Medicare basics — a Hawaii resident's guide
Medicare is the federal health insurance program for people 65 and older, and for some younger people with disabilities or End-Stage Renal Disease. This guide explains how Medicare works in Hawaii.
The four parts of Medicare
Medicare Part A — hospital insurance
Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. Most people qualify for premium-free Part A based on their (or a spouse's) work history. The 2026 hospital deductible is $1,736 per benefit period. Read the full Part A guide for Hawaii.
Medicare Part B — medical insurance
Part B covers doctor visits, outpatient services, preventive care, durable medical equipment, and some home health. The standard 2026 Part B premium is $202.90/month, with a $283 annual deductible. Higher-income beneficiaries pay more (IRMAA). Full Part B guide for Hawaii.
Medicare Part C — Medicare Advantage
Part C plans bundle Parts A and B (and usually D) through private insurance companies. They typically offer extra benefits — dental, vision, hearing, fitness — but use provider networks. In Hawaii, network design matters because of inter-island travel. Medicare Advantage in Hawaii.
Medicare Part D — prescription drugs
Part D covers outpatient prescription drugs through standalone plans or as part of a Medicare Advantage plan. 2026 brings a major change: a $2,100 out-of-pocket maximum on covered drugs — the first hard cap in Part D history. Part D in Hawaii.
Original Medicare vs. Medicare Advantage
This is the central choice every new Medicare beneficiary makes. Both options provide the same baseline of medically necessary care, but they work very differently.
| Original Medicare (A + B) | Medicare Advantage (Part C) | |
|---|---|---|
| Provider access | Any Medicare-accepting doctor or hospital nationwide | Plan's network only (HMO) or higher cost out-of-network (PPO) |
| Referrals | Not required for specialists | Often required (HMO plans) |
| Inter-island travel | Use any participating provider | May need to use Oahu providers in your network |
| Drug coverage | Add a standalone Part D plan | Usually included |
| Out-of-pocket maximum | None (Medigap can cap costs) | Required by law; varies by plan |
| Extra benefits | None (Medicare-covered services only) | Often dental, vision, hearing, fitness, transportation |
| Monthly premium | Part B + optional Medigap + optional Part D | Often $0 plan premium (still pay Part B) |
What's different about Medicare in Hawaii
The federal Medicare program is identical across the country, but Hawaii has unique characteristics that shape how beneficiaries use it:
- Inter-island care: Specialists and certain procedures may only be available on Oahu. Plan choice affects how easy this travel is.
- High dual-eligible rates: Many Hawaii kupuna qualify for both Medicare and Med-QUEST (Hawaii Medicaid). D-SNP plans are designed for this.
- Native Hawaiian health systems: The five Native Hawaiian Health Care Systems coordinate culturally appropriate care alongside Medicare. Learn more.
- Multilingual needs: Hawaii has substantial populations speaking Tagalog, Ilocano, Japanese, Chinese, Korean, and Hawaiian. Multilingual resources.
- Disaster SEPs: Hurricanes, volcanic events, and the 2023 Maui wildfires have triggered federal disaster declarations and Special Enrollment Periods. More on disaster SEPs.
Who can help you in Hawaii
Three free resources serve Hawaii residents:
- Sage PLUS: Hawaii's SHIP — free, unbiased Medicare counseling. Call 1-888-875-9229.
- 1-800-MEDICARE: Federal Medicare help, available 24/7.
- Licensed Medicare agents: Free to consumers (paid by insurance carriers). Find a Hawaii agent.
Frequently asked questions
Medicare eligibility starts at age 65 for U.S. citizens and legal residents who have lived in the U.S. for 5+ years. You may also qualify earlier if you have a qualifying disability (24 months on SSDI) or End-Stage Renal Disease.
Generally yes for Part A (it's premium-free for most people). Whether to delay Part B depends on whether your employer coverage qualifies as creditable. Talk to Sage PLUS or a licensed agent before delaying.
The 2026 Part B premium is $202.90/month for most beneficiaries. Add-on costs depend on your choices: Part D drug coverage, Medigap supplement, or a Medicare Advantage plan. Many Hawaii residents qualify for help paying these costs through Medicare Savings Programs or Extra Help.