Medicare in Hawaii

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When you turn 65 or qualify by disability at any age, you become eligible for Original Medicare if you’re an American citizen or permanent legal resident of at least five continuous years. You may also qualify at any age if you have end-stage renal disease or amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease).

Original Medicare doesn’t include most prescription drug coverage, so if you need coverage for your prescription medications, you can sign up for a stand-alone Medicare Part D Prescription Drug Plan. Offered by private insurance companies approved by Medicare, these plans have formularies (lists of prescription drugs they cover). When you’re comparing Medicare Prescription Drug Plans, you may want to make sure your medications are included in the formulary of the plans you’re looking at. The formulary may change at any time. You will receive notice from your plan when necessary.

Instead of getting your coverage through Original Medicare and a Medicare Part D Prescription Drug Plan, you may have the option of enrolling in a Medicare Advantage plan in Hawaii. Available from private, Medicare-approved health insurance companies, Medicare Advantage plans include the same coverage you get from Original Medicare, except for hospice care, which Medicare Part A still covers.

Many Medicare Advantage plans include extra benefits, like routine dental care. Most of them also include prescription drug coverage. If you sign up for a Medicare Advantage Prescription Drug plan, you can get all your Medicare benefits through a single plan. No matter what type of Medicare Advantage plan you enroll in, you must continue paying your Medicare Part B premium, along with your plan premium if there is one.

If you decide to stay with Original Medicare, another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.

Medicare resources in Hawaii

Executive Office on Aging: To help the elderly population in Hawaii, the state Department of Health has established the Executive Office on Aging (EOA). The EOA is the top state agency designated for elderly citizens. Its mission is to coordinate and develop aging and support services throughout the state. With federal and state funding, the EOA helps provide assistance and information on nutrition, preventative health, elder rights, and caregiver support. Examples of programs supported by the Hawaii EOA include:

  • Health Aging Partnership
  • Sage PLUS Program
  • The Long-Term Care Ombudsman Program

Senior Medicare Patrol (SMP Hawaii): Medicare fraud and abuse can be detrimental to seniors. To help prevent and monitor for fraud, Hawaii has established the Senior Medicare Patrol (SMP Hawaii). SMP Hawaii believes that protecting individuals’ personal information is the best method for fighting Medicare fraud, waste, and abuse. Medicare beneficiaries who suspect any case of fraud or abuse should contact SMP Hawaii. SMP Hawaii is staffed by volunteers who are trained to educate and empower beneficiaries to review billing, ask doctor billing departments for error corrections, and even take the lead in contacting a medical office if the Medicare beneficiary is uncomfortable doing so.

Sage PLUS: Sage PLUS is the Hawaii State Health Insurance Assistance Program (SHIP). Sage PLUS depends on a network of trained volunteers from all state islands to provide support to beneficiaries. These trained volunteers provide information, education, and counseling about Medicare issues and questions for Hawaii’s aging population. People with Medicare and their families can contact Sage PLUS to speak with trained SHIP volunteers to get help understanding basic Medicare coverage and Medicare plan options, as well as help enrolling in most cases.

Medicare statistics in Hawaii

Here are some interesting statistics from the Centers for Medicare and Medicaid Services regarding Medicare in Hawaii as of 2015:

  • Hawaii had a total of 242,552 Medicare beneficiaries (Part A or Part B).
  • There were 112,326 Medicare beneficiaries enrolled in Medicare Advantage plans. Of these people, 108,148 had prescription drug coverage as part of their Medicare Advantage plans.
  • CMS reported that all Hawaiians who were enrolled in Medicare Prescription Drug Plans in 2015 could get lower-priced plans in 2016.

Statistical data from the Centers for Medicare & Medicaid Services, “On its 50th anniversary, more than 55 million Americans covered by Medicare” as of July 28, 2015; and “2016 MA Part D Landscape State-by-State Fact Sheet” as of September 21, 2015.

This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.


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