Medicare Advantage in Hawaii

Medicare Advantage was introduced in 1997 as an alternative way for Medicare recipients to receive health care benefits. It combines Part A and Part B into a single plan, also known as Part C. Plans are managed by private companies rather than the government. In addition to Original Medicare benefits, Medicare Advantage Plans offer coverage of extra services to enhance the health of enrollees. This can include wellness programs, dental care and transportation to medical appointments. Most plans also include prescription drug coverage, which means seniors don’t have to purchase a separate drug plan.

Although these plans are overseen by the federal government, companies have control over many aspects of the plans. Providers can set their own requirements regarding referrals and use in-network providers. They can also set their own out-of-pocket costs for copays, deductibles and coinsurance within the guidelines set by the Centers for Medicare & Medicaid Services.

From 2022 to 2023, there was a 3.3% increase in the number of Hawaiians enrolled in Medicare Advantage. Hawaii has one of the highest rates of Part C enrollment in the country, with 53% of eligible people currently choosing a Medicare Advantage Plan. This is a slight increase over 2022, when 52% of enrollees chose Part C. Nationally, 48% of eligible people choose Medicare Advantage, and this number has been growing since the program started. 

This guide can help seniors decide whether Medicare Advantage suits their health insurance needs. It has information about popular providers in Hawaii, what the plans cover, eligibility guidelines and how to find a suitable plan.

The Top 10 Medicare Advantage Plans in Hawaii

There are a number of companies that offer Medicare Advantage Plans to Hawaii’s seniors, providing a range of choices to Medicare-eligible residents. The table below lists the top seven providers in the state based on the total number of people enrolled. Most providers have multiple plans available, so cost information is included as a range rather than an average. The table also shows how providers are ranked out of five stars based on customer satisfaction surveys. This information is correct as of August 2023. Seniors can get the most up-to-date information on plans and prices in New Mexico at Medicare.gov.

How Medicare Advantage Plans Work in Hawaii

Understanding the different plan types available in Hawaii can help Medicare-eligible residents make the best choice for their health needs. Each provider can offer multiple plans, including health maintenance organization plans (HMOs), preferred provider organization plans (PPOs) and private fee-for-service plans (PFFS). Each plan type has different rules regarding prescription drug coverage, the need for a primary care physician, referrals and in-network coverage. The four most common plan types are described below.

What Medicare Advantage Plans Cover in Hawaii

All Medicare Advantage plans must offer the same benefits as Original Medicare, including hospital care, preventive screenings, mental health services and lab tests. The one exception is hospice care, which is not included in Medicare Advantage plans. Medicare Advantage plans can also offer extra benefits, such as dental care, prescription drugs and vision services. These extra benefits differ depending on the plan and provider, so seniors should check that their needs are covered before deciding on a plan.

*Select plans offer this coverage

** Most plans offer this coverage

Eligibility for Medicare Advantage in Hawaii

Medicare Advantage plans are available to people who meet Medicare eligibility requirements and already have Medicare Part A and Medicare Part B. To qualify for Medicare, an applicant must be a U.S. citizen or lawful immigrant who is aged 65 or older. People younger than 65 may be eligible if they have a disability. To be eligible for a specific Medicare Advantage plan, a person must live in the plan’s service area. 

As with other types of health insurance, Medicare Advantage has limited enrollment periods. It’s important that seniors understand when they can enroll in or change a Medicare Advantage plan to ensure they’re health care needs are properly covered. The list below has more information about the timing of Medicare enrollments.

• Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
• Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
• Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.

Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.

How to Find & Choose a Medicare Advantage Plan in Hawaii

Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.

First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.

State-Wide Medicare Advantage Resources

Local Medicare Advantage Resources