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Medicare Options In Hawaii

Are you officially a senior now? Congrats on reaching the golden years of your life. Aging doesn’t mean the way you live your life has to be less fun! Whether you want to spend time amidst the calming deep blue ocean or plan to hike on a mesmerizing mountain trail, nothing should stop you, especially not your age!

People in Hawaii can drive to the peak of dormant volcanoes or take rides in glass-bottomed boats to experience the true beauty of each sunset and sunrise in a completely new way. Activities are abundant at your disposal if you’re living your best life in Hawaii. We know what you’re thinking! What about the risks of injuries and the ever-rising healthcare costs that make it difficult for almost every American citizen to spend any money on leisure?  

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After all of your life’s hard work, you’re allowed to make plans that allow for maximum protection and coverage that can make your life more convenient and comfortable. To avoid unforeseen hefty healthcare expenses, choosing the right insurance plan for yourself is crucial. The right healthcare plan will help you prevent any exorbitant medical bills that you could be paying until the end of time.

Get in touch with us today by calling us at (562) 735-3553! Our Medicare insurance agents will provide you with all the details you need to get started.

Medicare Hope insurance agents at Integrity Now Insurance Brokers are a certified team of insurance agents, certified for their services by America’s Health Insurance Plan (AHIP). We offer free assistance as we ensure all your needs and requirements are met.

With our access to the top-rated Medicare insurance providers in Hawaii, you’re in expert hands. You can rely on us to connect you with the best insurance carriers.


What You Need to Know About Medicare Insurance in Hawaii

Medicare is a federal health insurance program for people who’re 65 or older or those who qualify for disability at any age. People with amyotrophic lateral sclerosis or end-stage renal disease can also qualify for the program.

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This government-run health program covers an extensive range of medical expenses. It is available for anyone who has been a permanent legal American resident for more than five continuous years. However, the Original Medicare plan available for people in Hawaii doesn’t include prescription medication coverage. However, those needing the coverage can sign themselves up for standalone Medicare Part D plans offered by private Medicare insurance carriers. These plans typically include formularies, so you must consider the list of prescription drugs included in the plan’s formulary to ensure you’re adequately covered.

People who don’t want to get coverage through the Original Medicare plus the Part D Prescription Drug plan can enroll in a Medicare Advantage plan in Hawaii. Medicare-approved health insurance providers offering the plan provide the same coverage one can get from Original Medicare.

Medicare Advantage in Hawaii

Also known as Medicare Part C, Medicare Advantage provides another way to get Medicare Part B and Part A benefits in Hawaii. However, hospice care is excluded, which is still covered by Medicare Part A. Some Medicare Advantage plans come with additional benefits, like routine hearing, sight, and dental care.

Most of them also cover prescription medications and exercise and fitness support. This means signing up for a Medicare Advantage plan could help you enjoy all the Medicare benefits through a single plan. Moreover, unlike the no out-of-pocket maximum in Original Medicare, the Medicare Advantage comprises out-of-pocket maximums.

Many Medicare Advantage plans are available in Hawaii with different coverage when it comes to benefits the Original Medicare doesn’t cover. Typically, if Original Medicare offers a certain benefit, all Medicare Advantage plans also cover it.

The plan’s cost is something you must consider when investing. Medicare Advantage plans in Hawaii have monthly premiums, but you can find providers offering Medicare Advantage with premiums as low as $0. However, regardless of the Medicare Advantage plan type you sign up for, you need to continue paying the Medicare Part B premium in addition to the plan’s premium.

A deductible is another cost you’ll need to pay out-of-pocket before the plan begins to pay. Like premiums, some insurance carriers offering Medicare Advantage plans have deductibles as low as $0. The same goes with coinsurance or copayment, the amount paid for the services used. This means if you use the ambulance service or visit the doctor’s office or emergency room, you’d typically need to bear the separate copays. However, you can get Medicare Advantage plans that charge as low as $0 copays for particular services.


People in Hawaii must also consider the type of plan they want as they vary in terms of how you can access specialists, primary care practitioners, and use networks. You can use our Medicare plan finder tool available on our website to check how many Medicare Advantage plans are available in your area. There are four types of Medicare Advantage plans in Hawaii.

Health Maintenance Organization (HMO)

The Health Maintenance Organization is an insurance structure that is very popular in Hawaii since it provides coverage through a network of physicians for a monthly or annual fee. It’s a conglomeration of Medicare insurance providers that offers comprehensive health insurance plans with coverage of medical care provided by your doctors and healthcare providers who are under a contract with them.

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Since the healthcare providers have patients directed to them, these contracts allow the costs and premiums to be significantly reduced. To be eligible for the HMO, you must have a primary care physician (PCP), a specialist’s referral, and approvals for certain treatments and drug prescriptions.

Preferred Provider Organization (PPO)

The PPO is another popular health insurance plan consisting of a network of medical professionals, facilities like primary and specialty physicians, and hospitals in contract with insurance providers that provide services to enrolled participants.

However, it offers much more flexibility, as you’re not required to select the PCP or get specialty referrals. The PCP healthcare plans also include prescription drug coverage. Subscribers can seek coverage outside of the network, but those premiums cost relatively higher.

Private Fee-For-Service (PFFS)

This Medicare Advantage health plan is offered by a State-licensed organization that has contracts with the Centers for Medicare & Medicaid Services (CMS). It pays providers on a fee-for-service basis, so they aren’t on the brink of financial risk.

This service also doesn’t restrict the members’ choices among the providers that have lawful authorization to offer their services. Any provider who accepts the terms and conditions of the Medicare plan is eligible for these Medicare benefits. Drug coverage is included, but you can opt for a separate drug plan if you want.

Special Needs Plan (SNP)

This Medicare advantage plan limits membership to people who have been diagnosed with specific diseases or characteristics. For this Medicare advantage plan, you will need a primary care physician (PCP) and a specialist’s referral. Prescription drug coverage is included, and you can join this plan at any moment if you meet the requirements.

Each Medicare Advantage plan has a different price plan and offers different levels of freedom in choosing your healthcare providers.


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Medigap Options in Hawaii

If you want to stay with Original Medicare, you can sign up for Medigap, a Medicare Supplement insurance coverage, to fill the gaps that come as out-of-pocket costs in Original Medicare. Part A covers 80% of the hospital’s inpatient care and skilled nursing facilities. In contrast, Medicare Part B covers 80% of the total outpatient care costs with the necessary medical supplies. Hence, many people opt for supplemental coverage called Medigap for the coverage for the leftover 20%.

Currently, ten different Medigap plans are being offered in Hawaii. Medigap plan is Medicare supplement insurance offered by private insurance carriers for covering cost-sharing requirements for the Original Medicare Part A and Part B. Although Medicare pays for a significant chunk of the healthcare expenses, you’re still responsible for some costs, typically in the form of copays, deductibles, and coinsurance. Medigap plans not only to help pay for these costs but also offer opportunities to add coverage for excess charges or health emergencies during foreign travel.

Medicare supplement programs are labeled from A through N. While there are ten basic Medigap plans, the most popular are Plans F, G, and N.

Medigap Plan F

Through the years, Plan F has become popular because it covers all the gaps left by Medicare Parts A and B. It covers Medicare Part A coinsurance and hospital expenses for up to a year after you’ve used your Medicare benefits. Plan F can also ease the financial burden of coinsurance for hospice or skilled nursing care.

A visit to the doctor is much more comfortable when there are no copayments. All Medicare services should be free of charge for those on Hawaii Medicare Plan F coverage, regardless of the hospital or doctor they’re being provided by.

As of January 1, 2020, Plan F is only available to people whose Part A effective date was before the beginning of 2020.

Medigap Plan G

Plan G covers the same gaps as Plan F, except for the deductible on Part B. Once a year, you will be responsible for paying your own Part B deductible. Many new Medicare subscribers are unable to sign up for Plan F, which is why Plan G is a viable alternative. Aside from this, the plans are identical.

All these options can get confusing, which is where our services come in. Our Medigap and Medicare insurance specialists can offer quotations for any healthcare plan you’re considering. Whichever plan you decide to go with, we can provide you with quotes from various top insurers in Hawaii.

Medigap Plan N

Plan N is another popular option among Hawaii residents. Plan N includes all of Plan G’s coverage except the Part B premiums. You may face these expenses if your doctor does not accept Medicare terms and conditions.

You’ll also have to front the copay for doctor’s appointments and hospital stays under Plan N. You will be responsible for up to $20 in-office visits and up to $50 in emergency rooms. These copays often lower Plan N’s rates than Plan G’s.

Medicare Advantage vs. Medigap Plans in Hawaii

You should consider getting supplemental insurance in the form of a Medigap plan if you rely on Original Medicare for your healthcare coverage. Since Medigap plans are designed to supplement the Original Medicare plans, they’re standardized across the United States.

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Medigap covers things like deductibles, copayments, coinsurance, and also foreign travel emergency expenses, and excess Part B costs in some plans. Alternatively, with Medicare Advantage plans, Hawaiians get another way of receiving the benefits offered by Medicare. The Medicare Advantage plan covers all Original Medicare services, like the hospital, medical, and prescription drug insurance in Parts A, B, and D. However, additional services can be added to include vision, auditory, and dental care.

Medigap covers Original Medicare, whereas Medicare Advantage replaces Original Medicare. Moreover, Medigap works in tandem with Part D prescription medication coverage, whereas the latter restricts purchasing a standalone prescription drug coverage policy. Moreover, its network of providers is selected by insurance companies.

So, it’s better to get enrolled in Medigap if you’re looking for freedom of choice when it comes to healthcare providers, as it allows you to see any Medicare provider throughout the United States. However, it’s not a good idea if you want Medicare Advantage plans with low or zero monthly premiums.

Hawaiians shouldn’t enroll in Medigap just because the policy they want isn’t available, the premiums are too high, or because they missed the enrollment period. However, if you want emergency care coverage for foreign traveling or can afford the monthly premiums, you should consider it.

For now, those with Medicaid or other creditable coverage and who don’t need Medicare Part B don’t need supplemental insurance as most of their out-of-pocket Medicare expenses are paid for. When you enroll in Part B, the six-month period for Medigap enrollment will automatically start.

In a nutshell, Medigap is recommended for those who frequently access the Part A and Part B benefits, like to select the healthcare providers, but want the out-of-pocket costs covered. With Medicare Advantage, it works best for those looking to get their healthcare and medication costs covered through a single plan. It also requires following the network restrictions and rules set in the plan but often comes with extra benefits.


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Enrolment in Hawaii

Once you begin receiving Social Security or Railroad Retirement Board payments at least four months before your 65th birthday, Medicare will register you automatically. Alternatively, you can apply online or at your local Social Security office.

Enrollment in Medicare is open during the following time frames:

Initial Enrollment

Starting three months before your 65th birthday until three months after it, you can enroll for Medicare Parts A and B. For people with qualifying disabilities, this translates to the three months before or after the 25th disability compensation payment.

General Enrollment

If you cannot enroll during the initial enrollment period, you get another six-month window from January 1 to March 31 to sign up for Medicare. You can enroll in Medicare and Medicare Advantage plans during this period.

Open Enrollment

This enrollment runs from October 15 to December 7 each year. You can enroll in, opt out of, or adjust your Medicare Part C or D plans.

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Medigap Enrollment

Medicare Supplement programs are not subject to an annual open enrollment period like other private Medicare coverage (Part C and Part D) plans. Instead, federal regulations provide a six-month window during which Medigap coverage is guaranteed to be issued.

Once a person turns 65 and is enrolled for Medicare Part B, they’re eligible for this special enrollment period. You cannot purchase Medigap coverage until both Part A, and Part B are active.

Special Enrollment

Medicare offers special enrollment periods for unexpected life events like leaving your work (and health coverage) or relocating from your insurance carrier’s service region. You may be eligible for an 8-month special enrollment period if you meet the criteria.


Why Trust the Medicare Insurance Agents at Integrity Now Insurance?

As an independent Medicare insurance broker, we have one goal: to serve your best interests. We will help you compare quotes and weigh your options so you can settle on an affordable and appropriate Medicare insurance plan.

As an independent Medicare insurance brokerage, we have access to all Medicare insurance carriers in Hawaii. Our independence enables us to give objective recommendations on the best Medicare insurance company for you.

Our insurance agents in Hawaii are licensed and well-versed in the local policies. Most clients are intimidated by hefty consultation fees and decide to do things independently. Luckily, we offer all our assistance free of charge!

Call us to speak with one of our representatives and get started today!

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