Hawaii's Medicare Advantage market ranks among the most concentrated in the country: 57% of the state's roughly 314,700 Medicare beneficiaries were enrolled in a Medicare Advantage plan in 2026, well above the national average and trailing only a handful of states such as Florida. That high penetration traces back decades to Hawaii's HMO-heavy insurance culture, anchored by Kaiser Permanente's long-standing presence on Oahu and Hawaii Island and by HMSA (Hawaii Medical Service Association), the state's Blue Cross Blue Shield affiliate and the largest Medicare Advantage sponsor statewide. Only 36 Medicare Advantage plans are available across the islands in 2026, a fraction of the plan count in large mainland states, because Hawaii's isolated island geography and smaller population support fewer competing carriers. The statewide average monthly premium is $22 in 2026, higher than the national MA average of about $14, driven partly by HMSA's PPO products, which carry premiums up to $150 per month for members who want flexibility to see providers on other islands or the mainland.
Kaiser Permanente and HMSA split most of Hawaii's Medicare Advantage enrollment between them. Kaiser operates a closed-network HMO model concentrated on Oahu and Hawaii Island, earning a 4.5-star rating in 2026 for its coordinated care model, while HMSA's Akamai Advantage plans, offered in both HMO and PPO form, are available on every inhabited island and carry a 3.5-star rating. UnitedHealthcare and Humana compete statewide with $0 to low-premium HMO options, and Hawaii-based AlohaCare, along with Ohana Health Plan (a Centene brand), focus heavily on Dual Eligible Special Needs Plans (D-SNPs) for Hawaii residents who also qualify for Med-QUEST, the state's Medicaid program. Plan choice narrows sharply outside Oahu: Honolulu County offers roughly 28 plans, while Kauai County residents may choose from only about 7. Anyone splitting time between islands or traveling frequently to the mainland should weigh a PPO's out-of-network flexibility against an HMO's lower cost.
Hawaii's 2026 Medicare Advantage market is the focus of this guide: how many plans are available, which carriers dominate each island, what to check before enrolling, and the enrollment dates that apply statewide. Hawaii's Annual Election Period runs October 15 to December 7, 2026, with coverage starting January 1, 2027, the same federal calendar used nationwide. Hawaii Medicare beneficiaries considering a Dual Eligible Special Needs Plan should also note a new 2027 Med-QUEST alignment rule covered later in this guide, along with the new $0 premium plan options and the step-by-step enrollment process at medicare.gov.
2026 Medicare Advantage Market Overview in Hawaii
In 2026, Hawaii has 36 Medicare Advantage plans available, with 179,382 beneficiaries enrolled (57% MA penetration). The average monthly premium is $22 and the statewide average Star Rating is 3.9.
Top Medicare Advantage carriers in Hawaii (2026)| Carrier | Plans | Avg Star Rating | Avg Premium |
|---|
| Kaiser Permanente | 6 | 4.5 | $10/mo |
| HMSA (Hawaii Medical Service Association) | 10 | 3.5 | $55/mo |
| UnitedHealthcare | 8 | 4.0 | $18/mo |
| Humana | 5 | 3.5 | $6/mo |
| AlohaCare | 3 | 4.0 | $0/mo |
| Ohana Health Plan | 2 | 3.5 | $0/mo |
| Devoted Health | 2 | 4.0 | $10/mo |
Source: KFF Medicare Advantage 2026 Hawaii Spotlight, CMS Medicare Plan Finder Q4 2025
Plan Types in Hawaii: HMO vs PPO vs SNP
Medicare Advantage plan-type breakdown in Hawaii| Plan Type | Plans Available | Avg Premium | Best For |
|---|
| HMO | 20 | $12/mo | Lower premiums, single-island provider networks |
| PPO | 8 | $55/mo | Inter-island or mainland travel flexibility |
| Special Needs Plan (SNP) | 8 | $0/mo | Dual-eligible (Med-QUEST + Medicare), chronic conditions, institutional |
HMO plans dominate Hawaii, about 56% of all 2026 Medicare Advantage plans, reflecting the state's island-based provider networks. PPO enrollment concentrates in HMSA's Akamai Advantage line for members who need mainland or inter-island flexibility.
Source: KFF Medicare Advantage 2026 Hawaii Spotlight, CMS Medicare Plan Finder
County-Level Variance in Hawaii
Hawaii's Medicare Advantage plan availability varies more by island than by land area. Honolulu County (Oahu) has the deepest carrier competition and the most plans; Hawaii Island, Maui County, and Kauai County have progressively fewer options and, in several cases, higher average premiums because fewer carriers compete for fewer members.
Plan count and average premium by county in Hawaii| County | Plans Available | Avg Premium |
|---|
| Honolulu County (Oahu) | 28 | $20/mo |
| Hawaii County (Big Island) | 12 | $15/mo |
| Maui County | 9 | $30/mo |
| Kauai County | 7 | $35/mo |
Hawaii plan counts and premiums are from CMS Medicare Plan Finder Q4 2025 by county. Run a personalized search at medicare.gov to see exact plans for your ZIP code.
Source: CMS Medicare Plan Finder Q4 2025, Hawaii county data
What to Look For in a Medicare Advantage Plan in Hawaii
Hawaii Medicare Advantage shoppers face a distinctly island-shaped set of trade-offs. Here's what matters most when comparing plans in 2026:
- Provider network and island coverage. Hawaii networks are built around individual islands, so [confirm your doctors are in-network before enrolling](/en/qa/can-i-keep-my-doctor-medicare-advantage), and check whether the plan covers referrals to Oahu-based specialists if you live on a neighbor island.
- Prescription drug coverage (formulary). Most Hawaii Medicare Advantage plans include Part D. Check that your specific medications are on the plan's formulary at a tier you can afford. The 2026 Part D out-of-pocket cap is $2,100 across all plans nationwide.
- Star Ratings. CMS rates plans 1 to 5 stars annually on quality of care, member experience, and customer service. In Hawaii, Kaiser Permanente consistently scores 4.5 stars, while HMSA's Akamai Advantage plans, the most widely available option, run closer to 3.5 stars.
- Extras (dental, vision, hearing, transportation, telehealth). Hawaii Medicare Advantage plans differ widely on supplemental benefits, and telehealth access to Oahu specialists is especially valuable for neighbor-island members.
- Maximum out-of-pocket (MOOP). Medicare Advantage plans cap your annual in-network out-of-pocket spending. The 2026 federal MOOP ceiling for in-network MA is $9,250 (down $100 from $9,350 in 2025); most Hawaii plans set it between $6,700 and $7,700. Original Medicare has no MOOP.
- Prior authorization burden. Hawaii Medicare Advantage plans can require prior authorization for surgeries, advanced imaging, or off-island specialist referrals. If you expect significant care, ask how often the plan requires prior authorization and check the denial rates CMS publishes.
Key Medicare Dates in Hawaii
Hawaii Medicare and Medicare Advantage have several enrollment windows in 2026. Miss them and you may face coverage delays or late enrollment penalties.
- Annual Election Period (AEP): October 15 - December 7, 2026 — Switch between Original Medicare and Medicare Advantage, change MA plans, or change Part D plans. Coverage starts January 1, 2027.
- Medicare Advantage Open Enrollment Period (MA OEP): January 1 - March 31, 2026 — If you're already in a Hawaii Medicare Advantage plan, you can switch to a different MA plan or return to Original Medicare. One switch only.
- Initial Enrollment Period (IEP): 7-month window around your 65th birthday — Starts 3 months before your 65th birthday month, includes the birth month, and runs 3 months after. Enroll in Medicare Parts A and B, then choose Medicare Advantage or Original Medicare plus Part D.
- Special Enrollment Periods (SEPs): Varies by qualifying event — Triggered by moving between Hawaii islands or out of state, losing employer coverage, qualifying for Med-QUEST (dual eligible), or other life events. Triggers a [Special Enrollment Period](/en/glossary/special-enrollment-period), typically a 2-3 month window.
Notable Extras in Hawaii Plans
Hawaii Medicare Advantage plans include several state-specific features shaped by island geography and Med-QUEST integration, worth knowing before you enroll:
- Med-QUEST dual-eligible D-SNPs and the 2027 alignment rule: Hawaii residents who qualify for both Med-QUEST (Hawaii's Medicaid program) and Medicare can enroll in a Dual Eligible Special Needs Plan (D-SNP) through AlohaCare, HMSA, Kaiser Permanente, Ohana Health Plan, or UnitedHealthcare Community Plan. Starting January 1, 2027, Hawaii dual-eligible beneficiaries must enroll with the same insurer for both their Med-QUEST managed care plan and their Medicare D-SNP, so confirm alignment before the 2026 AEP.
- Inter-island referral and telehealth networks: Because Hawaii Island, Maui County, and Kauai County have fewer specialists than Oahu, many Hawaii Medicare Advantage plans build in covered inter-island referrals and telehealth visits with Oahu-based specialists, reducing the need for costly inter-island flights for routine specialty care.
- Limited carrier choice compared to mainland states: Hawaii's 36 Medicare Advantage plans in 2026 come from just seven carriers, far fewer than large mainland states, because the isolated island market cannot support as many competing national insurers. Hawaii-based carriers like HMSA and AlohaCare fill much of that gap with deep local provider relationships.
- Mainland travel and snowbird considerations: Hawaii Medicare Advantage members who travel frequently to the mainland to see family should confirm whether their plan is an HMO (limited or no out-of-network coverage except emergencies) or a PPO like HMSA's Akamai Advantage, which allows out-of-network care nationwide at a higher cost share.
Medicare Advantage vs Original Medicare in Hawaii
Hawaii residents choosing between Original Medicare and Medicare Advantage face a distinctly island-shaped trade-off. Original Medicare (Parts A and B) plus a Medigap supplement and a standalone Part D drug plan gives you provider freedom anywhere in the country, including specialist access on Oahu or the mainland without a referral, but Medigap plus Part D premiums in Hawaii commonly run $180 to $350 per month combined. Medicare Advantage plans bundle hospital, medical, and usually drug coverage into a single plan for a statewide average of $22 per month in 2026, but you generally must use in-network providers on your home island or get a referral and prior authorization to see specialists elsewhere. Neighbor-island residents feel this trade-off most sharply: Hawaii Island, Maui County, and Kauai County have fewer specialists than Oahu, so many Medicare Advantage HMOs there build in inter-island referral networks or telehealth access to Oahu-based specialists.
One Hawaii-specific quirk: under federal rules, you can switch from Medicare Advantage back to Original Medicare during AEP or MA OEP, but Medigap insurers are not required to sell you a policy at that point unless you qualify for a guaranteed issue right. Hawaii does not have a state-mandated Medigap birthday rule like California's, so once your initial 6-month Medigap open enrollment window closes, medical underwriting can apply. Hawaii Medicare beneficiaries who want the option to return to Original Medicare later should weigh that risk before enrolling in Medicare Advantage.
How Star Ratings work in Hawaii
Hawaii Medicare Advantage Star Ratings, like every state's, are published by CMS every October and score plans from 1 to 5 stars across roughly 40 quality measures covering chronic disease management, member complaints, customer service, and Part D drug safety. Plans that score 4 stars or higher receive quality bonus payments from CMS, which many Hawaii carriers reinvest into richer extras such as dental, transportation, or telehealth benefits for the following plan year.
Hawaii's 2026 statewide weighted-average Star Rating is 3.9, slightly above the roughly 3.8 national average. Kaiser Permanente is Hawaii's highest-rated carrier at 4.5 stars, reflecting its integrated HMO model on Oahu and Hawaii Island, while HMSA's Akamai Advantage plans, the most widely available option across all islands, run closer to 3.5 stars. A 5-star plan, if one is offered in your county, triggers a Special Enrollment Period that lets you switch into it at any point during the year, not just during AEP.
How to enroll in Hawaii Medicare Advantage
Hawaii residents enrolling in Medicare Advantage in 2026 follow the same federal process used nationwide, but with island-specific plan availability. Use medicare.gov/plan-compare as your starting point; CMS's plan finder tool filters results by ZIP code, which on the neighbor islands often narrows the list to a handful of HMO options.
Common reasons Hawaii Medicare Advantage applications are delayed or denied include: enrolling before your Part B coverage is active, listing a ZIP code outside your chosen plan's service area (a frequent issue for neighbor-island residents choosing an Oahu-based HMO), missing Med-QUEST eligibility documentation when applying for a Dual Special Needs Plan, identity verification mismatches between your Social Security and Medicare records, and selecting a Special Needs Plan you don't qualify for, such as a chronic-condition SNP without a qualifying diagnosis.
- Step 1: Confirm Medicare Part A and Part B eligibility. You must already be enrolled in both before joining a Medicare Advantage plan. If you're newly turning 65, your 7-month Initial Enrollment Period covers this.
- Step 2: Gather your documents. You will need your Medicare card (showing your Medicare number and Part A/B effective dates), your ZIP code (Oahu, Hawaii Island, Maui, and Kauai each have different plan lists), a list of current prescriptions for formulary lookup, a list of current doctors and specialists (including any you see on Oahu if you live on a neighbor island), and your Med-QUEST card if you are dual-eligible.
- Step 3: Compare plans at medicare.gov/plan-compare. Filter by your ZIP code and sort by Star Rating, monthly premium, total estimated annual cost, or maximum out-of-pocket. Hawaii residents can also call Hawaii SHIP (the Hawaii State Health Insurance Assistance Program) for free, unbiased counseling on plan options in their county.
- Step 4: Apply. Enroll directly at medicare.gov, by calling 1-800-MEDICARE (1-800-633-4227), or through the carrier directly. Most online enrollments take 10 to 15 minutes.
- Step 5: Confirm your coverage start date. AEP enrollments made between October 15 and December 7, 2026, start coverage January 1, 2027. Special Enrollment Period enrollments typically start the first of the following month. Expect a member ID card and Evidence of Coverage from your carrier within 7 to 10 business days.
$0 premium plans in Hawaii for 2026
Hawaii has a smaller set of $0 monthly premium Medicare Advantage plans in 2026 than large mainland states, concentrated among Humana, Kaiser Permanente, AlohaCare, and UnitedHealthcare offerings on Oahu and Hawaii Island. A $0 premium does not mean $0 cost: Hawaii Medicare Advantage members still pay the Part B premium ($202.90 per month in 2026) plus any drug copays, deductibles, and out-of-pocket costs specific to their plan.
$0 premium plans in Hawaii for 2026 detail| Carrier | Plan Type | Star Rating | Counties Available |
|---|
| Humana | HMO | 3.5 | Honolulu, Hawaii |
| Kaiser Permanente | HMO | 4.5 | Honolulu, Hawaii |
| UnitedHealthcare (AARP Medicare Advantage) | HMO | 4.0 | Honolulu, Maui |
| AlohaCare Advantage | HMO D-SNP | 4.0 | Honolulu, Hawaii, Maui, Kauai |
| Ohana Health Plan | HMO D-SNP | 3.5 | Honolulu, Hawaii, Maui, Kauai |
Hawaii $0 premium plan availability sample; full list at medicare.gov/plan-compare keyed to your ZIP code. Star Ratings reflect the 2026 plan year.
Source: Hawaii CMS Medicare Plan Finder Q4 2025
Med-QUEST and dual eligibility in Hawaii
Hawaii residents who qualify for both Med-QUEST (Hawaii's Medicaid program) and Medicare at the same time are dual-eligible, and can enroll in a Dual Eligible Special Needs Plan (D-SNP) that coordinates both programs into one plan, typically with $0 premium, $0 copays, and no prescription drug costs. Five carriers offer D-SNPs in Hawaii for 2026: AlohaCare, HMSA, Kaiser Permanente, Ohana Health Plan, and UnitedHealthcare Community Plan, though availability varies by island.
Hawaii is transitioning its D-SNP structure in 2026: Highly Integrated D-SNPs (HIDE SNPs) can no longer enroll new members starting January 1, 2026, and all five Hawaii carriers now offer Fully Integrated D-SNPs (FIDE SNPs) instead. Starting January 1, 2027, Hawaii dual-eligible beneficiaries must enroll with the same insurance company for both their Med-QUEST managed care plan and their Medicare D-SNP, so Hawaii residents nearing dual-eligible status should confirm that alignment before the 2026 AEP. Beneficiaries unsure whether their income and assets qualify for Med-QUEST can check current thresholds against the Hawaii Medicaid income limits.
Frequently Asked Questions
How many Medicare Advantage plans are available in Hawaii in 2026?
Hawaii has 36 Medicare Advantage plans available statewide in 2026, per CMS Medicare Plan Finder data and the KFF Medicare Advantage 2026 Spotlight. That is far fewer than large mainland states because Hawaii's island geography supports fewer competing carriers, and the seven active carriers are Kaiser Permanente, HMSA, UnitedHealthcare, Humana, AlohaCare, Ohana Health Plan, and Devoted Health. Oahu (Honolulu County) offers the most choice, with about 28 plans, while Kauai County residents may see as few as 7. Run a ZIP-code search at medicare.gov to see your exact county options.
What is the average Medicare Advantage premium in Hawaii for 2026?
The statewide weighted-average Medicare Advantage premium in Hawaii is about $22 per month in 2026, higher than the national MA average of about $14. Several Kaiser Permanente, Humana, and UnitedHealthcare HMO plans charge $0 monthly premium on Oahu and Hawaii Island, while HMSA's Akamai Advantage PPO plans, which offer inter-island and mainland flexibility, can run $40 to $150 per month. Even on a $0 premium plan you still owe the 2026 Part B premium of $202.90 per month plus any plan copays and drug costs.
When can I sign up for Medicare Advantage in Hawaii?
The main enrollment window is the Annual Election Period (AEP), October 15 to December 7, 2026, for coverage starting January 1, 2027. You can also enroll during your 7-month Initial Enrollment Period around your 65th birthday, or during a Special Enrollment Period triggered by moving between islands or off-island, losing employer coverage, or a change in Med-QUEST status. Existing Hawaii Medicare Advantage enrollees can switch plans once during the Medicare Advantage Open Enrollment Period, January 1 to March 31, 2026, but cannot use it to add or drop Part D.
Who has the best Medicare Advantage plans in Hawaii?
Kaiser Permanente leads Hawaii in Star Ratings at 4.5 stars in 2026, with strong coordinated care on Oahu and Hawaii Island. HMSA's Akamai Advantage plans, rated 3.5 stars, offer the widest availability across all four counties, including PPO options for members who travel between islands or to the mainland. UnitedHealthcare and Devoted Health also rate 4.0 stars in 2026. The best plan depends on your island, your doctors, and whether you prioritize premium cost or network flexibility over a wider provider list.
Can I switch from Medicare Advantage back to Original Medicare in Hawaii?
Yes. Hawaii Medicare Advantage members can switch back during the Annual Election Period (October 15 to December 7) or the Medicare Advantage Open Enrollment Period (January 1 to March 31). However, Hawaii does not have a state-mandated Medigap birthday rule like California's, so Medigap insurers are not required to sell you a policy outside your initial 6-month Medigap window unless you qualify for a guaranteed issue right. Confirm Medigap availability in your county before you switch, especially if you have ongoing health conditions.
What is the difference between an HMO and a PPO in Hawaii Medicare Advantage?
HMOs make up about 20 of Hawaii's 36 Medicare Advantage plans in 2026 and require in-network providers, usually on your home island, plus referrals for specialists. They average about $12 per month in premium and Kaiser Permanente is the dominant HMO carrier. PPOs (8 plans) let you see out-of-network and inter-island providers at a higher cost share without referrals, but average around $55 per month, with HMSA's Akamai Advantage the leading PPO option for members who travel often.
Does Medicare Advantage cover prescription drugs in Hawaii?
Most Hawaii Medicare Advantage plans include Part D prescription drug coverage bundled in (MA-PD plans). The 2026 Part D annual out-of-pocket maximum is $2,100 across all plans nationwide, set by the Inflation Reduction Act signed August 16, 2022, and insulin is capped at $35 per month on every Part D and MA-PD plan. Always check a Hawaii plan's formulary to confirm your specific medications are covered and at what tier, since formularies vary by carrier and by island.
Are dental, vision, and hearing covered by Medicare Advantage in Hawaii?
Most Hawaii Medicare Advantage plans include some dental, vision, and hearing benefits that Original Medicare does not cover. Coverage depth varies: some plans cover only routine cleanings and eye exams, while others add hearing aids and crowns. Kaiser Permanente and AlohaCare plans in Hawaii tend to offer some of the more generous supplemental packages, and several also include annual OTC allowances. Always check the plan's Evidence of Coverage for the exact annual dollar limits before you rely on a benefit.
What is a Special Needs Plan (SNP) and who qualifies in Hawaii?
A Special Needs Plan is a type of Medicare Advantage plan designed for people with specific needs, including chronic-condition, institutional, and dual-eligible categories. Hawaii offers Dual Eligible Special Needs Plans (D-SNPs) for residents who qualify for both Medicare and Med-QUEST (Hawaii's Medicaid program), through AlohaCare, HMSA, Kaiser Permanente, Ohana Health Plan, and UnitedHealthcare Community Plan. Starting January 1, 2027, Hawaii dual-eligible beneficiaries must enroll with the same insurer for both their Med-QUEST plan and their Medicare D-SNP, so check alignment before you enroll.
