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Medicare Part D in Hawaii

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Hawaii is more than the habitat of sea turtles and tropical fish. Hawaii is also the home to almost 263,000 Medicare beneficiaries according to the Centers for Medicare and Medicaid Services (CMS). Over 71% of these beneficiaries have Medicare Part D coverage.

What is Medicare Part D in Hawaii?

Medicare Part D in Hawaii is prescription drug coverage offered by private insurance companies regulated by Medicare. Enrollment in Medicare Part D in Hawaii is optional. You may have to pay your prescription drug expenses out-of-pocket if you don’t have a Medicare prescription drug coverage in Hawaii because Original Medicare does not cover most prescription drugs you take at home.

There are two ways to get Medicare Part D coverage. You can get:

  • A stand-alone Medicare Part D Prescription Drug Plan. A stand-alone plan can only be used alongside Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans. According to CMS, there are 20 Medicare Part D stand-alone prescription drug plans available in Hawaii in 2018.
  • A Medicare Advantage Plan with Part D prescription drug coverage. Medicare Advantage is another way to get your Medicare Part A and Part B benefits through a private insurance company. Medicare Advantage must cover everything that Original Medicare covers, with the exception of hospice care, which is still covered by Part A. Medicare Advantage allows you to get hospital, medical, and prescription drug coverage under one plan. According to CMS, there are 20 Medicare Advantage plans available in Hawaii in 2018.

How much will I pay for Medicare Part D in Hawaii?

Cost of Medicare Part D in Hawaii include

  • A premium: this is the monthly amount you pay to have the plan. According to CMS, the lowest monthly premium for a Medicare prescription drug plan in Hawaii in 2018 was $20.40.
  • A deductible: this is amount you pay before your plan begins to pay. In 2018, the highest allowed deductible was $405.
  • Coinsurance or copayment: this is the amount you pay when you fill a prescription. Coinsurance is a percentage and a copayment is a set dollar amount, for example $15. Medicare prescription drug plans may organize prescription drugs into five tiers, with tier 1 prescription drugs having the lowest coinsurance or copayment and tier 5 prescription drugs having the highest coinsurance or copayment.

If you are struggling to pay for prescription drugs, you can apply for Medicare’s Extra Help program. In 2018, 26 percent of Medicare beneficiaries with a prescription drug plan in Hawaii get Extra Help, also called the low-income subsidy according to CMS.

What should I consider when choosing a Medicare Part D Prescription Drug Plan in Hawaii?

Aside from cost, one important thing to consider when looking for Medicare Part D coverage in Hawaii is whether your plan will cover the medications you are currently taking. Each private insurance company approved by Medicare may differ when it comes to the specific brand-name or generic medications it will cover. To look up whether a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan covers your medications, check the formulary, which is a list of covered prescription drugs. Keep in mind that the formulary may change at any time. You will receive notice from your plan when necessary.

How do I enroll in Medicare Part D in Hawaii?

To be eligible for Medicare Part D in Hawaii, you must:

  • Be enrolled in Medicare Part A and/or Part B, and
  • Live in the service area of a Medicare plan that covers prescription drugs.

You’re first eligible for Medicare Part D during your Initial Enrollment Period for Part D, which typically coincides with your Initial Enrollment Period for Part B. If you qualify for Medicare by age, this seven-month period starts three months before you turn 65, includes the month you turn 65, and ends three months later. If you get Medicare because of disability, it starts three months before your 25th month of disability benefits from Social Security or the Railroad Retirement Board and lasts seven months.

After your Initial Enrollment Period has passed, your next opportunity to make coverage changes is the Annual Election Period, which runs from October 15 to December 7 of each year. During this time, you can enroll in a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan for the first time, switch Medicare plans, or disenroll from a plan.

If you use the Medicare Advantage Disenrollment Period (January 1 to February 14) to disenroll from your Medicare Advantage plan and go back to Original Medicare, you can also use this period to enroll in a stand-alone Medicare Prescription Drug Plan (since Original Medicare doesn’t include Medicare Part D coverage). These are the only coverage changes you can make during this period.

After the above periods have passed, you can only make changes to your Medicare Part D coverage in certain situations that qualify you for a Special Election Period. For example, if you lose your Medicaid eligibility, move into a nursing home, or move out of your Medicare plan’s service area, you may be eligible for a Special Election Period to make changes to your prescription drug coverage.

If you’d like to start searching for Medicare Part D coverage in Hawaii, simply enter your zip code in the plan finder tool on this page, and we will provide you with a customized list of Medicare plan options available in your area. You can even enter the names of your current prescription medications to help narrow your search. Need help more quickly? Contact eHealth today to speak with a licensed insurance agent.

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.

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