Medicare beneficiaries in Hawaii have the option to get prescription drug coverage from Medicare in a prescription drug plan. Considering that Original Medicare only offers limited medication coverage in hospitals, a prescription drug plan can cover much of the rest of your medication needs.
If you decide to enroll in a Medicare prescription drug plan, you should do so soon after becoming a Medicare beneficiary. Late enrollment fees (link) will add to your monthly premiums if you wait too long to enroll. Though there are cases when these fees can be waived, it’s best to get drug insurance early to avoid unnecessary hassle. It will also save you from a situation where you’d have to pay out-of-pocket costs for medications while waiting for an election period to sign up for drug insurance.
Medicare Part D vs. Medicare Advantage
Both Medicare Part D and Medicare Advantage can cover your prescription medication. Both are administered by private insurance companies rather than the federal government, and both offer plenty of options. However, their structures and availabilities differ. Medicare Part D is an additional insurance you add to Original Medicare. Medicare Advantage, however, offers in a single package both what Original Medicare covers as well as dental and prescription medication coverage. Medicare Part D is available in all 5 Hawaii counties; Medicare Advantage has coverage zones restricted to certain counties and regions.. In spite of Hawaii’s small size, in each county there are five or more Medicare Advantage plans to choose from. This is in addition to the 19 Medicare Part D plans available in all counties.
It is important to note that enrolling in Part D while on Medicare Advantage will automatically disenroll you from Medicare Advantage, returning you to Original Medicare. The same principle applies if you’re switching to a Medicare Advantage plan from a Medicare Part D plan. You will no longer be enrolled in Parts A and B. Even if you find a better deal for your medications with a different plan type, you should think carefully about how switching plans will affect your other health insurance before enrolling.
Before you decide to take prescription drug coverage with Part D, you should consider how Medicare drug coverage will work with your current insurance. Enrolling in Medicare Part D may disqualify you from getting insurance from your union or employer. You should contact your previous insurance and visit this article (link) on how Medicare Part D works with other insurance before making a decision.
When to sign up
There are three main time windows to enroll in Medicare Part D. These are as follows:
- The Initial Enrollment Period (IEP). This is the largest window of time you have to enroll in a Medicare prescription drug plan. It is also the only period you can sign up for Medicare Part D without risking late enrollment fees, regardless of your previous insurance or financial status. The IEP lasts for a total of seven months: It begins three months before the month you’re eligible to become a Medicare beneficiary, includes the month you become eligible (your birth month), and ends three months after.
- The Annual Election Period (AEP). This enrollment period lasts from October 15th to December 7th every year. Should you miss your IEP, this is the most common time to sign up for a Medicare prescription drug plan. Even if you don’t need to enroll in Medicare Part D during this period, it’s a good time to review your prescription drug insurance and decide whether you would benefit from switching to another plan.
- A Special Election Period (SEP). This enrollment period can take place at any time of the year, but you must have specific circumstances to be granted one. One of these circumstances is losing your previous drug coverage because you moved out of your coverage zone. For a full list of the circumstances allowing you a SEP, visit our article here (link).
What are my choices?
Shown below is a table including the 19 Medicare Part D plans available in Hawaii. Out of these, four plans offer extra drug coverage in the donut hole (link). The cheapest plan with a deductible has an $18.40 monthly premium, and the cheapest plan without a deductible has a $25.80 premium. Plans without deductibles generally have much more costly premiums. For an explanation on the different Part D benefit types, like “actuarially equivalent standard,” visit our article here (link).
In addition to this chart, you should consider whether or not your plan has a pharmacy network that will reduce costs if you get medication at certain locations. You should also know whether your specific medications are covered in the plan’s drug formulary, which can change at any time. If you have further questions, you can speak to one of our insurance agents with the information below.
|Organization Name||Plan Name||Plan ID||Benefit Type||Total Premium||Drug Deductible||Gap Coverage
|Aetna Medicare||Aetna Medicare Rx Saver (PDP)||67||Actuarially Equivalent Standard||$24.20||$360.00||No|
|EnvisionRx Plus||EnvisionRxPlus Silver (PDP)||33||Actuarially Equivalent Standard||$31.90||$360.00||No|
|Express Scripts Medicare||Express Scripts Medicare – Value (PDP)||135||Actuarially Equivalent Standard||$31.00||$360.00||No|
|Express Scripts Medicare||Express Scripts Medicare – Choice (PDP)||203||Enhanced Alternative||$62.60||$360.00||No|
|First Health Part D||First Health Part D Premier Plus (PDP)||195||Enhanced Alternative||$45.70||$0.00||Yes|
|First Health Part D||First Health Part D Value Plus (PDP)||198||Enhanced Alternative||$29.20||$0.00||Yes|
|Humana Insurance Company||Humana Enhanced (PDP)||93||Enhanced Alternative||$72.20||$0.00||Yes|
|Humana Insurance Company||Humana Preferred Rx Plan (PDP)||115||Actuarially Equivalent Standard||$28.70||$360.00||No|
|Humana Insurance Company||Humana Walmart Rx Plan (PDP)||179||Enhanced Alternative||$18.40||$360.00||No|
|SilverScript||SilverScript Choice (PDP)||66||Basic Alternative||$25.80||$0.00||No|
|SilverScript||SilverScript Plus (PDP)||67||Enhanced Alternative||$80.10||$0.00||Yes|
|Symphonix Health||Symphonix Value Rx (PDP)||46||Actuarially Equivalent Standard||$28.30||$360.00||No|
|Symphonix Health||Symphonix PrimeSaver Rx (PDP)||76||Enhanced Alternative||$42.20||$200.00||No|
|United American Insurance Company||United American – Select (PDP)||38||Actuarially Equivalent Standard||$55.90||$360.00||No|
|United American Insurance Company||United American – Essential (PDP)||134||Enhanced Alternative||$41.80||$230.00||No|
|UnitedHealthcare||AARP MedicareRx Preferred (PDP)||32||Enhanced Alternative||$52.90||$0.00||No|
|UnitedHealthcare||AARP MedicareRx Saver Plus (PDP)||381||Actuarially Equivalent Standard||$28.30||$360.00||No|
|WellCare||WellCare Classic (PDP)||170||Basic Alternative||$36.20||$360.00||No|
|WellCare||WellCare Extra (PDP)||204||Enhanced Alternative||$68.20||$0.00||No|
Plans are subject to change as contracts are finalized.
Includes contracts/plans as of April 22, 2016. The data does not reflect information for Employer sponsored plans, Part B only plans, or plans not offering a Part D drug benefit.