Medicare in Hawaii: Plans and Coverage (2026)

Medicare works the same in Hawaii as everywhere else for Parts A and B. Two things set the state apart: Hawaii's Medicare Savings Program income limits are higher than the 48-state standard, and Hawaii SHIP offers free one-on-one Medicare counseling through the state Executive Office on Aging.1,2

In This Guide

• Key Takeaways
• Original Medicare: Parts A and B
• Medicare Advantage in Hawaii (Part C)
• Medicare Part D: Prescription Drugs
• Medigap in Hawaii
• Help Paying for Medicare in Hawaii
• Medicare Enrollment Periods
• Free Medicare Help: Hawaii SHIP
• Frequently Asked Questions

About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year, so check that CMS fact sheet or medicare.gov for the figures in force when you read this.3 To reach a person, call 1-800-MEDICARE (1-800-633-4227), staffed 24 hours a day, 7 days a week except some federal holidays, or 1-877-486-2048 (TTY).5 Hawaii SHIP answers at 808-586-7299 on Oahu or toll-free at 1-888-875-9229.1

Original Medicare: Parts A and B

Original Medicare, which combines Part A and Part B, is run directly by the federal government. The mechanics and costs are the same in Hawaii as in every other state.

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.3

The hospital deductible applies per benefit period, not per calendar year. A benefit period starts the day you're admitted and ends once you've gone 60 days in a row without inpatient hospital care or skilled care in a nursing facility; get readmitted after that gap and the deductible resets.

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care. Routine dental, vision, and hearing are not covered.3

• Monthly premium: $202.90 (higher if your 2024 income exceeded $109,000 single or $218,000 married, under the income-related adjustment)3
• Annual deductible: $2833
• After the deductible: 20% of the Medicare-approved amount for most outpatient services3

Delay Part B without qualifying for a Special Enrollment Period or a Medicare Savings Program and you'll owe a permanent 10% premium penalty for every 12-month period you could have had it.6

Medicare Advantage in Hawaii (Part C)

Medicare Advantage plans are offered by private insurers as an alternative to Original Medicare. They cover everything Parts A and B do, except hospice, which Original Medicare continues to cover. Most plans bundle Part D drug coverage along with extras like dental, vision, and hearing.7

Plan availability in Hawaii is uneven by island. Honolulu and Oahu generally have the widest selection. Maui, Hawaii Island (Big Island), Kauai, and Molokai typically see fewer plan options and narrower networks. Before enrolling, use the Medicare Plan Finder to check what's available in your specific county.

How These Plans Work

• You continue paying your Part B premium ($202.90 a month) on top of any plan premium, though CMS says some plans may help pay all or part of it. The average Medicare Advantage plan premium is about $14 a month in 2026, and many plans charge $0 extra.7,3
• Most plans run on HMO or PPO networks. Confirm your doctors are in-network before you enroll.
• Plans typically require prior authorization for certain services; Original Medicare generally does not.7
• Every plan caps your annual in-network out-of-pocket spending at no more than $9,250 in 2026 (many plans set it lower). Original Medicare has no such cap. CMS puts it this way: there is no yearly limit on what you pay out of pocket unless you have supplemental coverage like Medigap, Medicaid, employer, retiree, or union coverage. With none of those, your exposure is open-ended.7

Hawaii SHIP counselors can help you compare available MA plans for free on any island.

Medicare Part D: Prescription Drugs

Part D covers outpatient prescription drugs. You can add a standalone Part D plan to Original Medicare or get drug coverage built into a Medicare Advantage plan.

The Inflation Reduction Act restructured Part D. The coverage gap (donut hole) no longer exists starting in 2025.4 The redesigned benefit has three phases:

1. Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).8
2. Initial coverage: you pay copays or coinsurance while your plan and drug manufacturers cover the rest.
3. Catastrophic: once your out-of-pocket costs reach $2,100, you pay $0 for covered drugs for the rest of the year.4

The $2,100 cap is the figure that matters most in 2026 Part D. The average standalone Part D premium runs roughly $34.50 a month in 2026, though plan premiums vary widely by carrier.3 Every plan must offer the Medicare Prescription Payment Plan, which lets you spread out-of-pocket drug costs across monthly payments during the year instead of paying in full at the pharmacy.4

People who qualify for Extra Help pay much less.

Medigap in Hawaii

Medigap is extra insurance you buy from a private health insurance company to help pay your share of out-of-pocket costs in Original Medicare. It works only with Original Medicare: you can't use Medigap to pay a Medicare Advantage plan's copayments, coinsurance, deductibles, or premiums.9

Medigap plans are lettered A, B, C, D, F, G, K, L, M, and N, and every insurance company that sells Medigap must offer at least Plan A. Plans C and F are no longer available to people new to Medicare on or after January 1, 2020, who have the right to buy Plans D and G instead.10 Plan G is the most common choice for people newly eligible: it covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing coinsurance, leaving only the $283 Part B deductible out of pocket.10,3

Your best window is Medigap open enrollment, and Hawaii's Medigap open enrollment rule (Hawaii Administrative Rules §16-12-6.2) starts it with the first month you are enrolled in Medicare Part B, at any age. For six months from then, an insurer can't deny you a policy it has available in Hawaii, or price it differently, because of your health status, claims experience, receipt of health care, or medical condition, and each policy it has available must be offered to qualifying applicants without regard to age.10 The federal Medigap Open Enrollment Period starts only once you are both 65 or older and enrolled in Part B. Outside any open enrollment or guaranteed issue period, you may have to pay more for a policy, and an insurance company is allowed to deny you a policy if you don't meet its medical underwriting requirements.11

Certain events give you a guaranteed issue right under HAR §16-12-6.3, such as an employer plan that supplements Medicare ending, or your Medicare Advantage plan being discontinued in your area. If you apply during that guaranteed issue period and submit evidence of the date your coverage ended, an issuer can't deny you a policy the rule covers, price it higher because of your health, or exclude a preexisting condition, and each such period ends sixty-three days after a stated event.10

Medigap or Medicare Advantage?

Pairing them does not work, and while you are in an Advantage plan it is illegal for anyone to sell you a Medigap policy unless you are switching back to Original Medicare. That is not permanent: if you join an Advantage plan for the first time and aren't happy with it, a federal trial right lets you buy a Medigap policy and a separate Medicare drug plan if you return to Original Medicare within 12 months of joining.9 Medigap means staying on Original Medicare with the freedom to see any provider who accepts Medicare nationwide, typically at a higher monthly premium. Medicare Advantage means trading some of that flexibility for a plan network and often a lower upfront cost. For a side-by-side comparison, see our guide to Original Medicare vs. Medicare Advantage.

Help Paying for Medicare in Hawaii

If you have limited income and resources, two programs can cut your Medicare costs significantly.

Medicare Savings Programs

Hawaii administers the Medicare Savings Programs through Med-QUEST, the state's Medicaid division.2 Hawaii's income limits are higher than the standard 48-state figures because Hawaii's Federal Poverty Level is set higher than the contiguous-state FPL.

Hawaii gets its own row in the Social Security Administration's 2026 limits tables, separate from the row for the other 48 states, and those are the Hawaii figures.2 Each is Hawaii's own gross Federal Poverty Level standard as published by Med-QUEST ($1,530 and $2,075 at 100% FPL, $1,836 and $2,490 at 120%, $2,066 and $2,801 at 135%) plus the $20 monthly general income exclusion.2 The comparable QMB limit in the contiguous 48 states and the District of Columbia is $1,350 for an individual and $1,824 for a couple, so a Hawaii resident on $1,500 a month who would be over the line on the mainland is under Hawaii's QMB limit.2 Neither Social Security's section nor Med-QUEST's chart says which income counts toward those figures, so read them as limits rather than a verdict: Social Security instructs its own staff that even if an individual's income or resources appear somewhat higher than the state limits, they should be encouraged to apply.2 QMB is the most generous tier: CMS says it provides Medicare coverage of Part A and Part B premiums and cost sharing, and federal law prohibits Medicare providers and suppliers, pharmacies included, from billing someone in the QMB group for Medicare cost sharing.2

The 2026 resource limit for QMB, SLMB and QI-1 is $9,950 for one person and $14,910 for a couple. QDWI, the fourth program, is the exception: its resource limit is $4,000 and $6,000, well under half the others, so don't carry the bigger number across.2 Unlike the income limits, none of those figures is higher in Hawaii: the Social Security Administration prints the same resource row in its Hawaii table as in its table for the other 48 states.2 They are limits states may effectively raise by disregarding certain resources, not absolute cutoffs, and neither Social Security's section nor Med-QUEST's chart lists what is excluded from the count, so apply rather than rule yourself out.2 Confirm current income limits with Med-QUEST: the figures above come from Med-QUEST's 2026 chart effective January 13, 2026 and Social Security's tables effective February 26, 2026. Enrolling in QMB, SLMB, or QI automatically qualifies you for Extra Help with Part D.2

To apply, contact Med-QUEST directly or ask a Hawaii SHIP counselor to help you through the process.

Extra Help for Part D

Extra Help (also called the Low-Income Subsidy) pays Part D premiums, deductibles, and copays for people with limited income and resources.12 Since 2024 the partial-subsidy tier is gone; everyone who qualifies now gets the full subsidy.

• Income limit (2026): about $1,995 a month for an individual and $2,705 for a couple in the 48 contiguous states and DC. Those are not Hawaii's figures. Hawaii's Extra Help limits are higher, because Hawaii's 2026 poverty guideline for one person is $18,360 against $15,960 in the contiguous states. Check the Hawaii figure with medicare.gov or SSA rather than screening yourself out against the numbers above.12
• Resource limits: $16,590 for an individual, $33,100 for a couple, rising to $18,090 and $36,100 if you tell Social Security you expect to use some of your resources for burial expenses12
• Enrollment in QMB, SLMB, or QI qualifies you for Extra Help automatically2
• QDWI, the Medicare Savings Program for people who lost premium-free Part A after returning to work, pays the Part A premium but does not carry Extra Help with it, so a QDWI enrollee has to apply to Social Security for Extra Help separately2,12

Apply through the Social Security Administration at its Extra Help page or call SSA at 1-800-772-1213 (TTY 1-800-325-0778).12,13

Medicare Enrollment Periods

Miss a Medicare deadline and you may face a coverage gap or a permanent penalty.14 Hawaii's Medigap window differs from the federal rule: it starts with the first month you are enrolled in Part B, at any age.10

Changes during Annual Open Enrollment take effect January 1. If you start receiving Social Security at least 4 months before you turn 65, you're enrolled in Parts A and B automatically. If not, sign up through Social Security.14 The General Enrollment Period runs January through March; under Section 120 of the Consolidated Appropriations Act, 2021, coverage now starts the first of the month after you sign up.15 If you delayed Part B because you had employer coverage, you get an 8-month Special Enrollment Period counted from the month that job or coverage ends, whichever comes first (COBRA and retiree coverage do not count), though this Special Enrollment Period does not apply if you're eligible for Medicare based on End-Stage Renal Disease (ESRD). If you're self-employed, or your plan isn't available to everyone at the company, ask your insurer whether it counts as employer group health plan coverage before you delay; if it doesn't, sign up at 65.15

Free Medicare Help: Hawaii SHIP

The Hawaii SHIP (State Health Insurance Assistance Program) is run by the Executive Office on Aging, part of the Hawaii Department of Health.1 Counselors are trained volunteers who provide free, unbiased one-on-one Medicare guidance. They do not sell insurance.

Hawaii SHIP counselors can help you:

• Understand what Original Medicare, Medicare Advantage, and Medigap cover
• Compare Part D drug plans side by side
• Apply for the Medicare Savings Programs and Extra Help
• Sort out billing questions, denials, and appeals
• Understand your enrollment windows and avoid late penalties

Visit health.hawaii.gov/eoa/home/hawaiiship/ for local counselor locations on each island.1

Learn More

Find personalized help with Medicare in Hawaii at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.