Hawaii Health Insurance Guide | healthinsurance.org (2024)

Virtually all residents of Hawaii are eligible to buy Marketplace health insurance with the following exceptions:¹

• People who are not legally in the U.S.
• People already enrolled in Medicare
• People who are incarcerated

But eligibility for financial assistance in the Marketplace is a bit more involved. Eligibility for premium subsidies depends on how the cost of coverage in your area compares with your household income.

And to be eligible for subsidies you must not be eligible for Med-QUEST (Medicaid/CHIP), premium-free Medicare Part A,² or an employer’s plan that’s considered affordable and comprehensive. However, most Marketplace enrollees do qualify for premium subsidies.

Hawaii’s open enrollment period for individual and family health coverage is from November 1 to January 15. This is set by the federal government since Hawaii uses the federal exchange.

Here are some key dates to remember:³

• November 1: Open enrollment starts! This is when you can first sign up for or change plans for the following year. If you enroll by December 15, your coverage will begin on January 1.
• December 15: Last day to change plans or enroll for coverage to begin on January 1. After this date, any changes or new plans will start on February 1.
• January 15: Open enrollment ends.

After open enrollment, you can sign up for or make changes to an ACA Marketplace health through a special enrollment period (SEP). To be eligible for a SEP, you’ll need a qualifying life event.

Some SEPs don’t depend on a qualifying life event. For example:

• If you’re a Native American, you can enroll whenever necessary.⁴
• If you’re eligible for premium tax credits and your income is not more than 150% of the poverty level, you can enroll anytime until at least 2025.⁵
• People eligible for Medicaid/CHIP (Med-QUEST in Hawaii) can enroll in that coverage anytime.

If you qualify for an ACA Marketplace plan, there are a variety of ways you can sign up, either during open enrollment or during a special enrollment period:

1. Enroll online via HealthCare.gov.
2. Enroll by phone at (800) 318-2596.
3. Enroll 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.⁶

Hawaii’s uninsured rate has long been lower than the national average, due in large part to the state’s Prepaid Health Care Law, which has been in effect for nearly half a century.

Under this law, Hawaii’s employers must provide coverage to employees who work at least 20 hours per week, and the employee’s portion of the premiums can’t be more than 1.5% of their gross wages.⁷ So employer-sponsored health coverage is more accessible in Hawaii than it is in most of the rest of the country.

(A note about small group health insurance: Hawaii was the first state to receive approval for a 1332 waiver, which allowed Hawaii to no longer have a SHOP exchange.⁸ Small businesses in Hawaii purchase small group health plans directly from the insurers that sell these plans.)

But for those who aren’t eligible for an employer’s health plan or Medicare, coverage is available through the Marketplace (HealthCare.gov) or Med-QUEST (Medicaid/CHIP).

ACA Marketplace plans (on HealthCare.gov)

• About 83% of Hawaii Marketplace enrollees were receiving premium subsidies as of 2023.
• Subsidies – or Advance Premium Tax Credits (APTC) – help reduce premiums.
• The average premium subsidy for eligible enrollees is $545/month, meaning those subsidized enrollees pay an average of $140/month in premiums.⁹
  
• If your income is no more than 250% of the federal poverty level, you may qualify for cost-sharing reductions (CSR) to reduce your deductibles and out-of-pocket expenses, as long as you select a silver plan through the Marketplace.¹⁰ As of early 2023, 27% of Hawaii Marketplace enrollees were receiving premium subsidies.¹¹

Source: CMS.gov¹²

Medicaid

Hawaiians may find affordable coverage through Medicaid (Med-QUEST) if eligible.

According to Hawaii SERFF filings, the following average pre-subsidy rate changes were approved for 2024 (note that HMSA’s is slightly smaller than their originally proposed increase, which was 12.2%):¹⁴

Source: HealthCare.gov¹³ and Hawaii SERFF¹⁵

As is always the case, these average premium changes are based on full-price premiums, but most enrollees are eligible for subsidies and thus do not pay full price. The subsidies are designed to keep pace with the cost of the benchmark plan in each area, so they grow when average benchmark premiums grow.

For perspective, here’s a summary of how average pre-subsidy premiums for ACA-compliant individual/family plans have changed each year in Hawaii:

• 2015: 7.8% increase¹⁶
• 2016: 30% increase¹⁷
• 2017: 30.7% increase¹⁸
• 2018: 32.8% increase¹⁹
• 2019: 5.3% increase²⁰
• 2020: 4% decrease²¹
• 2021: 2.4% decrease²²
• 2022: 1.6% increase²³
• 2023: 2% increase²⁴

During the open enrollment period for 2024 coverage, 22,170 people enrolled in private health insurance plans through the Hawaii Marketplace.²⁵

Although nationwide Marketplace enrollment set a significant new record high in 2024, Hawaii’s enrollment was still a little lower than it had been in 2021²⁶ and 2022.²⁷ But it was higher than 2023, when 21,645 people enrolled.⁹

Here’s a summary of how enrollment has changed over time in Hawaii’s Marketplace:

Source: 2014,²⁸ 2015,²⁹ 2016,³⁰2017,³¹ 2018,³²2019,³³ 2020,³⁴ 2021,²⁶2022,²⁷ 2023,³⁵ 2024³⁶

HealthCare.gov
This is the ACA Marketplace, where you can enroll in a health insurance plan online. You may also get help by calling (800) 318-2596.

Hawaii’s Insurance Division of the Department of Commerce and Consumer Affairs
Licenses and regulates health insurers, agents, and brokers. They also handle consumer questions and complaints about insurance.

Legal Aid Society of Hawaii
The Navigator organization funded by the federal government in Hawaii.

Hawaii Medicaid (Med-QUEST)
This program provides health coverage for eligible residents.

Hawaii Prepaid Health Care Law information
This law helps ensure that many workers in Hawaii have access to health coverage through their jobs.