Over the past decade, Medicare Advantage (MA) has nearly doubled in popularity. Also known as Medicare Part C, the program now has over one-third of all Medicare enrollees, with most beneficiaries having 28 Medicare Advantage plans to choose from. This page explains Medicare Advantage plans in Hawaii, how the program works, and how to compare your options.

What is Medicare Advantage in Hawaii?

Medicare Advantage plans must provide the same level of coverage as you'd get with Original Medicare. This includes:

  • Medicare Part A covers inpatient services such as you'd receive in a hospital or skilled nursing facility (SNF)
  • Medicare Part B covers outpatient services, including doctor visits, lab work, outpatient procedures performed in a hospital, durable medical equipment (DME), and more

Original Medicare does not include prescription drug coverage. For that, you need a Medicare Part D plan.

One reason Medicare Advantage keeps growing in popularity is that most plans offer additional benefits. These vary from plan to plan, but the most common are:

  • Prescription drug coverage
  • Routine vision and dental care
  • Fitness programs like SilverSneakers

Please note that, even if you join a Medicare Advantage plan in Hawaii, you'll still have to pay the Medicare Part B premium.

Hawaii Medicare Advantage plans with prescription drug coverage

Medicare Advantage Prescription Drug plans (MA-PD) are often called all-in-one plans, because they combine your Original Medicare and Part D benefits into a single plan.

The extra benefits you get with an MA-PD plan could save you money, even if your plan has a monthly premium. That's because you don't have to buy separate policies or pay out-of-pocket for prescription medications or whatever other benefits your plan provides.

Who is eligible for Medicare Advantage in Hawaii?

If you have Medicare Parts A and B, you are eligible for Medicare Advantage in Hawaii.

American citizens and permanent legal residents aged 65 and older qualify for Medicare. However, you will only be automatically enrolled in the program if you began collecting Social Security benefits at least 4 months before your 65th birthday.

You may qualify for Medicare before you turn 65 if you collect disability benefits from either Social Security or the Railroad Retirement Board (RRB) for 24 months. In this case, you will be automatically enrolled in both Parts A and B.

Finally, if you receive a diagnosis of either amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease) or end-stage renal disease (ESRD), you may also qualify for Medicare before turning 65.

When can you sign up for a Medicare Advantage plan in Hawaii?

Medicare limits enrollment to specific times. The first is your Initial Enrollment Period (IEP), which begins 3 months before you become eligible for Medicare and lasts for 7 months. For example, if your 65th birthday or 25th month of collecting disability benefits occurs in January, your IEP begins on October 1 and extends through April 30.

If you did not sign up for Medicare Part A and/or Part B during your IEP, you may do so during the General Enrollment Period. This lasts from January 1 through March 31. After General Enrollment ends, you may then sign up for a Medicare Advantage plan from April 1 through June 30.

The Medicare Annual Enrollment Period (AEP) lasts from October 15 through December 7 and allows current Medicare beneficiaries to make any necessary change to their coverage. This includes signing up for an Advantage plan.

If you already have a Medicare Part C plan, you can take part in the Medicare Advantage Open Enrollment Period. Lasting from January 1 through March 31, your options are limited to switching to a new MA plan or returning to Original Medicare. But, if making that change means you'll lose your prescription drug coverage, you may also enroll in a standalone Part D plan.

Certain life changes may qualify you for a Special Enrollment Period (SEP). The most common are moving and losing your current coverage, but there are dozes of ways to qualify. The full list is on Medicare.gov.

Types of Medicare Advantages plans in Hawaii

There are four common types of Medicare Advantage plans in Hawaii. The most popular is health maintenance organizations. HMO plans use a provider network to help manage costs. If you receive non-emergency care from an out-of-network provider, your HMO plan probably won't cover the service. HMOs also require members to choose a primary doctor, who helps coordinate care and provides referrals to specialists.

Preferred provider organizations (PPO) also use a provider network. However, members may receive out-of-network care, they'll just have a higher copay for the service. PPO plans also don't require members to choose a primary doctor or get a referral to see a specialist.

private fee-for-service (PFFS) plan determines how much it and its members will pay for any covered service. Most use a provider network but do allow members to receive out-of-network care for a higher price. Like PPOs, PFFS plans do not require you to choose a primary doctor or get a referral for a specialist.

Special needs plans (SNPs) set guidelines as to who qualifies for membership. SNPs may be limited to people who:

  • Have a chronic condition, such as diabetes, chronic heart failure, HIV/AIDS, dementia, or ESRD
  • Live in an institution, such as a nursing home, or require at-home care
  • Qualify for both Medicare and Medicaid (known as dual eligibility)

SNPs also require their members to choose a primary doctor who coordinates care and provides specialist referrals.

How to choose a Medicare Advantage plan in Hawaii

If you're looking for a Medicare Advantage plan in Hawaii, you should consider the following:

  • Costs: May include a yearly deductible, monthly premium, and copays or coinsurance.
  • Coverage: Benefits vary widely, so look closely at coverage to be sure you're comparing apples to apples. And don't forget the drug formulary of an MA-PD plan.
  • Network: Anyone who provides healthcare services may be included in the provider network.
  • Ratings: Medicare rates all Advantage plans on a wide range of metrics, with ratings released each fall before Annual Enrollment.

Our Find a Plan tool makes it easy to compare Medicare Advantage plans in Hawaii. Just enter your location information and estimated coverage start date to review Medicare plans in your area.

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