Purchasing the best Medicare Advantage Plans in Hawaii for 2020 for their 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. If you want extra help paying your cost-sharing amounts, you can buy a Medicare Supplement insurance plan.
- 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 see 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. A private insurance company coordinates your benefits.
Medicare plans in Hawaii also include prescription drug coverage:
- With Original Medicare, you have to buy a stand-alone Medicare prescription drug (Medicare Part D) plan.
- Most Medicare Advantage plans have drug coverage built into them. These are called Medicare Advantage Prescription Drug plans (MAPD).
- If you don’t choose an MAPD, you can buy a stand-alone Part D plan.
Whether you choose Original Medicare or a Medicare Advantage plan, you must stay enrolled in Medicare Part A and Part B.
Now that you understand how Hawaii Medicare works, you can begin to compare 2020 health plans to find the best one that fits your health and financial condition.
Overview of the Best Medicare Advantage Plans in Hawaii for 2020
To help beneficiaries compare Medicare Part C plans in Hawaii, CMS developed a system measuring quality assurance and the satisfaction of plan members. A 5-star rating is the highest rating a Medicare Advantage plan in Hawaii can achieve. As you evaluate plans, compare the ratings. Also, keep in mind the following:
- Because private insurance companies offer Medicare Advantage plans in Hawaii, rates will vary between carriers.
- Some Advantage plans have a $0 premium. Even if your Medicare Advantage plan has a $0 premium, you must still pay your Medicare Part B premium.
- Not all Advantage plans are available in all five counties.
- Beneficiaries must live in the plan’s service area.
- Beneficiaries can get help with their monthly premiums through a low-income subsidy (Extra Help) program.
- Unlike Medicare Part A and Part B, each Medicare Advantage plan in Hawaii for 2020 has a maximum out-of-pocket limit.
Best Medicare Advantage Plans in Hawaii: When Can You Enroll?
To qualify for a Medicare Advantage plan in Hawaii, you must be enrolled in Medicare Part A and Part B. Medicare Advantage enrollment offers several options:
- Medicare Initial Coverage Election Period ICEP. Your ICEP is the best time to enroll. It corresponds to your Medicare enrollment period, which starts three months before your 65th birthday and ends three months after.
- Medicare Annual Election Period AEP. The AEP runs from Oct. 15 to Dec. 7. During the AEP, you can join, disenroll from, or make changes to a Medicare Part C plan in Hawaii.
- Medicare Advantage Disenrollment Period MADP. Formerly Jan. 1 to Feb. 14. The MA Open Enrollment Period replaces the MAPD.
- Medicare Advantage Open Enrollment Period MA OEP. During the MA OEP, you can change Medicare Advantage plans, return to Medicare Part A and Part B, or join a Part D plan if you return to Original Medicare.
- Medicare Special Election Periods SEP. SEPs take into account unexpected situations such as moving, leaving your employer’s health insurance, or moving outside of a service area.
Best Types of Medicare Advantage Plans in Hawaii for 2020
Medicare Advantage plans in Hawaii vary in how a beneficiary receives care. Plan options include managed care and private fee-for-service.
Health Maintenance Organization HMO Plans in Hawaii
HMO Medicare Advantage plans are managed care plans that use in-network providers to deliver health care:
- Requires a primary care physician (PCP)
- Referrals required
- Out-of-network services not covered (emergencies only)
Preferred Provider Organization PPO Plans in Hawaii
PPOs are managed care plans that use a provider network, but they typically offer more flexibility compared to HMOs:
- No PCP
- No referrals
- Out-of-network services covered but at lower rates than in-network
Special Needs Plans SNPs in Hawaii
SNPs are managed care plans that tailor drug formularies, health care providers, and benefits to fit the needs of individuals who have specific diseases or meet certain criteria. SNPs must include prescription drug coverage, usually have PCP and referral requirements, and are limited to those meeting the following conditions:
- Individuals with chronic health conditions such as end stage renal disease ESRD
- Individuals living in institutional conditions such as nursing homes
- Individuals dual-eligible for Medicare and Medicaid
Private Fee-for-Service (PFFS) Plans in Hawaii
With PFFS plans, you can go to any doctor or hospital that accepts the plan’s fees:
- Might or might not have provider networks
- Requires no primary care doctor
- Out-of-network costs reimbursed lower than in-network
Enrollment Figures for Hawaii Medicare Advantage Plans
Hawaii’s nearly 1.4 million people live in five counties:
- Honolulu, 998,650
- Hawaii, 200,381
- Maui, 166,260
- Kauai, 72,159
- Kalawao, 88
In 2018, nearly 19% of Hawaii residents were enrolled in Medicare. Here are other Medicare facts about Hawaii:
- Number of beneficiaries who have Medicare Advantage: 46%
- Number enrolled in Medicare Part A and Part B who have a Medicare Part D prescription drug plan: 37%
- Number of dual-eligible beneficiaries enrolled in Special Needs Plans: 50%
- Number who had PPO Medicare Advantage plans: 59%
Do Medicare Advantage Plans in Hawaii Cover Prescription Drugs?
In 2016, 49% of beneficiaries enrolled in Medicare Advantage Prescription Drug plans that had a $0 premium. In 2016, monthly premiums averaged $37 and ranged from $28 to $76.
Each MAPD has a list of drugs (formulary) that it covers for 2020. Those drugs are arranged into prescription drug tiers. Copays, deductibles, and restrictions vary by plan; the amounts often depend on which tier your drug falls under.
Each company’s formulary is different, so the covered medications also vary. It’s critical to compare 2020 Medicare Part C plans carefully to make sure the formulary includes your drugs.
Network Restrictions for Medicare Advantage plan in Hawaii?
Here’s how HMO and PPO Advantage plans compare concerning network restrictions:
- In coverage area: PPOs cover out of network at a lower rate, whereas HMOs don’t cover out-of-network costs except in emergencies.
- Traveling: HMOs and PPOs cover emergency care regardless of network.
- Moving: When you move to another state or out of the plan’s service area, you have to change to a Medicare Advantage plan in your new location. Medicare Advantage enrollment in the new plan is through an SEP.
Added Benefits of Medicare Supplement Plan in Hawaii
Medicare Advantage plans in Hawaii (Medicare Part C) must offer, at a minimum, all of the benefits Original Medicare offers. Medicare Advantage plans can also offer supplemental benefits such as nutrition counseling, help with transportation, or the following:
- Routine vision and dental
- Wellness programs
- Healthy living classes
Because the coverage varies between insurance companies, the rates will differ, too. Review a complete description of benefits for each MA plan you’re considering and carefully compare them to find the one that’s best for you. If you need help, feel free to call one of our insurance agents.
Here are a few changes for 2020:
- Starting in 2020, insurance companies that provide Medicare Advantage plans in Hawaii will be able to add some supplemental non-health related benefits to certain beneficiaries, such as providing help with making structural changes to the home when needed. This is designed to help those who might need help with widening doorways or installing ramps for their homes.
- The Centers for Medicare and Medicaid Services approved a 2.53% payment increase to Medicare insurers that offer Medicare Advantage plans in Hawaii.
Top Companies Offering Medicare Advantage Plans in Hawaii
These are significant centers of Medicare recipients in Hawaii:
- Honolulu, HI: 371,657
- East Honolulu, HI: 49,914
- Pearl City, HI: 47,698
- Hilo, HI: 43,263
- Kailua, HI: 38,635
According to a relatively recent survey, over 110,000 residents have enrolled in Medicare Part C plans in Hawaii. Since there were only about 245,000 Medicare beneficiaries in the state, this is a relatively large percentage of the population when you compare it to other states.
This listing offers a quick comparison of some of the insurers that will provide Medicare Advantage Plans in Hawaii for 2019:
- Humana: About one in ten members of Medicare Part C plans in Hawaii chose Humana.
- Kaiser: Kaiser offers both 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.
You may have noticed the mention of Medicare’s star ratings in the overview of Medicare insurers above. Medicare compiles multiple factors about Medicare Advantage plans in Hawaii by county. They use this information to assign stars. This gives Original Medicare Part A and B recipients a quick way to judge an MA plan’s performance. Of course, insurers hope to earn a 5-star rating, but this is very difficult. At this time, no Medicare Advantage plans in Hawaii advertised a 5-star rating. However, several of the programs listed above had earned more than 4 stars.