Medicare in Hawaii
- Are you covered by Medicare in Hawaii? Find out about Medicare coverage in the state and what plans are available.
What Hawaii Medicare Plans Are Available?
Once you're eligible for Medicare, you can choose from different health insurance plans to get the coverage that best meets your needs.
Close to 147,500 Hawaiians are enrolled in Original Medicare, which is the government's basic health insurance plan to pay for medically necessary services. Original Medicare includes:
- Part A hospital insurance for hospital, skilled nursing, hospice and some home health care
- Part B medical insurance for preventing, diagnosing and treating illnesses and medical conditions
Original Medicare is delivered through the federal government and doesn't include supplemental benefits like prescription drugs and dental care. If you want benefits beyond Original Medicare, you can purchase coverage through a private insurance company.
Here are some of the Medicare options sold by private insurers in Hawaii:
- Medicare Advantage (Part C): More than 131,000 Hawaiians choose to receive Part A and B benefits through Medicare Advantage instead of Original Medicare. These plans include health-related benefits such as prescription drugs, dental cleanings, eyeglasses, hearing aids, gym memberships and transportation to medical appointments. Your premiums and deductibles depend on the type of benefits offered and whether the plan has a network of health care providers.
- Prescription Drug Coverage (Part D): If you stay in Original Medicare, you can supplement your basic coverage by enrolling in a Part D drug plan. Each drug plan has a list of pharmacies you may use when filling your prescriptions and a formulary that lists the drugs covered by the plan. You can't combine standalone Part D plans with most Part C plans, so if you're enrolling in Medicare Advantage, you need to specifically choose a plan that includes drug coverage as part of the plan benefits.
- Medicare Supplement Insurance (Medigap): Medigap is an add-on to Original Medicare that helps pay for out-of-pocket expenses such as Part A and B copayments, coinsurance and deductibles. Medigap plans are categorized by letter: A, B, C, D, F, G, K, L, M and N. Plans within a category include the same selection of benefits. Some of the more comprehensive plans cover expenses such as foreign travel emergencies or excess fees doctors charge above Medicare-approved amounts.
Who Is Eligible for Hawaii Medicare?
Most people who receive Social Security benefits don't need to sign up for Medicare and automatically receive a welcome packet in the mail once they're eligible. You're automatically enrolled in Medicare Parts A and B if you've been receiving:
- Retirement benefits for at least 4 months prior to your 65th birthday
- Disability benefits for 24 months
Otherwise, you have certain periods in which you can sign up for Medicare. Late enrollment penalties can apply if you don't enroll in Parts A and B when you're first eligible.
- Initial Enrollment: Your first opportunity to enroll in Parts A and B begins 3 months before the month you turn 65. This period lasts for seven months.
- General Enrollment: When your initial enrollment period has ended, you can sign up for Medicare between January 1 and March 31 of each year. Late enrollment penalties may apply. Your Medicare coverage begins July 1.
- Special Enrollment: You may be able to join Medicare or change Medicare plans at other times of the year. Special enrollment may be granted if you've been living in another country and return to the United States, leave an employer-sponsored health plan or are no longer eligible for a Special Needs Plan because your health has improved.
- Open Enrollment: During Medicare's annual fall enrollment period (October 15 to December 7), you can make changes to your Medicare coverage. You can join or switch between Original Medicare, Medicare Advantage and Part D drug plans. Coverage begins January 1.
How Do I Enroll in Medicare in Hawaii?
Medicare registration is through the Social Security Administration (SSA). If you're not receiving SSA benefits and don't qualify for automatic enrollment, you can sign up for Parts A and B separately. You may apply for Social Security retirement benefits at the same time but aren't required to.
To enroll in Medicare in Hawaii, apply on the SSA website, call 1-800-772-1213 or visit a Social Security office near you.
Contact Information for Hawaii Medicare, Medicaid and Insurance Help
Here are some useful resources if you have questions about how Medicare works or difficulty affording health insurance in Hawaii.
- Learn how low-income Hawaiians can receive health care through the state's Medicaid program.
- Receive free, one-on-one counseling with a Medicare expert through the Hawaii State Health Insurance Assistance Program (SHIP). Trained SHIP counselors help Medicare-eligible residents and their caregivers to understand Medicare eligibility, compare options and enroll in plans. Call 1-888-875-9229 or visit the SHIP website.
- Read about applying for Medicare Savings Programs in the AARP Foundation's publication Your Guide to Public Benefits in Hawaii.
Get information about Hawaii RX card, which offers statewide prescription drug discounts for brand and generic drugs.