Hawaii Health Insurance: Find Affordable Plans

Hawaii has many options for enrolling in individual or family health insurance. If you don’t have group coverage through your employer, you may be able to sign up for Medicaid or Medicare, use military health insurance, compare plans via the Health Insurance Marketplace, or buy a plan directly from an insurance company.

This guide explains your affordable health insurance options in Hawaii in detail.

• Marketplace plans: In Hawaii, you can use the federal Health Insurance Marketplace or purchase health insurance from a company that offers off-exchange health plans.
• Open enrollment: Hawaii’s open enrollment period for coverage beginning in 2023 runs from October 15 through December 7, 2022. If you don’t sign up during open enrollment, you may miss out on the opportunity to enroll in a health plan until the next year.
• Special enrollment: If you miss out on open enrollment, you may be able to enroll in a new health plan or switch plans if you have a qualifying life event. For example, if you get married during the year, you may be able to purchase a plan that covers you and your spouse instead of just you.
• Health Insurance Marketplace: As a Hawaii resident, you have access to dozens of on- and off-exchange plans. In 2021, Hawaii insurers are offering 23 plans on the exchange and 36 plans off the exchange.
• Coverage types: 53.4% of Hawaii’s insured population had employer-sponsored health coverage. Another 15.9% were enrolled in Medicare, and 17% in Medicaid, while 4% used military health insurance, and 4.1% were enrolled in some type of non-group plan. Just over 4% of Hawaii’s residents were uninsured.

If you want to check your eligibility for a tax credit to help pay your insurance premiums, you must use the Health Insurance Marketplace to enroll in a plan. To do so, visit HealthCare.gov and create an account.

Once you set up your account, start a new application and fill out the questions on each page. If you want to determine your eligibility for an Advanced Premium Tax Credit, you must provide information about your household income, such as how much you earn from your job and whether you have any self-employment income. You’ll also have an opportunity to report some of your expenses, such as student loan interest.

When you finish answering the questions, you’ll be able to see a list of plans available in your area. You can also compare plans according to monthly premiums, annual deductibles, and other criteria. If you want to keep your current health care providers, you can search for plans with those providers in the network. Once you choose a plan, you’ll have an opportunity to pay the first month’s premium to ensure your coverage goes into effect on the expected date.

The following insurance companies offer affordable health insurance plans to Hawaii residents in the Marketplace:

• HMSA
• Kaiser

When you’re shopping for affordable health insurance, there are some important considerations to keep in mind, such as how often you receive health care services and how much you can afford to pay for coverage. These factors are the same whether you’re looking for an individual or family plan, but shopping for family coverage is a little more complicated because you have to account for the needs of multiple individuals.

Insurance for individuals in Hawaii

For many people, the monthly premium is the most important consideration, as it determines how much you can expect to pay for coverage each month. You must pay the premium even if you never use your health benefits, so review your budget carefully to determine what you can afford.

If you have a chronic health condition, think carefully about whether you want to prioritize the monthly premium or the out-of-pocket costs you incur each time you receive health care. If you see multiple doctors, or if you need to see your doctor every month, choosing the cheapest plan may cost you in the long run. As you shop for coverage, pay attention to the deductibles, copays, and coinsurance amounts for each plan, as they can help you determine which plan gives you the best coverage at the most affordable price.

In-network versus out-of-network care is also an important distinction. Many plans won’t pay for out-of-network care, and the ones that do usually pay a lower percentage for out-of-network services than they do for in-network services. If you love your doctor and don’t want to see someone new, it’s important to look for a plan that considers your doctor an in-network provider.

There are also different types of plans you can choose from:

• A Health Maintenance Organization plan (HMO) offers the best choice if you don’t make many visits to a doctor or a specialist or require prescriptions. It has lower monthly premiums and higher deductibles. HMO plans are the least expensive plans. However, there are restrictions with an HMO plan. You’ll need to get a referral if you want to see a specialist, you’ll need to name a primary care physician, and you’re limited to using the HMO plan’s in-network medical providers.
• A Preferred Provider Organization (PPO) plan is a better idea if you regularly visit doctors or specialists. You’ll have more flexibility with a PPO plan, although you’ll pay more for it. You aren’t limited to in-network providers, you don’t need to name a primary care physician, and you’ll never need to obtain a referral to see a specialist.
• A Point of Service Plan (POS) is a hybrid of an HMO and a PPO. You can use out-of-network providers, but any time you want to see a specialist, you’ll need to get a referral.

Insurance for families in Hawaii

If you’re shopping for a plan that covers several family members, you need to consider these factors even more carefully. When you buy a family plan, the premium is based on how many people are covered, along with their ages and their history of tobacco use. Depending on the number of people in your family, it can cost well over $1,000 per month to purchase coverage, making it even more important to weigh the benefits of a low premium against the drawbacks of high deductibles, copays, and coinsurance amounts.

You also need to think carefully about your family’s medical needs. Needs can vary by age; for example, your child may need to have their tonsils removed. An older spouse may need to undergo screening for diseases that become more common in late adulthood. You’ll want to choose a plan that gives everyone access to the care they need at a price that’s manageable based on your budget.

When you shop for coverage on the Health Insurance Marketplace, you may notice that each plan is marked with a Bronze, Silver, Gold, or Platinum designation. These “metal tiers” are used to categorize on-exchange plans based on their monthly premiums and other out-of-pocket costs.

• Bronze plans are the most affordable health insurance plans on the marketplace. These plans have the lowest monthly premiums and work best if you don’t use a lot of health care services each year. In exchange for the low premium, Bronze plans come with a high deductible, high copays, and high coinsurance requirements. For example, you may have to pay as much as 40% of the cost of each approved service. Bronze plans in Hawaii declined from $336 per month in 2018 to $329 per month in 2023.
• Silver plans cost a little more each month, but you typically benefit in the form of lower out-of-pocket costs when you receive medical care. For example, you may have a lower deductible or a lower primary care copay with a Silver plan than you would with a Bronze plan. If you need ongoing care due to a chronic health condition, a Silver plan may end up costing less than a Bronze plan when you account for deductibles, copays, and coinsurance. In Hawaii, the cost of the most affordable Silver plan decreased from $437 per month in 2018 to $430 per month in 2023.
• Gold plans give you the best coverage but also have some of the highest premiums. Depending on which plan you select, your annual deductible could be $0 or just a few hundred dollars per year. Coinsurance for a Gold plan is usually around 20%, which means you only have to pay 20% of the cost of each covered service. Gold plans also have lower copays than Bronze or Silver plans, which is helpful if you see several medical specialists each year. The cost of Hawaii’s most affordable Gold plan hasn’t changed much over the past five years, decreasing from $449 per month in 2018 to $439 per month in 2023.

If you live in a low-income household, you have two main options for getting cheap health insurance. The first is Medicaid, a joint effort between the federal government and Hawaii’s state government to ensure that low-income residents have access to health care. The second, if you have children, is the Children’s Health Insurance Program (CHIP), which your children may qualify for even if your household income exceeds the Medicaid limit.

Medicaid in Hawaii

Hawaii has two forms of Medicaid: Hawaii QUEST and the Medicaid fee-for-service program. Services provided under Hawaii-QUEST include primary and acute medical care, behavioral health services, and long-term services. To qualify for Hawaii QUEST, you must meet the following requirements:

• Resident of Hawaii
• U.S. citizen or lawful immigrant
• Under the age of 65
• Not certified as disabled or blind
• Not living in an institution
• No access to health coverage through an employer
• Have a valid Social Security number

You must also meet requirements regarding your household income and assets. The income limit is 100% of the Federal Poverty Level (FPL), while the asset limit is $2,000 for a single person, $3,000 for a two-person household, and $250 for each additional person in your household. The asset limits don’t apply to pregnant women or children born after September 30, 1983.

The fee-for-service program is typically reserved for Hawaiians who are over the age of 65, disabled, or blind. Under this program, your health care providers are paid directly for the services they provide. The income limit for Medicaid fee-for-service is slightly higher at 133% of the FPL, but the asset requirements remain the same; therefore, you can’t have more than $2,000 in countable resources as a single person, or $3,000 for a two-person household.

To apply for Medicaid coverage, fill out the online application, call Med-QUEST Customer Service at 1-800-316-8005, or print an application and mail it to your local Department of Human Services office.

Hawaii Children’s Health Insurance Program

Hawaii CHIP provides health coverage for children in households meeting certain eligibility requirements. The income limits are higher for CHIP, so your children may qualify for coverage even if your household income is too high for Medicaid. Some children qualify with household incomes up to 308% of the FPL.

Hawaii’s CHIP program provides comprehensive coverage for children from eligible households. Covered services include routine medical care, dental care, and immunizations.

To apply for CHIP, visit the State of Hawaii MyBenefits site and click “Apply On-Line for Benefits.” If you’re not sure if your child qualifies for CHIP coverage, click “Am I Eligible?” to access a screening tool that can help determine if your household meets the eligibility requirements.

Even if you don’t qualify for Medicaid, you may be eligible for Medicare, a federal program designed to give eligible adults access to health coverage.

If you’re eligible, you have two options: sign up for Original Medicare, or choose a Medicare Advantage Plan offered by individual insurance companies.

• Original Medicare includes hospital insurance and medical insurance, but it doesn’t cover most prescriptions. It also has deductibles, copays, and coinsurance, which can add up quickly. To make these costs more manageable, you have the option of combining your Original Medicare coverage with Medicare Part D and/or Medicare Supplement Insurance. Medicare Part D pays for your prescriptions, while Medicare Supplement Insurance (Medigap) pays for deductibles, coinsurance, and other out-of-pocket costs. The Medicare Part deductible for inpatient hospital stays is $1,600 in 2023. Medicare Part B enrollees pay a standard monthly premium of $226 for 2023.
• Medicare Advantage gives you more flexibility by allowing you to buy your Medicare coverage directly from an insurance company. Medicare Advantage Plans typically cover more services than Original Medicare, and most also cover prescriptions. In 2019, Hawaii had eight Medicare Advantage Plans available. As of 2023, there are 38 Medicare Advantage Plans available in the state, however, you can only select a plan that’s available in your county.

If you choose Original Medicare, you can also purchase supplemental plans to extend your coverage. Medicare Part D covers prescription medications, while Medicare Supplement Insurance (Medigap) covers deductibles, copays, and other out-of-pocket Medicare costs.

Eligibility

To receive Medicare coverage based on your age, you must be at least 65 years old. Medicare is also available to younger people with certain disabilities. In most cases, you must receive disability benefits for at least 24 months before you qualify for Medicare based on a disability; however, there are some exceptions. For example, if you’re diagnosed with Lou Gehrig’s disease or end-stage renal disease, you qualify for Medicare immediately.

Enrollment

You may qualify for automatic Medicare enrollment if you meet certain requirements. For example, if you start receiving Social Security retirement benefits at least four months before you turn 65, you’ll be automatically enrolled. If you don’t qualify for automatic enrollment, you’ll have to sign up for Medicare during your initial enrollment period or the annual general enrollment period.

You can enroll in Medicare during the following periods:

• Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
• General enrollment: Choose this enrollment period if you missed your initial enrollment period. The Medicare general enrollment period is January 1 to March 31. You can choose Original Medicare, Medicare Advantage, Medigap, or Part D.
• Medicare Advantage open enrollment: You can make changes to your Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
• Open enrollment: You can join, switch plans, or drop your coverage from October 15 to December 7 each year.
• Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Medicare Resources

To sign up for Medicare, fill out the online application or contact your local Social Security office for assistance. For answers to questions about Medicare and help comparing your coverage options, you can call 1-888-875-9229 to speak with a Hawaii State Health Insurance Assistance Program (SHIP) counselor at no cost.

Short-term health insurance can be a cheap health insurance option if you’re in between qualified coverage. Under Hawaii law, a short-term health insurance contract must expire no more than 90 days from its issue date. You can’t renew the contract or extend the coverage in any way. Because the state’s short-term insurance laws are so strict, insurers have stopped selling short-term policies in Hawaii.

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