Hawaii Health Insurance Carriers Explained

Hawaii has a unique health insurance landscape, with several carriers offering plans to residents and visitors.

There are three main types of health insurance carriers in Hawaii: government-sponsored, private, and Medicare supplement carriers.

Private health insurance carriers in Hawaii offer a range of plans, including HMOs, PPOs, and EPOs.

One popular private carrier is HMSA, which offers a variety of plans, including a comprehensive plan with a $1,000 deductible.

Medicare supplement carriers in Hawaii offer additional coverage to Medicare recipients, helping to cover out-of-pocket costs.

Health insurance options in Hawaii are quite unique, thanks to the Prepaid Health Care Law, which has been in effect for nearly half a century. This law requires employers to provide coverage to employees who work at least 20 hours per week, with the employee's portion of the premiums capped at 1.5% of their gross wages.

For those who aren't eligible for employer-sponsored health plans or Medicare, coverage is available through the Marketplace (HealthCare.gov) or Med-QUEST (Medicaid/CHIP). More than a quarter of Hawaii Marketplace enrollees were receiving premium subsidies as of early 2024, which can significantly lower their monthly premiums.

If you're shopping for individual/family health coverage, you'll find that only two private insurance companies offer Marketplace coverage in Hawaii. These plans can be purchased through HealthCare.gov, and you may be eligible for income-based financial assistance to help lower your costs.

Here's a breakdown of the average premium subsidy and net premium paid by enrollees in Hawaii's Marketplace as of early 2024:

Overall, Hawaii's health insurance landscape is shaped by its unique laws and regulations, which prioritize accessibility and affordability for its residents.

Short-term health plans provide temporary health insurance for consumers who may find themselves without comprehensive coverage.

If you're in Hawaii, you can learn more about short-term plan availability in your state.

Short-term plans are designed to be a stopgap measure, offering coverage for a limited time - usually up to 12 months, but sometimes up to 36 months in some states.

You can use short-term plans to bridge the gap between losing your job and getting new health insurance, or between graduating from college and qualifying for a group plan through your employer.

Hawaii's state care options are designed to provide affordable health insurance to its residents.

The Prepaid Health Care Law in Hawaii requires employers to provide coverage to employees who work at least 20 hours per week, with the employee's portion of the premiums capped at 1.5% of their gross wages.

This law has contributed to Hawaii's low uninsured rate compared to the national average. Employer-sponsored health coverage is more accessible in Hawaii than in most of the rest of the country.

There are several options for those who aren't eligible for an employer's health plan or Medicare. You can purchase a plan through the Marketplace (HealthCare.gov) or Med-QUEST (Medicaid/CHIP).

Here are some key facts about Hawaii's Marketplace plans:

Medicaid (Med-QUEST) is another option for affordable coverage in Hawaii. If you're eligible, you can find affordable coverage through Medicaid.

To enroll in a Marketplace plan in Hawaii, you have a few options. You can enroll online via HealthCare.gov, by phone at (800) 318-2596, or with the help of an agent/broker, Navigator, certified application counselor, or an approved enhanced direct enrollment entity.

Two private insurance companies offer individual/family health coverage through Hawaii's health insurance Marketplace.

Here's a quick look at the insurers offering Marketplace coverage in Hawaii:

The average pre-subsidy rate changes for 2025 in Hawaii are as follows: HMSA has an 8% increase, and Kaiser has a 4% increase, resulting in a weighted average rate increase of about 6.7%.

Enrolling in a Marketplace Plan is a straightforward process, but it's essential to know the eligibility criteria and enrollment options. Virtually all residents of Hawaii are eligible to buy Marketplace health insurance, except for those who are not legally in the U.S., already enrolled in Medicare, or incarcerated.

To enroll, you can choose from various options, including enrolling online via HealthCare.gov, enrolling by phone at (800) 318-2596, or enrolling in person, over the phone, or online with the help of an agent/broker, Navigator, certified application counselor, or an approved enhanced direct enrollment entity.

You can enroll in an ACA Marketplace plan during the open enrollment period, which runs from November 1 to January 15. This is the best time to sign up for or change plans for the following year, and if you enroll by December 15, your coverage will begin on January 1.

Here are the key dates to remember:

After open enrollment, you can sign up for or make changes to an ACA Marketplace health through a special enrollment period (SEP), which usually requires a qualifying life event. But don't worry, some SEPs don't depend on a qualifying life event, such as enrolling as a Native American or eligible for premium tax credits with income not more than 150% of the poverty level.

Hawaii's Marketplace health insurance premiums have seen significant fluctuations over the years.

The average pre-subsidy rate changes for 2025 show a weighted average rate increase of about 6.7%, with HMSA and Kaiser Foundation Health Plan, Inc. experiencing 8% and 4% increases respectively.

In Hawaii, the average pre-subsidy premium for ACA-compliant individual/family plans has changed dramatically each year.

Here's a summary of the changes:

It's worth noting that these average premium changes are based on full-price premiums, but most enrollees are eligible for subsidies that grow with the cost of the benchmark plan.