Medicare in Hawaii

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Hawaii Medicare Plans

By the end of November 2018, around 267,831 Hawaii residents were enrolled in Medicare that is nearly 19% of the state’s total population.


Hawaii is known to have the smallest percentage of disabled Medicare beneficiaries in the country, as just 9% of Medicare beneficiaries in Hawaii are eligible due to disability and the remaining 91% are eligible due to their age.

Original Medicare

Original Medicare comprises of two parts, Medicare Part A and Medicare Part B. Medicare Part A covers inpatient care along with care received while being in a hospital or in a skilled nursing facility and also in limited circumstances at home. All the Hawaii residents who are either a U.S. citizen or a legal permanent resident of at least five continuous years are eligible for Original Medicare Plan. Some of the Part A benefits are only covered in certain situations and if some conditions are met. Medicare Part A home care benefits like skilled nursing care, physical therapy, speech-language pathology services, occupational therapy and durable medical equipment are covered when deemed medically necessary and ordered by the doctor.

Medicare Part B is also a part of Original Medicare and provide coverage for medical services and supplies that are essential to treat insured health condition. The coverage usually include outpatient care, preventive services, ambulance services, and durable medical equipment along with intermittent home health and rehabilitative services like physical therapy if advised by doctors. In order to become eligible for Original Medicare, individuals must be 65 years or older and they must be a U.S. citizen or a permanent resident residing lawfully in the state for at least five continuous years. Individuals under 65 can also automatically qualify for Original Medicare on the disability ground.

Medicare Part C

With more than 260,000 Medicare beneficiaries in Hawaii, around 122,847 beneficiaries are enrolled in Medicare Advantage or other Medicare Health plans. Medicare Part C or Advantage plans are offered by private insurance companies that should have contract with Medicare to offer these plans. Medicare Part C is another name for Medicare Advantage and covers everything that Original Medicare cover and may include some extra benefits as well. Medicare Part C covered inpatient care in a hospital and skilled nursing facility care usually covered by Medicare Part A and also covers Home health care, though they may have different cost sharing amounts than Original Medicare. Part C also covers the outpatient care usually covered by Medicare Part B that include medically necessary services along with preventive services to prevent and detect disease. Besides Original Medicare benefits, Medicare Part C also offers coverage for prescription drugs that are taken at home, routine dental care, routine vision care, routine hearing care and fitness benefits like exercise classes. However, not every Part C plans cover all the extra benefits in the same way as some may only cover routine dental care and other may cover only routine vision care.

Some Vital Facts Related to Medicare Advantage Plans

  • In 2019 there are 26 Medicare Advantage plans available in Hawaii.
  • 100% Medicare beneficiaries of Hawaii have access to a Medicare Advantage plan.
  • The lowest monthly premium for a Medicare Advantage Plan is $0.
  • The medicare Advantage plan premium in 2019 has been considerably reduced compared to 2018.

Hawaii Medicare Advantage Prescription Drug Plans

Medicare Advantage Prescription Drug plans are ideal alternative for Hawaii residents to get their Original Medicare, as these plans help them cover the costs of services provided by hospitals, doctors and lab tests along with some preventive screenings. Besides, the prescription drug component of the plan cover medication cost. There are around 24 stand-alone Medicare prescription drug plans available in Hawaii but people looking for these plans need to enter their zip code to check the availability of the plan in their area. All beneficiaries of Medicare plans can have access to these plans, if available in their area. The lowest monthly premium for Advantage Prescription Drug plans is $13.90 in Hawaii.

Medicaid in Hawaii

Medicaid services in Hawaii are mostly delivered through Managed Care Organization and it is basically a medical assistance program provided for eligible low-income Hawaii residents. The state has two medical assistance programs, Hawaii QUEST and Medicaid Fee-for-Service. Medicaid plans is designed to benefit low-income Hawaii residents especially those individuals who have low or no employment and also do not have access to the employer-based health insurance. The number of Hawaiians covered either by Medicaid or CHIP is considerably increasing every year.

Medicaid Fee-For-Service

It is a program that provides free or low cost health coverage to people of age 65 and older or people with certain disabilities. Under this plan, health care providers are paid directly for the covered services.


To all the eligible individuals of medicaid QUEST, coverage is provided under a managed care program called Hawaii QUEST.

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