In July 2020, 280,006 Hawaii residents were enrolled in Medicare, accounting for approximately 20% of the state's population.
For the vast majority of Americans, applying for Medicare is an integral part of reaching the age of 65. People under the age of 65 who have been getting disability insurance for at least two years, or who have ALS or end-stage renal disease, will still get Medicare coverage. Since they are at least 65 years old, 85 percent of Medicare recipients are qualified nationwide, while the remaining 15% are under 65.
Hawaii has the lowest number of disabled Medicare beneficiaries in any state in the country: only 9% of Hawaii's Medicare beneficiaries are under 65 and qualified due to a disability (and only 8% of the Virgin Islands' Medicare beneficiaries are under 65 if we include U.S. territories). The remaining 91 percent of Hawaii's Medicare recipients are eligible due to their age.
Medigap programs complement Original Medicare by covering some or all of the out-of-pocket costs (such as coinsurance and deductibles) that individuals would otherwise face if they only had Original Medicare.
There will be 13 insurers selling Medigap services in Hawaii by 2020.
Federal laws govern Medigap programs, but states are free to add their own rules. The Hawaii Medigap regulations can be found here.
All Medigap insurers must sell all policies on a guaranteed-issue basis (without changing premiums based on medical underwriting) to any enrollee during the six-month window that starts when the individual enrolls in Medicare Part B (see 16-12-6.2). This is true in Hawaii regardless of age. A six-month guaranteed-issue open enrollment window is available under federal law, but only for people who are enrolled in Part B and are 65 years old. As a result, Hawaii's legislation applies the same rights to individuals under the age of 65 who are eligible for Medicare due to a disability. As previously stated, Hawaii has the lowest percentage of beneficiaries qualifying for Medicare because of a disability in the nation.
The majority of states have passed legislation to ensure that enrollees under the age of 65 have some access to Medigap policies, but Hawaii, unlike the majority of them, still forbids Medigap insurers from offering higher rates for individuals under the age of 65 who are disabled. In other jurisdictions, it's normal to see under-65 Medigap plans sold with premiums well above those for people over 65, but this isn't the case in Hawaii.