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It’s easy to get overwhelmed when shopping for Medicare plans. There are many options in Hawaii to choose from, and some providers offer more enticing benefits than others.
Before you begin exploring plans, it’s a good idea to know what Medicare covers, where to sign up and how much you should expect to pay in premiums. Keep reading to learn more about how Medicare works. We’ve also included a list of the 5 best companies for Medicare in Hawaii.
The Best Medicare in Hawaii:
- Best Overall in Hawaii: Kaiser Permanente
- Cheapest in Hawaii: Humana
- Best for Low Deductibles: WellCare
- Best for Routine Care: HMSA Akamai Advantage
- Best for Health and Wellness Programs: UnitedHealthcare
What is Medicare?
Medicare is a form of health insurance that caters to seniors and individuals with select disabilities. The program is funded by the federal government and managed by the Centers for Medicare and Medicaid Services (CMS) under the U.S. Department of Health and Human Services (HHS).
It is comprised of 4 components: Parts A, B, C and D. You can find more information on each below.
Part A: Medicare Part A (Hospital insurance) covers costs associated with skilled nursing facility care, in-patient care in a hospital, hospice care and home health care. It also covers short term in-patient care services you receive in a skilled nursing facility.
Part B: Medicare Part B (Medical insurance) covers both preventive and medically necessary services. This includes durable medical equipment, select outpatient prescription drugs, ambulance services and clinical research. In-patient and outpatient care, along with partial hospitalization for mental health care, is also covered under Medicare Part B.
Part C: Also known as Medicare Advantage plans, Medicare Part C offers comprehensive coverage under a single plan that is managed by a private company that contracts with Medicare. They include the same benefits you’ll find under Medicare Part A and Medicare Part B. Some also extend benefits found under Medicare Part D, along with dental, hearing and vision coverage.
Part D: Medicare Part D plans (Prescription Drug coverage) cover the drugs included in the plan documents. If a medication you need is not covered, the pharmacy may recommend a comparable drug. Or you have the option to ask your plan administrator for an exception.
You may be eligible for a Medicare plan in Hawaii if you meet the following criteria:
- Are at least 65 years of age
- Have a qualifying disability
- Suffer from permanent kidney failure that requires a transplant or dialysis, or have Lou Gehrig’s disease
Legalities of Medicare in Hawaii
Medicare in Hawaii is regulated by the Hawaii Employer-Union Health Benefits Trust Fund (EUTF). It oversees the provision of Medicare benefits to retirees in City and County of Honolulu, County of Hawaii, County of Kauai and the state of Hawaii. The EUTF also works with insurance carriers and pharmacy benefit managers to develop health benefit plans and corresponding rates.
To date, approximately 47,000 retirees receive Medicare benefits in Hawaii.
Types of Medicare Advantage Plans
Medicare Advantage plans make it easy to get the care you need without spending a fortune or jumping through hoops. There are 2 types of plans to choose from: health maintenance organization (HMO) and preferred provider organization (PPO) plans. You can find an overview of each below.
HMO: These plans require that you patronize medical providers inside the network to qualify for the copayment and coinsurance figures noted in the plan documents. Otherwise, you may incur higher out-of-pocket expenses. You must also choose a primary care doctor under Medicare Advantage HMO plans. And if the need arises to see a specialist, you will need to request a referral for the services to be covered.
PPO: Medicare Advantage PPO plans afford you the flexibility to choose where you receive care. But as mentioned earlier, out-of-network visits equal more expenses for you to cover. Another significant benefit is the ability to see a specialist without getting a referral first. These plans also don’t require you to choose a primary care doctor.
Although HMO plans are a bit more restrictive, they usually come with lower monthly premiums than you’ll find with PPO plans.
How to Sign Up for Medicare in Hawaii
It’s simple to sign up for Medicare in Hawaii. You can enroll by:
- Registering for a plan online here.
- Calling the Social Security Administration at 800-772-1213. They’re available on weekdays from 7 a.m. to 7 p.m. to assist you with enrollment.
- Visiting a Social Security office near you. Use this tool to find the closest location. You should also call 800-772-1213 to schedule an appointment. Otherwise, you may not be seen by a representative promptly.
- Reaching out to the insurance provider directly. They will send you a link to their online application, complete it for you by phone or schedule an in-home appointment with one of their representatives.
Open enrollment for Medicare spans from October 15 to December 7 unless you qualify for a Special Enrollment Period (SEP).
Average Cost of Medicare Advantage Plans in Hawaii
The monthly premiums you will pay for Medicare Advantage plans in Hawaii depend on the plan type and covered services. Below you will find a chart that displays health and drug costs for insurance providers that offer Medicare Advantage plans in Hawaii.
|Plan Name||Company||Plan Type||Health & Drug Costs|
|Senior Advantage||Kaiser Permanente||HMO||$196 (Medicare Advantage with drug coverage) $146.60 (Standard Part B premium)|
|Gold Plus H0028-004 (HMO)||Humana||HMO||$0 (Medicare Advantage with drug coverage)$144.60 (Standard Part B premium)|
|‘Ohana Plus||WellCare||HMO||$16.20 (Medicare Advantage with drug coverage)$144.60 (Standard Part B premium)|
|Standard Plus||HMSA Akamai Advantage||PPO||$190 (Medicare Advantage with drug coverage)$144.60 (Standard Part B premium)|
|AARP Medicare Advantage Choice||UnitedHealthcare||PPO||$28.00 (Medicare Advantage with drug coverage)$144.60 (Standard Part B premium)|
Best Medicare Insurance Providers in Hawaii
You want a Medicare provider that prides itself on providing exceptional service. Their plans should also be affordable and offer incentives to help you lead a healthy lifestyle.
Here are Benzinga’s top for picks companies with the best Medicare plans in Hawaii:
1. Best Overall in Hawaii: Kaiser Permanente
The Kaiser Foundation Health Plan was ranked as the top Medicare Advantage Provider in the J.D Power 2019 Customer Satisfaction Study. Kaiser Permanente also received a 5-star rating from Medicare.gov. And U.S. News also recognized the provider as the Best Insurance Company for Medicare Advantage in Hawaii for 2020.
Its health plans feature an extensive network of the best healthcare providers in the industry. You’ll never pay copays for preventive care and there are no high-dollar deductibles. Plus, Kaiser Permanente offers an extensive suite of health and wellness programs. So, you can receive holistic, high-quality healthcare at an affordable price.
It is easy to apply for and receive coverage with its seamless online application process. And if you still have questions after reviewing plan options, you can attend a free seminar to learn more about all its plans have to offer.
2. Most Affordable in Hawaii: Humana
Worried about spending a fortune to receive adequate Medicare coverage in Hawaii? Humana provides Medicare Advantage, prescription drug and Medicare supplemental insurance plans that feature low copays, coinsurance and deductibles.
It claimed the 3rd spot on J.D. Power’s 2019 list of top Medicare Advantage providers. Humana also received an above-average rating for average out-of-pocket costs from customers who participated in the study.
You can enroll in a Humana Medicare Hawaii plan directly through its online portal or by phone. If neither of these options works, contact a sales agent by phone. Humana will send a representative to your home to get you signed up.
3. Best for Low Deductibles: WellCare
WellCare also landed on J.D. Power’s 2019 list of top Medicare Advantage providers with a 5-star rating for costs. Its ‘Ohana Plus HMO plan in Hawaii comes with deductibles of $185 and $435 for in-network healthcare services and prescription drugs, respectively.
As a Wellcare Medicare Advantage subscriber, you have access to fitness benefits without incurring additional costs. This means you can receive a free annual membership at select health clubs or fitness centers. And if you don’t live within close proximity to a qualifying facility, WellCare may ship a home exercise program to you.
You may also be eligible for routine dental, hearing and vision care that’s not covered under Medicare. And the plan features lucrative discounts for health and wellness services, online pharmacy orders and the Medical Alert device.
4. Best for Routine Care: HMSA Akamai Advantage
HMSA Medicare Advantage plans are exclusive to residents of Hawaii. With premiums starting at $0 per month, low costs for routine care and a vast provider network, it may be worth considering.
Subscribers pay minimal fees for out-of-pocket costs for routine care under its plan. If you enroll in the Standard Plus (PPO) Plan, you’ll pay a $10 copay to your primary care doctor for each visit and there’s no deductible.
The Standard (PPO) Plan has a slightly higher copay of $30 per doctor visit, and the health plan deductible is $150. But the monthly premiums are much lower.
Both plans include vision, hearing and fitness benefits to help you keep your health in check.
5. Best for Health and Wellness Programs: UnitedHealthcare
UnitedHealthcare offers exceptional health and wellness programs to Medicare Advantage subscribers. It was also featured on J.D. Power’s Customer Satisfaction List for 2019.
Its plans include minimal copayments for mental health services. Opioid treatment services are covered at full cost.
You may also have access to Renew Active, a fitness program by UnitedHealthcare. It includes enticing perks, like a gym membership, interactive health tools and learning activities, recipes, videos, an online brain health program and so much more. Renew Active also grants you exclusive access to health and wellness events near you.
Get the Best Medicare Coverage in Hawaii
Take the guesswork out of finding the perfect Medicare plan in Hawaii. Simply enter your ZIP code to retrieve a quote from the top providers on the market. And feel free to shop around as there’s no penalty to inquire, and you’re not obligated to enroll in a plan.
Frequently Asked Questions
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.