The islands of Hawaii are a beacon for retirees and the national Medicare and Medigap trends are similar in the tropics. The most popular Medigap plan in every state is Plan F, which also comes with a high-deductible option. Many Medigap beneficiaries see a high-deductible option as a risk worth taking in order to save money on monthly premiums. There were 2,310 Hawaiians enrolled in Plan F in 2011 which is by far the most popular option in the state. The runners-up were Plan J with 857 and Plan C with 557. Fill out the zip code form to compare plans and rates side by side instantly.
Medicare and Medigap plans fall under the description of “fee for service.” This means that hospitals or doctors are directly reimbursed from Medicare when a qualified Medicare beneficiary is a patient. Hawaii currently has four major health markets: fee for service, managed care, health maintenance organizations (HMOs), and preferred provider organizations (PPOs). HMOs and PPOs are options for residents with private insurance or company-sponsored insurance.
All fee-for-service patients in Hawaii are Medicare beneficiaries. However, upcoming changes to Medicare might make the fee for service model obsolete in favor of managed care. Managed care requires a hospital or doctor to focus on disease management, increased quality of care, and cost control. More responsibility is being placed on healthcare providers to ensure that patients aren’t re-admitted to a hospital within 30 days of release. This is troubling for hospitals that have no control over the actions of a patient once the patient has been released.
Medicare is a government program. The number of Hawaii residents taking advantage of government health programs has increased 29 percent in the past ten years. This is compared to a small two percent increase in residents covered by private plans. Within the government programs, Medicare and Medigap account for 36 percent of the total. The increasing number of Hawaii residents depending on Medicare is slated to put unprecedented pressure on hospitals to take a holistic approach to healing in order to receive Medicare reimbursement under the managed care model.
Hawaii has long been a supporter of managed care systems with an emphasis on wellness and long-term care. The state’s current project, the QUEST Expanded Section 1115 demonstration (the Demonstration), is overseen by the Centers for Medicare and Medicaid Services (CMS).
The Demonstration has provided comprehensive, managed care to Medicaid beneficiaries since 1994 but it’s scheduled to expire in June 2013. The Demonstration also provides a number of programs to include non-Medicaid eligible adults who are elderly, blind, or disabled and includes long-term care. The State is planning to request a three-year extension of the Demonstration in order to continue to provide care for beneficiaries. Aspects of the Demonstration will not be aligned with the Affordable Care Act that will go into effect in January, 2014, so the Department of Human Services is planning to submit an amendment to the Demonstration in order to keep the program afloat.
There is no news about the State’s plans for comprehensive care after the Demonstration has expired. However, an extension gives residents three additional years to plan for future health care. Some options might include additional Medigap Plans that include hospice care. To view plans that are currently available in Hawaii, fill out the zip code form and compare rates instantly.
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