Though many are aware of Medicare Part A and Part B, or Original Medicare, not everyone is aware that it does not include prescription drug coverage. In every state, Hawaii included, you need to get prescription coverage through a Medicare Part D plan.
Medicare Part D in Hawaii
Hawaii is like every other state, in that Part D plans are provided by private insurance companies. While enrollment in Medicare Part D is optional, if you do not have creditable drug coverage elsewhere (i.e., through an employer), you pay for medications out-of-pocket since they are not covered by Original Medicare. You also face late penalties if you delay Part D enrollment without other coverage. This penalty is paid for the entire time you have a Medicare Part D drug plan.
To obtain drug coverage, you can either sign up for a standalone Part D plan in addition to your Original Medicare, or for a Medicare Advantage plan that includes prescription drug coverage (MA-PD). Medicare Advantage plans, also known as Medicare Part C, cover everything that Parts A and B do. If you choose an MA plan with drug coverage, you get all of your Medicare coverage in a single plan.
What does Part D cost in Hawaii?
Costs for Medicare Part D plans vary based on the plan you choose, where you live, and the insurance company that provides it. General costs you can expect include:
- Annual deductible
- Coinsurance or copays
- Monthly premium
Part D plans have a tiered pricing structure, with more expensive medications occupying the higher tiers. This tiered list is called a drug formulary, and it contains all the medications a plan covers.
How to get help paying for Medicare Part D plan in Hawaii
If you have limited resources, you may qualify for Extra Help, which provides assistance with out-of-pocket costs for medications. Medicare beneficiaries that qualify for Medicaid as well get Extra Help automatically.
What should I know when choosing a Medicare Part D plan in Hawaii?
Though cost is an important factor in choosing a Medicare Part D plan in Hawaii, the most important factor is whether the plan covers your medications. Always be sure to check the formulary for the prescriptions you need. It is also a good idea to talk to your doctor about any future medication needs before picking a plan.
Medications leave and enter formularies throughout the year, with insurers notifying you when it happens. If you find your medication is no longer covered, talk to your doctor and have them help you file an exception. You can look for a new plan during Annual Enrollment.
How do I access Medicare Part D in Hawaii?
All you need to get Medicare Part D in Hawaii is to be enrolled in Original Medicare and live in an area that includes a Medicare Part D prescription drug plan. There are a few times you can sign up for Medicare:
- Initial Enrollment Period (IEP): This is also when most people become eligible to enroll in Medicare. Your IEP starts three months before the month you turn 65, includes your birth month, and lasts for the following three months. You can sign up for Original Medicare, a Part D plan, or an MA-PD plan.
- Annual Enrollment Period (AEP): From October 15 through December 7 every year you can switch from Original Medicare to Medicare Advantage (or vice versa) and enroll in an MA-PD plan or a standalone Part D plan.
- Medicare Advantage Open Enrollment Period (OEP): From January 1 through March 31, people who have an MA plan can change to a new plan or switch back to Parts A and B. If you lose prescription drug coverage by making that change, you can also use this time to enroll in Part D.
- General Enrollment Period (GEP): If you missed your IEP, you can sign up for Medicare Part A and/or Part B during General Enrollment, which runs from January 1 to March 31. You then have from April 1 to June 30 to choose a Part D prescription drug plan.
Outside of these times, you may only make changes to or enroll in a Part D plan if you qualify for a Special Enrollment Period (SEP). Special circumstances such as a no-fault coverage loss may qualify you for this period. For a full list of special circumstances, check here.
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