Hawaii Medicare glossary
A reference dictionary of Medicare and Hawaii-specific terms. Federal Medicare vocabulary alongside the Hawaii programs, cultural concepts, and acronyms you'll encounter when navigating Medicare in the islands.
A
ADRC — Aging and Disability Resource Center. Hawaii's statewide ADRC line is 643-ADRC (643-2372) — the front door for senior services on any island.
AEP — Annual Enrollment Period — October 15 through December 7 each year, when you can join, switch, or drop Medicare Advantage and Part D plans for the following year. See full guide.
ALS — Amyotrophic lateral sclerosis. People with ALS qualify for Medicare immediately upon SSDI approval — no 24-month waiting period.
AAA — Area Agency on Aging. Hawaii has four — one for each county — administering Older Americans Act services and Kupuna Care.
Advance Directive — Legal document specifying your medical treatment wishes if you can't speak for yourself. Hawaii has a statutory form available free through Kokua Mau.
Aiga — Samoan word for extended family — the unit of healthcare decision-making in many Hawaii Samoan communities.
B
Beneficiary — Anyone enrolled in Medicare. The term applies whether you have Original Medicare, Medicare Advantage, Medigap, or Part D.
Benefit Period — How Part A measures hospital stays. Begins when you enter a hospital and ends 60 days after you leave. The Part A deductible ($1,736 in 2026) applies per benefit period, not per year.
C
CMS — Centers for Medicare & Medicaid Services — the federal agency that runs Medicare.
COFA — Compact of Free Association. Citizens of the Marshall Islands, Federated States of Micronesia, and Palau. Full guide.
Coconut Wireless — Hawaii expression for word-of-mouth — how news, recommendations, and advice travel through the islands. The way most kupuna find out about Sage PLUS, a trusted Medicare agent, or a plan that worked for someone they know. Helpful for good information; risky when scams travel the same way.
Coinsurance — The percentage of a covered service you pay after meeting the deductible. Original Medicare Part B is 20% coinsurance for most services.
Copay — A flat fee you pay for a covered service (e.g., $5 for a generic prescription). Common in Medicare Advantage and Part D.
Creditable Coverage — Drug coverage that's expected to pay at least as much as Medicare Part D. Having creditable coverage lets you delay Part D without late penalty.
C-SNP — Chronic Condition Special Needs Plan — a Medicare Advantage plan for beneficiaries with specific chronic conditions (e.g., diabetes, heart disease, ESRD).
D
Deductible — The amount you pay before Medicare or your plan starts paying. Part A deductible is $1,736 per benefit period in 2026; Part B deductible is $283/year.
DME — Durable Medical Equipment — wheelchairs, walkers, hospital beds, oxygen, CPAP, glucose monitors. Covered under Part B with 20% coinsurance.
D-SNP — Dual Eligible Special Needs Plan — Medicare Advantage for those with both Medicare and Med-QUEST. Typically $0 premium, $0 copays. Full guide.
Dual Eligible — A beneficiary with both Medicare and Medicaid (Med-QUEST in Hawaii). Med-QUEST pays for Medicare premiums, deductibles, and copays.
E
EOA — Hawaii Executive Office on Aging — the state's lead agency for aging services, located at 250 South Hotel Street, Suite 406, Honolulu.
ESRD — End-stage renal disease — permanent kidney failure requiring dialysis or transplant. Qualifies you for Medicare at any age. Full guide.
EUTF — Employer-Union Health Benefits Trust Fund — Hawaii's retiree health benefits program for state, county, DOE, and UH retirees. Reimburses Part B premium. Full guide.
Extra Help (LIS) — Low-Income Subsidy — federal program that reduces Part D costs for income-eligible beneficiaries. Caps copays at $1.55 generic / $11.20 brand. Full guide.
F
FEHB — Federal Employees Health Benefits — health coverage for federal civilian employees and retirees. Hawaii guide.
Formulary — The list of prescription drugs your Part D or Medicare Advantage plan covers. Drugs are organized into tiers with different copays.
FQHC — Federally Qualified Health Center — community health centers offering sliding-scale care. Hawaii has FQHCs on every island serving Medicare and uninsured patients.
G
GEP — General Enrollment Period — January 1 through March 31. For people who missed their Initial Enrollment Period and don't qualify for an SEP. Coverage starts the month after enrollment.
Grievance — A complaint about quality of care, customer service, or other non-coverage issues. Different from an appeal, which disputes coverage decisions. Full guide.
Guaranteed Issue — The right to buy a Medigap policy without medical underwriting. Strongest during your 6-month Medigap Open Enrollment Period at age 65.
H
HCBS — Home and Community-Based Services — Med-QUEST benefits that help kupuna remain in their homes rather than nursing facilities. Includes personal care, adult day care, meals, transportation.
HHSC — Hawaii Health Systems Corporation — public benefit corporation operating safety-net hospitals on neighbor islands.
Ho'oponopono — Traditional Hawaiian conflict resolution and forgiveness practice, often relevant in family medical decision-making.
Hospice — Comfort-focused care for terminal illness with life expectancy of 6 months or less. Comprehensively covered by Medicare. Full guide.
I
IEP — Initial Enrollment Period — the 7-month window centered on your 65th birthday month when you can first enroll in Medicare. Full guide.
IRMAA — Income-Related Monthly Adjustment Amount — extra Part B and Part D premiums for higher-income beneficiaries (above ~$109,000 single in 2026).
ISC — Hawaii Insurance Division — state agency regulating Medigap and Medicare Advantage insurers. Phone: (808) 586-2790.
K
Kainga — Tongan word for extended family — the decision-making unit in many Hawaii Tongan communities.
Keiki — Hawaiian for children — used widely in Hawaii public health language.
Kokua Mau — Hawaii's nonprofit advance care planning organization (kokuamau.org). Provides free advance directive and POLST forms in multiple languages.
Kupuna — Hawaiian for elder or grandparent. Used widely in Hawaii to refer to older adults — Kupuna Care, Kupuna Caregivers Program, etc.
Kupuna Care — Hawaii's state-funded program providing in-home services for older adults who don't qualify for Med-QUEST. Full guide.
Kupuna Caregivers Program — Hawaii program providing stipends (up to $210/week, $10,500/year) to working family caregivers — first of its kind in the nation.
L
La'au lapa'au — Traditional Hawaiian herbal medicine practice.
Late Enrollment Penalty — Permanent premium surcharge for delayed enrollment. Part B: 10% per year of delay; Part D: 1% per month of delay. Avoid by enrolling on time or having creditable coverage.
LCSW — Licensed Clinical Social Worker — qualified Medicare mental health provider.
Livanta — Hawaii's Quality Improvement Organization (QIO). Handles hospital discharge appeals and quality reviews. 1-877-588-1123.
Lomilomi — Traditional Hawaiian massage and bodywork — sometimes covered by Medicare when delivered by a licensed massage therapist as part of physical therapy.
M
MAC — Medicare Administrative Contractor — companies that process Medicare claims regionally. Handles first-level appeals.
MA-OEP — Medicare Advantage Open Enrollment Period — January 1 through March 31. People in MA can make one change.
MAPD — Medicare Advantage Prescription Drug plan — an MA plan that includes Part D drug coverage.
Med-QUEST — Hawaii's Medicaid program. Covers ~396,000 Hawaii residents. Eligibility line: 1-800-316-8005. Full guide.
Medicare Advantage (Part C) — Bundled Medicare alternatives offered by private insurers, replacing Original Medicare. Often $0 premium with extra benefits.
Medigap — Medicare Supplement Insurance — private policies that fill gaps in Original Medicare. Plans G and N are most common in 2026.
MMNA — Minimum Monthly Maintenance Needs Allowance — amount the non-applicant spouse keeps when applying for nursing home Medicaid. Hawaii uses the federal max of $4,066.50/month.
MOOP — Maximum Out-of-Pocket — annual limit on what you'll pay for covered Medicare Advantage services. Ranges from about $3,000 to $9,250 in 2026.
N
NEMT — Non-Emergency Medical Transportation — covered under Med-QUEST and many Medicare Advantage plans.
NHHCS — Native Hawaiian Health Care Systems — five federally funded systems integrating cultural and Western healthcare. Full guide.
O
Ohana — Hawaiian for family. Often used to describe extended-family care models — especially in healthcare decision-making and aging in place.
Original Medicare — Parts A and B together — federal government-administered Medicare. Distinct from Medicare Advantage (Part C).
P
Papa Ola Lokahi — Native Hawaiian Health Board — coordinating organization for the five Native Hawaiian Health Care Systems. Phone: (808) 597-6550.
Part A — Hospital insurance — covers inpatient hospital, skilled nursing facility, hospice, and home health. Free for most workers with 40+ quarters of Medicare-taxed earnings.
Part B — Medical insurance — covers doctor visits, outpatient services, preventive care, durable medical equipment. $202.90/month standard premium in 2026.
Part C — Medicare Advantage — bundled private alternative to Original Medicare.
Part D — Prescription drug coverage. New $2,100 out-of-pocket cap in 2026.
PMM — Patient pay amount or patient share of monthly income — used in Hawaii nursing home Medicaid (Share of Cost model).
POLST — Physician Orders for Life-Sustaining Treatment — a medical order signed by a physician translating your treatment wishes into orders. Hawaii's POLST is available through Kokua Mau.
Premium — The monthly amount you pay for a Medicare or insurance plan. Part B premium is $202.90/month standard in 2026; many MA plans are $0.
Q
QI — Qualifying Individual — a Medicare Savings Program category. Also stands for Quality Improvement (re: organizations like Livanta) and QUEST Integration (Hawaii's Medicaid program).
QIO — Quality Improvement Organization. Hawaii's QIO is Livanta. Handles hospital discharge appeals.
QMB — Qualified Medicare Beneficiary — Medicare Savings Program category that pays Part A and B premiums plus all Medicare cost-sharing.
QUEST Integration — Hawaii's comprehensive Medicaid managed care program (the modern form of Med-QUEST since 2015). Covers all Med-QUEST beneficiaries through managed care plans.
S
Sage PLUS — Hawaii's State Health Insurance Assistance Program (SHIP) — free Medicare counseling. 1-888-875-9229. Full guide.
SEP — Special Enrollment Period — windows triggered by life events (moving, losing coverage, qualifying for Med-QUEST, federal disasters) when you can change Medicare plans.
SHIP — State Health Insurance Assistance Program — federally funded Medicare counseling in every state. Hawaii's SHIP is Sage PLUS.
SLMB — Specified Low-Income Medicare Beneficiary — Medicare Savings Program that pays Part B premium only.
SMP — Senior Medicare Patrol — volunteer program helping beneficiaries spot Medicare fraud. Hawaii: 1-888-875-9229.
SNF — Skilled Nursing Facility. Medicare covers SNF care after a 3-day inpatient hospital stay; days 21-100 cost $217/day in 2026.
SNP — Special Needs Plan — Medicare Advantage for specific populations: D-SNP (dual-eligible), C-SNP (chronic condition), or I-SNP (institutional).
Spend-Down — Hawaii's medically needy pathway — allows seniors with income above the limit to qualify for Med-QUEST by deducting medical expenses. Hawaii's spend-down limit is $469/month for individuals.
SSDI — Social Security Disability Insurance. Qualifies you for Medicare after 24 months on benefits (immediate for ALS).
T
TFL — TRICARE For Life — Medicare-eligible TRICARE coverage for military retirees. Requires Part B enrollment. Full guide.
TPMO — Third-Party Marketing Organization — entities that market Medicare Advantage and Part D, including agents, call centers, and websites. Subject to specific CMS rules.
Tripler — Tripler Army Medical Center, Honolulu — the largest military hospital in the Pacific.
V
VAPIHCS — VA Pacific Islands Health Care System — serves veterans across all Hawaiian islands plus American Samoa, Guam, and Northern Mariana Islands.
W
Welcome to Medicare Visit — Free preventive visit you can have within the first 12 months of Part B enrollment. Includes a health review and personalized prevention plan.
Need help with a term not listed here?
Sage PLUS Hawaii — the state's free SHIP program — can answer Medicare questions and explain unfamiliar terms. Call 1-888-875-9229.
For Med-QUEST and Hawaii Medicaid terminology, call Med-QUEST at 1-800-316-8005.