Introduction to Medicare Advantage in Hawaii (Part C)

Medicare Part C, or Medicare Advantage, is a unique way to protect yourself from existing (and potentially expensive) gaps in Medicare Parts A and B coverage. Unlike most other supplemental coverage, Medicare Advantage replaces your Traditional Medicare benefits, as opposed to supplementing them the way a Medigap policy does. When you subscribe to a Medicare Advantage policy, the federal government is no longer responsible for your health coverage – that responsibility get signed over to your Medicare Advantage policy provider.

Federal Regulations for Medicare Advantage

For your protection, and to make sure you get the medical benefits which you have earned from working hard over the years, there are specific laws in place regarding Medicare Advantage policies. Your provider must offer you equal or better coverage than Medicare Parts A & B; they cannot offer you anything less. Luckily, most companies are more than willing to offer more, including prescription drug coverage (a.k.a. “MAPD” plans).

Medicare Advantage Enrollment In Hawaii

Hawaii has the second highest rate of Medicare Advantage members out of all 50 United States. 46% of Hawaii seniors have an Advantage plan, as opposed to any other sort of supplement. There are a variety of different Advantage plans available, which break down according to the following chart:

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

Because Medicare Advantage is so popular in the State of Hawaii, it’s important to know what will and won’t influence your rates. Age is a big factor, as well as your current health status. Additional factors, such as your exact location, will have an influence too. Below are average estimates for seniors near you:

Most Popular Medicare Advantage Plans in Hawaii

Not all Medicare Advantage plans are the same. Some, such as the HMO plans, limit how many different doctors and facilities you can visit, but offer a lower rate. PPOs, on the other hand, will allow you a greater variety of access to medical care, but this type of plan will be significantly more expensive.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

Medicare Advantage plans are different from other Medicare supplements in that they are not as widely accepted as Traditional Medicare. Your insurance company will restrict your access to medical care based on your pre-approved provider network. If you don’t travel very often, and if you have access to a good network in a nearby major city, then you won’t have to worry about restrictions that often. Rural residents and snowbirds, for example, have to worry a great deal about network restrictions.

Doctor/Providers List

Drug, Vision and Dental Coverage

Unfortunately, most Medicare supplement insurance doesn’t provide for extra forms of coverage, such as dental or vision care. Some don’t even provide for prescription drugs – instead, you have to get those covered under Medicare Part D. But an Advantage policy gives you the convenient option to bundle your Original Medicare benefits, Part D benefits, and even extra benefits like vision or dental, all into one policy. However, this convenience will come with a larger price tag.

Enrollment Options & Best Time To Enroll

If you have a serious medical condition, such as End Stage Renal Disease, you may have a harder time finding a Medicare Advantage provider who will cover you. If this is the case, taking with your insurance agent or consulting your state department of insurance could help you find alternative solutions. But if you are in relatively good health, and/or within your first 6 months of Medicare enrollment, finding coverage will be easier. Keep in mind, though, that your company may still request information about your current health and pre-existing conditions.

  • Initial Enrollment Period: 6-month timeframe when you first enroll in Medicare to purchase a Medicare Advantage plan.
  • Annual Enrollment Period (AEP): This timeframe runs from October 15th through December 7th every year, and during this time you can change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): During special circumstances, you may be eligible to purchase/change a plan outside of the Annual Enrollment Period. Things such as moving out of the plans’ service area, losing group health or employer coverage, a company no longer offering plans in the area, etc. are all events that could trigger a SEP.

What Medicare Advantage Plan Is Best For Me?

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