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Medicare Advantage Plans

Medicare Advantage Plans in Honolulu, HI

What is a Medicare Advantage Plan?

Medicare Advantage is a bundled Medicare plan offered by private insurance companies that completely replaces your Original Medicare Part A and Part B benefits. It is very different from Medicare Supplement Plans that work alongside and, as the name says, supplements Original Medicare. Medicare Advantage plans must, at a minimum, offer the same benefits as Original Medicare Part A and Part B but, in most cases, offer significantly more benefits. These additional benefits are sometimes called supplemental benefits and include things such as lower cost-sharing, dental, vision, hearing, meal plans, fitness memberships, transportation, and much more. Most Medicare Advantage plans also include Medicare prescription drug coverage, commonly known as MAPD plans.

Medicare Advantage Plans in Honolulu, HI

  • Health maintenance organization (HMO) plans
  • Health maintenance organization, Point-Of-Service Plans (HMO-POS)
  • Preferred provider organization (PPO) plans
  • Dual Eligible Special needs plans (D-SNP)
  • Medicare Medical Savings Account plans (MSA)

There are two general categories of Medicare Advantage plans. All of those listed above fall into Medicare Advantage Prescription Drug Plans (MAPD), which include Part-D drug benefits, and Medicare Advantage Only Plans (MA), which do not have Part-D drug benefits. The majority are MAPD plans; MA plans are only used in special circumstances where other prescription drug benefits are available to the member, such as Veterans.

Medicare Advantage in Hawaii covers:

  • Dental Coverage
  • Vision Coverage
  • Hearing Coverage
  • Transportation to doctor offices
  • Over-The-Counter drug benefits
  • Adult daycare or companion services
  • Fitness club memberships
  • Home delivered meals after inpatient discharge
  • and many more…

Medicare Advantage Out-Of-Pocket Costs

Your Medicare Advantage out-of-pocket cost will vary from plan to plan based on the specific plan you choose and your health status. Medical out-of-pocket costs include the following:

  • Co-payments
  • Coinsurance
  • Annual deductible (not all plans have deductibles)
  • Increased out-of-pocket costs if you go out of network with PPO or HMO-POS plans
  • Decreased Part-D costs if you get Extra Help (Low Income Subsidy)
  • Costs if you pay a late enrollment penalty

Out-of-pocket costs will be limited by your plan’s Maximum Out-Of-Pocket (MOOP) limit. If you are enrolled in a PPO, your plan will set two MOOPS’s, one for in-network costs and another for a combination of in-network and out-of-network costs. In 2022, the maximum allowable MOOP for Medicare Advantage Plans is $7,550, but plans can set lower limits if they choose.

Medicare Advantage Enrollment Periods

There are several different enrollment periods for Medicare Advantage, which apply to you depend on your situation.

Medicare Advantage enrollment periods include:

  • Initial Enrollment Period (IEP)
  • Annual Enrollment Period (AEP)
  • Open Enrollment Period (OEP)
  • Special Enrollment Periods (SEP)

Initial Enrollment Period (IEP)

Your Initial Enrollment Period includes the three months before you turn 65, your birthday month, and the three months after your birthday month. During this time, you can:

  • Enroll in Medicare (Parts A and B)
  • Enroll in a Part-D drug plan
  • Enroll in a Medicare Advantage plan (Part C)

Annual Enrollment Period (AEP)

The Annual Enrollment Period runs from October 15th through December 7th every year. All changes made during AEP are effective January 1st the following year. During this time, you can do the following:

  • If you’re enrolled in Original Medicare, you can enroll in a Medicare Advantage plan or vice versa.
  • If you are enrolled in a Medicare Advantage plan with drug coverage (MAPD), you can switch to one without (MA Only) or vice versa.
  • You can join or drop a Part-D drug plan.
  • You can also change the Medicare Advantage plan you are enrolled in to a different plan offered by your insurance company or switch to another plan provided by another insurance company.

Open Enrollment Period (OEP)

The Open Enrollment Period takes place from January 1st through March 31st. This enrollment period allows individuals enrolled in a Medicare Advantage plan to make a one-time election to switch to another Medicare Advantage plan or Original Medicare. During OEP, you are only allowed to make one change which is effective the 1st of the month following the month the change is submitted. You cannot enroll in a stand-alone Part-D plan if you’re in Original Medicare or switch from one stand-alone Part-D plan to another if you’re in Original Medicare during OEP.

Special Enrollment Periods (SEP)

Special Enrollment Periods are available for special situations and may allow you to join, switch or drop a Medicare Advantage or Part-D drug plan. The length and changes allowed can vary depending on the type of SEP. SEP’s include things like:

  • Moving out of your plan’s service area
  • Loss of employer-based coverage
  • Natural disasters such as hurricanes
  • and many other unique situations

Understanding Medicare Advantage Plans” is a booklet on that explains how Medicare Advantage Plans work and how to join a Medicare Advantage Plan.

Medicare Advantage Eligibility in Hawaii

Unlike Medicare Supplement policies, enrollment in Medicare Advantage plans is not contingent on your health. Insurance companies offering Medicare Advantage plans cannot deny coverage or increase rates based on your health status. To enroll in Medicare Advantage, a person needs to meet two eligibility conditions:

  • Currently enrolled in Original Medicare, both Parts A, and B
  • Reside in the county where an insurance company offers the Medicare Advantage Plan you wish to enroll in.

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