Medicare vs. Med-QUEST in Hawaii
Medicare and Med-QUEST (Hawaii Medicaid) are different programs that sometimes overlap. Many Hawaii residents qualify for both — known as "dual-eligible." Here's how they differ.
Quick comparison
| Medicare | Med-QUEST (Medicaid) | |
|---|---|---|
| Eligibility basis | Age 65+ or disability | Income and assets |
| Administered by | Federal government (CMS) | Hawaii Department of Human Services |
| Funded by | Federal government | Joint federal & state |
| Premiums | Yes (Part B, often Part D) | Generally none |
| Deductibles | Yes | Generally none |
| Long-term care | Limited (skilled care only) | Yes (with eligibility) |
| Vision/dental adults | Generally not | Limited |
| Service area | Nationwide | Hawaii only |
What Medicare covers
- Hospital stays (Part A)
- Doctor visits and outpatient care (Part B)
- Skilled nursing facility care up to 100 days (Part A)
- Prescription drugs (Part D)
- Preventive services
- Hospice and limited home health
Medicare does not cover long-term custodial care (nursing homes for ongoing daily living help), most dental, vision, hearing, or care outside the U.S.
What Med-QUEST covers
Med-QUEST is Hawaii's Medicaid program, delivered through managed-care plans. Med-QUEST covers a comprehensive set of services for eligible residents:
- Hospital and outpatient care
- Doctor visits
- Prescription drugs
- Long-term care (nursing facility and Home- and Community-Based Services)
- Behavioral health
- Limited dental and vision for adults
- Comprehensive coverage for children
Dual-eligible Hawaii residents
If you qualify for both Medicare and Med-QUEST, you're "dual-eligible." Medicare pays first, Med-QUEST pays second. Together they can cover almost all of your healthcare costs.
Dual-eligible Hawaii residents have access to Dual Eligible Special Needs Plans (D-SNPs) — Medicare Advantage plans designed specifically to coordinate both programs. D-SNPs offer:
- $0 monthly premium (in addition to your Part B premium, which Med-QUEST may pay)
- $0 copays for most services
- Care coordinators who help you navigate both programs
- Often extra benefits like over-the-counter allowances, transportation, and dental
- Quarterly Special Enrollment Periods to change plans
Detailed D-SNP guide for Hawaii.
How to apply in Hawaii
- Medicare: Apply at SSA.gov or 1-800-772-1213
- Med-QUEST: Apply at medical.mybenefits.hawaii.gov or call 1-800-316-8005
- Free help applying: Sage PLUS at 1-888-875-9229
Frequently asked questions
Yes — many Hawaii residents qualify for both. This is called dual-eligibility. Medicare pays first, Med-QUEST pays secondary. Dual-eligible beneficiaries should consider D-SNP plans designed to coordinate both.
Yes — Med-QUEST covers long-term nursing facility care and Home- and Community-Based Services for residents who meet income, asset, and care-need eligibility. Medicare only covers up to 100 days of skilled care after a qualifying hospital stay.
Med-QUEST has income and asset limits. You may qualify if you receive SSI, are dual-eligible for Medicare, or have limited income. Apply at medical.mybenefits.hawaii.gov, call 1-800-316-8005, or get free help from Sage PLUS.