Medicare Plans in Hawaii – Coverage and Benefits
Enrolling in the Federal Medicare Program is easy for residents of Hawaii. All you have to do is be 65 years of age, and follow the enrollment process when the time comes. Successful enrollment will give you access to Medicare Parts A and B (a.k.a. “Original” or “Traditional” Medicare). Part A applies primarily to hospital stays and in-patient care, while Part B takes care of mostly out-patient and routine medical treatment.
Your initial Medicare costs will start with your regular Part B premiums, which are required for everyone who receives Medicare benefits. However, an additional premium may be required for access to Part A benefits; it all depends on your employment history. If your employment history is more than 40 quarters (or 10 years) long, you are good to go and will not be required to pay a premium. However, if your employment history is any shorter than that, you will be required to pay additional costs in order to receive Medicare Part A benefits.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
Different Types of Supplemental Medicare Plans in Hawaii
The number of beneficiaries receiving Medicare coverage in Hawaii comes out to a grand total of 217,678, which is a pretty sizeable chunk of the overall population. 46% of those Medicare recipients (100,131 people) are getting their coverage underwritten by a Medicare Advantage program. An additional 1.9% (4,065 beneficiaries) choose to supplement their Original Medicare with a Medigap policy (we’ll address Medigap policies later in this article). The remaining 52% of the beneficiary pool may prefer to cover their medical expenses using Traditional Medicare only, or they may have additional benefits through an employer-sponsored program.
Note: Medicare supplement policies can only be purchased by seniors who are 65 years of age (or older) and already enrolled in Medicare. If you are not enrolled, or if you have questions about Medicare enrollment, click the provided link.
Why Should Hawaii Residents Consider a Supplement Policy?
Generally, Medicare Parts A and B are designed to be fairly comprehensive. Unfortunately, there are gaps in this coverage which, if not supplemented, can leave you with some disastrous out-of-pocket expenses. Younger and healthier retired persons may not have to worry about large medical bills now. However, if you require frequent hospital stays or if you anticipate a downturn in your health in the near future, here are some of the expenses you can expect from Original Medicare:
|Medicare Part A Costs||Medicare Part B Costs|
Supplement policies help put your mind at ease in the event of a sudden health emergency. There are two very popular forms of coverage available to the public right now: Medicare Advantage, and Medigap policies. This article will help you learn the basics of each supplement so that you can make an intelligent decision about your health care needs.
Medigap Options for Hawaii Medicare Beneficiaries
Medigap Policies are named after the “gaps” in Original Medicare coverage which they are designed to cover. While a Medigap supplement policy is underwritten by a private insurance company, it does not replace your Original Medicare benefits. There are ten different varieties of Medigap plans: A-D, F, G, and K-N. There were additional packages labeled E, H, I, and J, however they were phased out in 2010 as part of the Medicare Modernization Act. Because of government legislation, A Hawaii resident looking to purchase a Medigap D policy can expect to receive the same benefits as someone with a Medigap D policy in Colorado or New York; the only aspects which will truly vary by location are the price, and the insurance company who manages the policy.
Here’s what you can expect from each of the 10 plans:
[chart category=”supplement” name=”planTypes” state=”HI” zipcode=”96817″]
Medicare Advantage Plans in Hawaii
Medicare Advantage may also be referred to as Medicare Part C. Medicare Advantage policies aren’t your typical form of Medicare coverage. If you sign up for a Medicare Advantage policy, you are essentially giving a private company permission to take over the responsibility for dolling out your Medicare Benefits – which means that the federal government will no longer be covering you. The good news is that these private companies are required by law to give you the exact same benefits as Medicare Parts A and B. Some Medicare Advantage policies offer additional benefits on top of Traditional Medicare in order to entice potential clients.
While the promise of additional benefits at an affordable cost may interest some, there are drawbacks. Having a private company handle your health care needs leaves you vulnerable to market fluctuations regarding pricing and plan availability. Additionally, the PPO and HMO networks of certain Medicare Advantage plans are said to be limited in some areas, in order to keep costs down. If you don’t mind switching doctors, this might not be an issue for you.
For the record, an HMO is a “Health Maintenance Organization”, and a PPO is a “Preferred Provider Organization”. Both are networks which Medicare Advantage programs rely upon in order to provide you with care.
[chart category=”advantage” name=”topHMOPlans” zipcode=”96817″ state=”HI”]
[chart category=”advantage” name=”topPPOPlans” zipcode=”96817″ state=”HI”]
Comparing Medigap and Medicare Advantage in Hawaii
This informative table further illustrates the differences and similarities between these two different types of supplement coverage:
|Questions||Medicare Advantage||Medicare Supplement|
|How are the plans funded?||Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company.||Your monthly premium takes care of the majority of your expenses.|
|Do I continue paying for Part B?||Yes||Yes|
|What does it cost me?||Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly.||While each plan does require a monthly premium, many of them are affordably priced.|
|What does the plan cover?||Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be.||All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.|
|Can I budget my health care expenses?||It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket.||Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.|
|Can my plan be cancelled?||Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage.||No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.|
|Are pre-approvals or pre-certifications required?||Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care.||No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.|
|Can I use any doctor or hospital?||Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time.||Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.|
|Can drug, vision, or dental coverage be included in the policy?||Yes.||No. These forms of coverage must be purchased separately.|
|Who is this plan type generally best suited for?||If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you.||If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.|
Hawaii Medicare Resources
It’s highly likely that you still have questions about Medicare Advantage and Medigap supplement insurance. That is to be expected. For this reason, we’ve included a helpful pool of contact resources for you to draw from. Try contacting representatives who can answer your Medicare supplement insurance questions to learn more about which policy is best for you.
[chart category=”general” name=”usefulContacts”]
Important Medicare-Related Healthcare Terms
- HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
- PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
- Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
- Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
- Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.