insurance) helps pay for outpatient care like a visit to a nurse practitioner, doctor, or physician assistant and preventive healthcare service, such as most vaccinations).

Medicare Advantage includes all of the basic coverage of Medicare Parts A and B, and these plans generally include additional benefits — such as integrated Part D prescription drug coverage and extras like dental and vision — for a single monthly premium. But members of Medicare Advantage plans may be required to use a limited provider network for the Medicare plan they select, and total out-of-pocket costs (like deductibles, co-payments, or co-insurance) may be higher than they would be under Original Medicare plus a Medigap plan. There are pros and cons to either option, and no single solution that works for everyone.

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.

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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 have age-related eligibility.

Medicare Advantage in Hawaii

In Hawaii in 2018, 45 percent of Medicare beneficiaries were enrolled in private Medicare 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 offered. (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.)

Time to sign up for Medicare?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 change 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 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

Outpatient prescription drugs are not covered by Original Medicare. However, Medicare beneficiaries can get coverage for prescription drugs 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 (a Medicare PDP).

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

As of mid-2020, there were 72,585 people with Medicare in Hawaii who were covered by 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 (e.g., they retire and lose the drug coverage that they had when employed). 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 a larger-than-average percentage of Hawaiian Medicare beneficiaries receive service via Medicare Advantage plans.

How does Medicaid provide financial assistance to Medicare beneficiaries in Hawaii?

Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums, prescription drug expenses, and services not covered by Medicare – such as long-term care.

Our guide to financial assistance for Medicare enrollees in Hawaii includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

Additional information and resources

Medicare in Hawaii: Resources for Medicare beneficiaries and their caregivers

For more information about Medicare benefits in Hawaii or for assistance applying for Medicare coverage, try one of these resources.

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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