About Medicare Advantage Plans in Hawaii

National healthcare issues press to the fore during election campaigns and often become the centerpiece for heated political debate. Countries worldwide struggle to balance essential healthcare against rising costs for its aging population. In the U.S., Medicare provides basic healthcare services for those 65 years of age and older. With the creation of the Medicare Advantage program, services can also be administered through private healthcare organizations, such HMOs and PPOs.

Medicare History

• Government-sponsored healthcare programs aim to mitigate the severe financial and economic risks that could potentially befall the elderly and infirm by collectively dispersing the risk onto society. The first U.S. healthcare insurance bill was introduced in 1935. Medicare legislation was passed in 1965 and today it provides assistance to one tenth of the U.S. population by offering low-cost hospitalization and health insurance.

Medicare Advantage

• The Original Medicare program consisted of two parts. Medicare Part A (hospital insurance) is free to most beneficiaries and covers medical services considered vital, such as inpatient hospital care, critical access care, short-term care in skilled nursing facilities, hospice and home health care. Medicare Part B (medical insurance) covers doctors' services, outpatient care and some preventive services.

  The Medicare Modernization Act of 2003 created Medicare Advantage, also known as Medicare Part C, to replace the Medicare+Choice program. Under Medicare Advantage, consumers have the added choice of receiving healthcare services delivered through private organizations approved by Medicare, such as HMOs and PPOs.

Hawaii Medicare Advantage Statistics

• According to the Kaiser Family Foundation, Medicare Advantage enrollment grew by 5.7 percent nationwide between March 2009 and 2010 despite premium increases and an 18 percent decline in the number of available plans.

  In Hawaii, 82,747 seniors were enrolled in Medicare Advantage plans in 2010, with the following types of organizations accounting for the majority share -- HMOs (26,097), local PPOs (14,377) and Cost Plans (36,270). Likewise, three firms, the Hawaii Medical Services Association (43.6 percent), Kaiser Permanente (29.2 percent) and United Healthcare (18.2 percent) dominated approximately 91 percent of the Medicare Advantage market in Hawaii.

HMSA Akamai Advantage

• The Hawaii Medical Services Association offers Medicare Advantage under its brand name of Akamai Advantage Secure (Regional PPO), Akamai Advantage Assured (Regional PPO) and Akamai Advantage Preferred (Regional PPO). These plans offer various levels of health-insurance benefits for doctor visits, in-patient and outpatient care, preventive services and prescription drugs. Seniors qualify for Akamai Advantage if they are entitled to Medicare Part A, are already enrolled in Medicare Part B and live in Hawaii. All three plans include Medicare Part B and Part D prescription drug coverage except for Akamai Advantage Assured.

Kaiser Senior Advantage

• Kaiser Permanente offers its Senior Advantage Basic (HMO) and Senior Advantage Enhanced (HMO) Medicare Advantage plans in Hawaii. Both plans cover Medicare Part B and Medicare Part D prescription drugs with the same Medicare eligibility requirements. While HMSA subscribers can opt to pay a higher cost for services rendered by providers outside of its PPO network, non-network services are not covered by Kaiser's HMO plan.