Medicare's annual sign-up window opens this week, and the changes are bad news for Hawaii seniors who will pay more for less coverage.

• Two popular Medicare Advantage plans covering 17,000 Hawaii seniors are ending December 31.
• The alternatives cost more and cover less, or push people back to traditional Medicare with fewer benefits.
• Extras like gym memberships and wellness programs disappear for anyone who switches back to traditional Medicare.
• Medicaid is also changing nationwide: most people now have to work 80 hours a month to qualify, and 7 million are expected to lose coverage.
• Hawaii is short 600 to 800 doctors, a quarter of what the state needs, which makes the squeeze worse.

Outlook: Open enrollment runs through the start of the year, and it is the only window most people get to switch plans before the old ones expire.