Medicare Advantage Plans in Hawaii

Written by: 
Matt Kiggins
Last updated: 
Jan 5, 2023

Purchasing the best Medicare Advantage Plans in Hawaii for 2022 for your unique situation is one way beneficiaries can manage their Medicare benefits. If you’re new to Medicare, the following information will help you understand Medicare coverage in Hawaii.

Most Hawaiians are first eligible for Medicare health insurance when they turn 65. As a Medicare beneficiary, you’ll get coverage for hospital costs, skilled nursing care, doctor visits, and medical equipment and supplies.

You have to choose how you want to receive your Medicare benefits. You have two options, both of which include out-of-pocket costs such as deductibles, coinsurance, and copayments:

  • Original Medicare. Original Medicare comes in two parts, Medicare Part A and Medicare Part B. The Centers for Medicare and Medicaid Services (CMS) manages your Medicare Part A (hospital) and Medicare Part B (medical) benefits. You can buy a Medicare Supplement insurance plan if you want extra help paying your cost-sharing amounts.
  • Medicare Advantage plans in Hawaii. Medicare Advantage plans are often called Medicare Part C or MA plans. They typically have network restrictions and require referrals to out-of-network health care providers. If you select a Medicare Advantage plan, you cannot buy Medicare supplement insurance to help with out-of-pocket costs. Instead, a private insurance company coordinates your benefits.
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Medicare Advantage Plans in Hawaii

Medicare Advantage in Hawaii (Medicare Part C) is increasing in popularity yearly. About 44% of Medicare recipients in Hawaii have a Medicare Advantage Plan.

To enroll in a Hawaii Medicare Advantage plan, you must be enrolled in Original Medicare (Medicare Part A and Part B) and continue paying the Part B premium.

Medicare Advantage in Hawaii is sold and administered by private insurance companies. With a Medicare Advantage Plan in Hawaii, administration of the insurance plans is the responsibility of the insurance company.

Medicare Advantage plans are attached to a specified network of doctors, hospitals, and medical facilities.

You cannot buy a Part D stand-alone plan with a Hawaii Medicare Advantage plan. Most HMO plans and some PPO plans include prescription drug coverage and are called “MAPD” (Medicare Advantage plans with Prescription Drugs).

Medicare Advantage plans often include additional coverage. Some extra benefits are vision, hearing, dental, fitness, wellness, transportation to medical appointments, and free meal delivery.

What is the Best Medicare Advantage Plan in Hawaii for 2022?

Best network freedom: Medicare Advantage PPO

Preferred Provider (PPO) Organizations offer more flexibility than Health Maintenance (HMO) Organizations.

PPOs are based on a network of providers, but the network will be more extensive than that of HMOs. As a result, there is more flexibility with seeing doctors out of network, although there may be added out-of-pocket costs.

With a PPO, you may see a specialist anytime without needing referrals.

PPO monthly premiums vary between $0 and $100.

Best for lowest out-of-pocket: Medicare Advantage HMO Plan

In an HMO, premiums are typically $0 a month. In addition, enrollees will enjoy lower out-of-pocket costs because of participating in a referral network.

Best for low income or health conditions: Medicare Advantage D-SNIP

Medicare beneficiaries who suffer from certain chronic health conditions or are in a low-income range may benefit significantly from this plan.

Individuals who qualify for Medicare Advantage D-SNIP can have Medicaid to help lower their out-of-pocket costs on premiums, deductibles, and copayments.

Hawaii Enrollment Facts

1. Number of lives enrolled in Medicare Advantage in Hawaii

In 2021, 14,701 Medicare recipients in Hawaii are enrolled in Medicare Advantage plans.

2. Number enrolled by plan, specifically the three plans below

Local HMO – 42,997

Local PPO – 71,704

Regional PPO – 0

3. Percentage of Medicare beneficiaries enrolled in Medicare advantage in Hawaii

In Hawaii, 49% of Medicare beneficiaries are enrolled in Medicare Advantage plans in 2021, a 7% increase over 2020.

4. Number of lives enrollment

61.6 million Medicare recipients were enrolled in Medicare Advantage plans in 2021.

5. Percentage of Medicare beneficiaries enrolled in Medicare advantage Nationwide

Nationwide, 42% of Medicare beneficiaries are enrolled in Medicare Advantage plans compared to 32% five years ago.

How much does Medicare Advantage in Hawaii cost?

Most states offer at least one HMO plan for a $0 monthly premium.

Some states offer a PPO plan with a $0 monthly premium. However, PPO plans are increasingly likely to charge a premium.

Monthly premiums vary from county to county. The average premium in Hawaii is $38.52.

When can I enroll in a Medicare Advantage plan?

Initial Enrollment Period

Your Initial Enrollment Period happens when your eligibility for Medicare begins. It starts three months before your 65th birthday month, includes the birthday month, and ends three months after your birthday month. You can sign up for the plan of your choice during this time.

Open Enrollment Period – AKA Annual Election Period

During the Open Enrollment Period (October 15 – December 7), you can enroll in or drop a Medicare Advantage Plan or make changes to your current plan. Without this enrollment period, you would be locked into your current plan through December 31.

Medicare Advantage Open Enrollment Period

The Medicare Advantage Open Enrollment Period lasts from January 1 to March 31. If you have Medicare coverage through Medicare Advantage, you can exchange one plan for another or change from advantage to Original Medicare (Medicare Part A and Medicare Part B). This change can be made only once during this enrollment period. Study the health insurance plans carefully to confirm they have everything you need. Consult an insurance agent who can help you compare health plans in various coverage options.

Special Enrollment Periods – Special Circumstances

Some circumstances that may qualify you for a Special Enrollment Period are:

Relocated outside your plan’s service area

  • Medicaid eligibility ended
  • Moved into or out of a Skilled Nursing Facility
  • Returned to the United States after living abroad

5-Star Special Enrollment Period

Using information from healthcare providers, plans, and member surveys, Medicare assigns performance star ratings to health and prescription drug plans. Plan ratings range from 1- to 5-stars.

Plans with a 5-star rating are considered excellent. Each fall, Medicare amends the ratings. These ratings can help you assess the performance and quality of plans and can change from year to year.

The 5-star Special Enrollment Period runs from December 8 to the following November 30. Once during that interval, if you find a 5-star MA plan, prescription drug plan, or cost plan, you can exchange your current plan for the 5-star one.

An insurance agent can help you compare plans to make sure you do not sign up for a 5-star MA plan without drug coverage unless there is a 5-star drug plan you can add to it. Getting the MA plan without a drug plan could mean waiting until the next enrollment period to get drug coverage and possibly paying a penalty.

Special Enrollment Periods if you get “Extra Help”

Special Enrollment Periods each year give people with Medicare and Medicaid an opportunity to join, drop, or exchange prescription drug coverage or a Medicare Advantage Plan.

The “Extra Help” Special Enrollment periods happen:

  • January through March
  • April through June
  • July through September

Only one change per period is permitted. The change will become effective on the first day of the following month.

No “Extra Help” enrollment period occurs in the 4th quarter of the year, but everyone can take advantage of the Annual Election Period during that time.

Which companies offer Medicare Advantage plans in Hawaii?

  • Humana: About one in ten members of Medicare Part C plans in Hawaii chose Humana.
  • Kaiser: Kaiser offers regular and SNP HMOs that have earned respectable star ratings.
  • HMSA Akamai Advantage: This small, regional insurer offers PPOs that have performed well in the past.
  • Other notable carriers to look out for in your area are Aetna and Cigna.

Ready to Learn More?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation’s top-rated Medicare Advantage carriers. Give us a call today, or request a quote online to learn more about plan options.

Matt Kiggins
Matt Kiggins
Senior Editor

For over 15 years, Matt Kiggins has been the senior editor at Senior Life Insurance Plans, giving detailed advice on Medicare, life insurance, and dental coverage to thousands of clients in more than forty states. His demonstrated expertise in assisting people with their health plan selection is remarkable — it’s evident that he stands out among competitors as the go-to source for knowledge and support.

Matt holds a resident 2–15 Florida Health & Life (Including Annuities & Variable Contracts) Agent License in Florida, his state license number is P116762 (Issued 10/1/2007).

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Matt Kiggins
Matt Kiggins
Senior Editor

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Key Takeaways

  • In Hawaii, PPO Medicare Advantage plans are very popular for many Medicare beneficiaries.
  • Most Hawaiians are first eligible for Medicare health insurance when they turn 65. As a Medicare beneficiary, you'll get coverage for hospital costs, skilled nursing care, doctor visits, and medical equipment and supplies.
  • In Hawaii, 49% of Medicare beneficiaries are enrolled in Medicare Advantage plans in 2021, a 7% increase over 2020.
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