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Medicare Advantage Plans in Hawaii


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What is Medicare Advantage in Hawaii?

Medicare Advantage, also known as Medicare Part C, is another way to get your Medicare Part A and Part B (Original Medicare) benefits in Hawaii. Medicare Advantage is offered by private insurance companies contracted with Medicare and must offer all the benefits of Original Medicare with the exception of hospice care, which is still covered by Part A. Medicare Advantage plans in Hawaii may offer extra benefits including:

  • Prescription drug coverage for medications you take at home
  • Routine vision care
  • Routine hearing care
  • Routine dental care
  • Exercise and fitness benefits

Unlike Original Medicare, which has no out-of-pocket maximum, Medicare Advantage plans have out-of-pocket maximums.

How do I chose a Medicare Advantage plan in Hawaii?

The first thing you may consider is what kind of coverage you want. Prescription drug coverage may be important to you but not fitness benefits, for example. Different Medicare Advantage plans in Hawaii offer different coverage for benefits not covered by Original Medicare. If a certain benefit is offered by Original Medicare, all Medicare Advantage plans must generally also cover it.

The next thing you may consider is plan cost. Medicare Advantage plans in Hawaii may have monthly premiums, which is the amount you pay to have the plan. Some Medicare Advantage plans have monthly premiums as low as $0, but you must continue to pay your Medicare Part B premium. Another cost is a deductible, which is the amount you pay out of pocket before the plan begins to pay. Some Medicare Advantage plans in Hawaii may have $0 deductibles. Another cost is copayment or coinsurance, or the amount you pay when you use a service. A doctor office visit, ambulance service, or emergency room visit all may have separate copays. Some Medicare Advantage plans in Hawaii may charge $0 copays for certain services.

A third thing you may consider is the type of plan you want. Plans vary in the way that you access primary care doctors, specialists, and use networks. Medicare Advantage plans are usually managed-care plans such as:

  • Health Maintenance Organizations (HMOs): HMOs in Hawaii typically have a provider network of hospitals and doctors you must use to get coverage. These plans require a referral from your primary care doctor to see a specialist
  • Preferred Provider Organizations (PPOs*): PPOs in Hawaii have more provider flexibility; you have the option to use doctors in the plan’s preferred provider network, or you can use out-of-network providers and pay higher costs. These plans don’t require primary care doctors, and you don’t need a referral before seeing a specialist.
  • Private Fee-for-Service plans (PFFSs**): PFFS in Hawaii do not have provider networks. Instead, you can use any doctor or hospital that agrees to the plan’s terms and conditions, on a case-by-case basis.

How many Medicare Advantage plans are available in Hawaii?

There are 20 Medicare Advantage plans available in Hawaii in 2018 according to the Centers for Medicare and Medicaid Services (CMS). Although not all plans may be available in all areas, in 2018 100% percent of Hawaiians with Medicare had access to at least one Medicare Advantage plan. In 2018, according to CMS, 46% of Medicare beneficiaries in Hawaii were enrolled in Medicare Advantage or another health plan and 54% were enrolled in Original Medicare.

How can I enroll in Medicare Advantage in Hawaii?

To be eligible to enroll in a Medicare Advantage plan in Hawaii, you must

  • Be enrolled in both Medicare Part A and Part B
  • Live in the plan’s service area
  • Not have end-stage renal disease (ESRD).

You may enroll in or switch plans during your Initial Coverage Election Period (ICEP), which begins three months before you become eligible for Medicare and lasts for a total of seven months

You may also enroll during the Annual Election Period (AEP), which occurs from October 15 to December 7 of each year.

Qualifying beneficiaries may also have the option of enrolling during a Special Election Period as well. Some circumstances where you may get a Special Election Period are if you change where you live or if you lose your current coverage.

You can start comparing Medicare Advantage plan options in Hawaii today. Simply enter your zip code where indicated on this page, and we will display a customized list of plan options available to you.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply.

Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.

The provider network may change at any time. You will receive notice when necessary.
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

**A Private Fee-for-Service plan is not Medicare supplement insurance. Providers who do not contract with our plan are not required to see you except in an emergency.

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eHealth's Medicare website is operated by eHealthInsurance Services, Inc., a licensed health insurance agency doing business as eHealth. The purpose of this site is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. eHealth and Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. We offer plans from a number of insurance companies.