Hawaii Health Insurance

As one of 1.4 million residents of the Aloha State, you have several options if you’re looking to buy or replace health insurance for yourself, your family or your employees.¹ 

If you aren’t one of the 55% of state residents who gets health coverage through your job,² you might get a qualified insurance plan through the federal Health Insurance Marketplace (also called an “exchange”). All plans sold through the Marketplace must adhere to requirements stipulated by the Affordable Care Act (ACA). 

And, if you qualify for coverage based on the size of your household and how much you earn, you might have access to government-run programs such as Medicare, Medicaid and the Children’s Health Insurance Program (CHIP).

Hawaii chose to expand Medicaid early, right after implementing the original ACA (also known as Obamacare). Between the two programs, the percentage of uninsured in the state decreased steadily, from 7% in 2013 to 4% in 2018.³ 

Here are answers to some questions Hawaiians often ask when looking to choose the right health insurance plan. 

WHAT YOU NEED TO KNOW

Each year, the Open Enrollment Period runs from November 1 to December 15. This is when you can sign up, renew or change your health insurance plan.

You can enroll online for an Affordable Care Act plan on Hawaii’s Marketplace through the federal government’s healthcare.gov site. 

When you apply, you’ll automatically also know what subsidies and other forms of coverage you’re eligible for, if any. 

In Hawaii, the average monthly premium in 2020 for an ACA plan for a 40-year-old ranges from $363 to $455, but you may qualify for help paying your premiums and out-of-pocket costs.

When Is Hawaii’s 2021 Open Enrollment Period?

You can enroll in a plan during Hawaii’s Open Enrollment Period (OEP) for 2021 coverage from November 1, 2020 to December 15, 2020. If you’re already enrolled through the Hawaii Health Insurance Marketplace, you can also renew, change or update your plan for the following year.⁴  

More than 18,000 Hawaii residents enrolled in an ACA policy in 2020, about 1,300 more than the year before.⁵ 

If you miss the OEP, you won’t be able to apply until next year’s OEP. However, you can sign up for health insurance at any time of the year if you’re eligible for a Special Enrollment Period because of what’s called a “qualifying life event,” such as getting married or losing the health coverage you had through your or your spouse’s job. Situations like these will trigger a short window during which you can get insurance.⁶

How Do I Enroll in the Hawaii Health Insurance Marketplace?

If you want to buy coverage through the federal Health Insurance Marketplace, you can apply directly at healthcare.gov.⁷ The website lets you compare plans, purchase coverage and find out if you qualify for subsidies that will help you pay your monthly premium. 

When you apply through the Marketplace, you’ll also find out automatically if you’re eligible for Medicaid or coverage for your children through CHIP.

How Much Does Individual Health Insurance Cost in Hawaii?

The individual plans available on and off the Marketplace are organized into “metal” tiers  of bronze, silver and gold. The more valuable the metal, the more coverage you get and the more expensive the plan.

All metal plans include the 10 “essential health benefits” the ACA requires. 

From 2018 to 2020, premiums in Hawaii for qualified bronze plans went up by 8%, while silver rose by over 5% and gold by just over 1%. Here are recent average monthly costs for a 40-year-old Hawaii resident for bronze, silver and gold plans sold through the Marketplace:⁸ 

Remember that these are the costs before any savings you might be eligible for based on your family size and household income. 

Your monthly premium could be much less if you qualify for tax credits or cost-sharing subsidies for a plan you buy from the Marketplace. How much you pay also depends on the type of plan you choose. Among metal plans, bronze-level coverage typically has the cheapest monthly premiums in Hawaii but the highest out-of-pocket costs. 

Subsidies are calculated based on a Marketplace silver “benchmark” plan. In Hawaii, on average, that benchmark plan will cost you $474 a month for 2020, down from $493 in 2019 and $438 in 2018.⁹     

Which Companies Offer Individual Health Insurance Plans in Hawaii?

In 2021, two health insurance companies, Hawaii Medicare Service Association and Kaiser Permanente Heatlh Plan of Hawaii, offer individual and family plans through the Hawaii Marketplace.¹⁰ Coverage is also available directly from the companies, but if you buy coverage directly from the company, you won’t have access to any subsidies available on the Marketplace. 

What Are My Coverage Options If I’m Low-Income and I Live in Hawaii?

ACA Marketplace Plans (Obamacare)

As mentioned above, submitting your application to Hawaii’s Marketplace at healthcare.gov will tell you how much you might save on an ACA plan as well as whether you qualify for Medicaid or the Children’s Health Insurance Program (CHIP). 

To qualify, your household income must be below four times the federal poverty level (FPL). Because Hawaii’s cost of living is higher, the state has higher Federal Poverty Level (FPL) limits than the mainland.¹¹ A family of three’s annual household income would have to be below $99,920 in 2020 to qualify for Hawaii subsidy assistance in 2021. About 84% of Hawaiians enrolled in an individual plan through the Marketplace received this assistance.¹² 

Here are some examples of cost savings with subsidies:

• A 28-year-old living in Honolulu who earns $24,000 a year could get a 2020 silver plan for $98 per month after subsidies.¹³ The same policy would cost $395 per month without the premium tax credits, which cover 75% of the cost. 

• A family of three living in Hilo with an income of $50,000 a year could pay $276 per month after subsidies for a 2020 silver plan.¹⁴ This policy would cost them $1,037 per month without the premium tax credits, which cover 73% of the cost.  

Cost-sharing reductions (CSRs) are another way you can save money on health insurance. They could help lower your deductible, copayments, coinsurance and other out-of-pocket expenses, but they only apply to silver plans you buy through the ACA Marketplace.¹⁵ Generally, you must earn up to 250% of the FPL to qualify.¹⁶  

Check a 2020 subsidy chart and calculator to see which subsidies you might qualify for.

Medicaid

Hawaii’s Medicaid programs, referred to as QUEST Integration, provide health coverage for low-income adults, children, foster children, parents and caretaker relatives, pregnant women and those who are elderly, blind or disabled. Eligibility depends on household income, family size and other requirements. 

QUEST Integration covers:¹⁷   

• Childless adults between ages 19 and 65 earning up to 138% of the FPL. 
• Infants and children under age 19 (or under 21 and receiving foster care), up to 313% of the FPL.
• Parents and caretaker relatives caring for a child under 19, up to 138% of the FPL.
• Pregnant women, including those under age 19 (or under age 21 and receiving foster care), up to 196% of the FPL. 
• Those who are elderly, blind or disabled, according to Title XIX of the Social Security Act, up to 100% of the FPL. 

Hawaii’s decision to expand Medicaid means that nearly all nonelderly adults under 138% of the FPL are now covered. In 2017, 118,500 adults were enrolled under the expansion.¹⁸

Over 320,000 Hawaiians, or nearly one in four, have Medicaid as of May 2020; that number climbs to 345,000 when CHIP enrollment is included.¹⁹ 

You can enroll in Medicaid at any time of the year.

Children’s Health Insurance Program (CHIP)

If your household income is too high to qualify for Medicaid but you have difficulty affording private insurance, you may qualify for the Children’s Health Insurance Program (CHIP). Children must be younger than 19 and be uninsured.²⁰ 

In Hawaii, the CHIP program is part of the state’s Medicaid program. 

As of May 2020, more than 25,000 residents were covered under CHIP.²¹

How Do I Apply for Health Coverage Assistance in Hawaii?

Hawaii’s Med-QUEST Division of the Department of Human Services processes applications for those seeking help with insurance. You can find out if you’re eligible for help using the online pre-assessment, where you’ll answer a series of questions. You can then create an account and proceed to the application itself.

The application for all forms of medical assistance, including affordable private health insurance plans, is called the Application For Health Coverage & Help Paying Costs. You’ll need to gather specific information to complete an application. In-person assistance with applications is available through Hawaii’s Community Partners. 

In addition to applying online, you can also call Med-QUEST Customer Service at (800) 316-8005. Or you can print the online application and Customer Service can tell you the closest Med-QUEST Division Eligibility Office to mail it to.²² If you’re eligible, you’ll likely be enrolled in one of five managed-care plans.²³

What About Medicare Seniors and People With Disabilities Living in Hawaii?

Medicare is a federal health insurance program that primarily covers people age 65 and older, younger people with a disability and kidney dialysis patients. Your income isn’t taken into account when you enroll in Medicare. 

As of 2018, nearly 270,000 Hawaiians, or one-fifth of the state’s population, had Medicare Part A (hospital insurance) and Part B (medical insurance).²⁴

More than half of Medicare enrollees in Hawaii access Part A and Part B coverage through the federal government’s Original Medicare program. The rest get these benefits through private Medicare Advantage (Part C) plans.²⁵ Part C plans roll in other benefits, including Part D prescription drug coverage.   

If you get your Part A and Part B coverage through Original Medicare, you may also want to buy an individual Part D prescription drug plan from a private insurer. In 2018, more than 70,000 Hawaii residents had a standalone Part D plan

Supplementing Medicare Coverage

Original Medicare only covers about 80% of approved costs. If you choose coverage through Original Medicare, you can add a Medicare Supplement Insurance plan (called a Medigap policy) to help pay other expenses.

Like most states, 10 standardized Medigap plans are available in Hawaii to help pay some to all of your uncovered, out-of-pocket costs. These include copayments, coinsurance and deductibles.

The federal government sets the benefits for each standardized plan, so the basic benefits for each type of plan are the same, no matter where you buy it. But since the insurance company can charge what it wants for its policies, premiums can vary depending on the insurer you buy it from.

If you receive Medicare coverage, you may also qualify for Medicaid assistance to help with some Medicare costs. The Medicare Savings Programs include Qualified Medicare Beneficiaries (QMB), Specified Low-Income Medicare Beneficiaries (SLMB), Qualified Disabled and Working Individuals (QDWI) and Qualifying Individuals (QI).²⁷

Hawaii SHIP is a program administered by the Hawaii State Department of Health that can help you select the best Medicare program by calling (808) 586-7299.

Can I Buy Short-Term Insurance in Hawaii?

In 2018, Hawaii passed a law prohibiting an insurer from renewing or re-enrolling a person into a short-term health policy or contract if he or she was eligible to buy insurance on Hawaii’s Health Insurance Marketplace during the prior calendar year.²⁸ The law also limits these temporary plans to a maximum duration of 90 days.

Because virtually everyone is eligible to purchase coverage on the Marketplace in any calendar year, the new law essentially eliminated the market for short-term plans in the state and insurers no longer offer them.