Hawaii Health Insurance

Health insurance in Hawaii

● Hawaii uses the federally managed health insurance marketplace to HealthCare.gov.

● Open enrollment for 2021 health plans will run out from December 1-15, 2020. Hawaii residents with qualifying events can sign up outside that window.

● Two carriers offer coverage through Hawaii's health insurance marketplace; both plan to reduce premiums for 2021.

● Average pre-subsidy premiums in the single marketplace also fell in Hawaii by 2020.

● More than 20,000 people enrolled in 2020 medical insurance through Hawaii's health insurance marketplace.

● The Hawaii law actually the marketplace for short-term insurance plans in the state.

● Hawaii allows transitional small-group health insurance plans (but not individual plans) to remain in effect until 2021.

● Hawaii implemented the ACA's Medicaid expansion in 2014.

● More than 280,000 Hawaiians are enrolled in Medicare.

This page is dedicated to helping consumers quickly find health insurance resources in the state of Hawaii. We've included an overview of different types of coverage, including marketplace insurance for people buying their coverage, short-term health insurance, Medicare (for disabled residents or 65-year-olds and Medicaid (for low-income residents).

Hawaii's health insurance marketplaceplace

Most older Americans get health coverage from an employer, but for people who are retired early, are self-employed, or employed by a small business that doesn't offer health insurance benefits, individual/family health plans are available through the Hawaii marketplaceplace.

After two years of using a technologically troubled state registration system, Hawaii began using the HealthCare.gov registration platform for the 2016 open enrollment period. In November 2016, Hawaii changed to a federally managed health insurance marketplace, though that state still oversees plans that are sold in the exchange.

Hawaii's health insurance marketplace has two insurers offering individual and family health plans: Kaiser and HMSA. Average full-price premiums have fallen in Hawaii's individual marketplace for 2020, for the first time since ACA-compliant plans debuted. And both insurers plan to cut premiums again by 2021. Rates rose sharply in 2016, 2017 and 2018, but grew by only about 5% in 2019 and then decreased by about 4% for 2020, bringing the weighted average back to just over 2018. The decrease in the premium for 2021 will bring further premium relief to people who are not eligible for premium subsidies and therefore have to pay the full cost of monthly premiums.

20,073 people enrolled in 2020 coverage through Hawaii's health insurance marketplace during the open enrollment period. Hawaii is one of the few states where marketplace enrollment has grown annually from 2014 to 2019, though it has declined slightly by 2020.

As described below, Hawaii no longer has a SHOP exchange for small businesses. But employees receive stronger consumer protection for health coverage in Hawaii than other states under federal rules.

Hawaii Open enrollment period and dates

Open enrollment in Hawaii for 2021 health plans will begin on November 1, 2020 and run out until December 15, 2020. The open enrollment period allows people to recently enroll in individual and family health plans, and is an opportunity for existing enrollees to renew or change their coverage for the following year.

The open enrollment period applies both on the stock exchange and outside the exchange (directly through health insurance companies). Outside of the open enrollment period, Hawaiians can only enroll in individual medical health coverage if they experience a qualifying event.

Medicaid expansion in Hawaii

A total of 346,791 people - nearly a quarter of Hawaii's population - were enrolled in Medicaid plans in May 2020. About 110,089 people had gained coverage in the state by 2019 because of Medicaid coverage Expansion. Nationally, Medicaid enrollment increased in 2020 due to widespread job and income losses caused by the COVID pandemic.

Expanding Medicaid coverage has certainly benefited low-income Hawaiians, particularly those with low or no jobs and no access to employer-based health insurance that most Hawaii residents enjoy (in Hawaii, people employed at least 20 hours a week get very affordable health coverage through their employers). Medicaid expansion is especially important during the COVID pandemic, as it provides a real safety net for people who lose their jobs and, in many cases, also lose their employer-sponsored health insurance.

Short-term health insurance in Hawaii

A 2018 Hawaii law prohibits the purchase of a short-term health insurance plan by anyone eligible to purchase a plan in the state's health insurance marketplace during the previous calendar year.

The law has effectively eliminated the marketplace for short-term health insurance plans in Hawaii and they are no longer for sale in the state.

How did Obamacare help Hawaii?

Hawaii has long advocated broad access to medical insurance. The historically low rate of the uninsured state is largely the result of the Hawaii Prepaid Health Care Act, which was enacted in 1974 and requires most employers to provide health insurance to employees who work more than 20 hours a week.

The Hawaii Prepaid Health Care Act has much stricter requirements for employer coverage than the ACA. Hawaii's 1332 waiver to eliminate the SHOP exchange (which was the first waiver of 1332 passed in the nation) was a direct result of the state's success under the Hawaii Prepaid Health Care Act.

According to U.S. Census data, Hawaii's uninsured rate was 6.7 percent in 2013 (well below the national average of 14.5 percent) and had fallen to 4 percent by 2015 (again, less than half the national average of 9.4 percent) percentage of that point). It had risen slightly, to 4.2%, by 2019, reflecting the national trend of raising uninsured rates under the Trump administration.

Many states have had much more significant declines than their uninsured rates, but they also started with a much higher percentage of the population without health insurance in 2013. As of 2019, only Massachusetts, Rhode Island, and the District of Columbia had lower uninsured rates than Hawaii; the average national uninsured rate at that point was 9.2%.

Medicare coverage and enrollment in Hawaii

280,662 Hawaii residents were enrolled in Medicare plans as of August 2020.

Hawaii has the smallest percentage of Medicare enrollment due to a disability -- only 9 percent. The other 91% of recipients qualify for Hawaii Medicare plans based on age alone (or at least 65 years).

As of 2018, Medicare spending per beneficiary in Hawaii was $6,971 - the lowest in the nation. (The national average was $10,096.)

Transitional health insurance plans (not grandmother) in Hawaii

Transitional health insurance plans (not grandmothers) went into effect after the ACA was signed in March 2010, but before most of its provisions went into effect in 2014. These plans were originally scheduled to end in late 2013 or their renewal dates in 2014, but a series of federal extensions allowed them to continue renewing, at each state's discretion.

No later than the regulation they released in 2018 (which allowed transitional plans to extend until the end of 2019), Hawaii was facing federal extensions, allowing transitional plans in both individual and small-group marketplaces to remain in place.

But the state's extension for 2020 and 2021 only applies to small-group plans. Although individual marketplace transitional plans were allowed to remain in place in Hawaii in 2019, HMSA chose to end all their individual transitional marketplace plans at the end of 2018 (see SERFF HMSA-131977825 depot; the insurer clarifies that about two-thirds of their transitional plan members subsequently signed up for the ACA-compliant HMSA plans for 2019).

Hawaii Health Insurance Resources

● About Hawaii Health Insurance (Insurance Division of the Department of Commerce and Consumer Affairs) - Licenses and regulates health insurers, agents, and brokers. Address consumer questions and insurance claims.

● Hawaii Medicaid

Hawaii Health Reform Legislation

Here's a look at Hawaii's recent state-level health care reform:

In July 2017, Governor Ige signed S.B,513 into law, joining states like New York and Oregon that have taken steps to protect and even improve contraceptive benefits conferred by the ACA.

Hawaii partially addressed this issue many years ago, when the state required all employer-sponsored health plans regulated by the state to cover the full range of FDA-approved contraceptives, starting in 2000 (the initial impacts of this change are discussed here).

Hawaii's new law, which is in effect immediately, allows pharmacists to dispense up to 12 months of contraceptives, even if the patient does not have a prescription from a doctor. The pharmacist must ensure that the patient completes a "self-screening risk assessment tool" and refer it to a GP, but must also provide contraceptives regardless of whether or not the patient follows the referral.

Hawaii law, along with the ACA, requires health plans to cover contraceptives, but S.B,513 extends coverage to include reimbursement for pharmacists who prescribe and dispense contraceptives.

During the legislative session, H.B,513 received broad support, but also some opposition. The Hawaii section of the American College of Obstetricians and Gynecologists (ACOG) opposed the legislation because they felt it had not staggered enough in terms of expanding access to contraceptives. The ACOG believed that birth control should be available over-the-counter and that even requesting a visit with a pharmacist was too restrictive.

Hawaii enacted legislation in 2017 that created a working group tasked with making recommendations to codify ACA protections into state law. In 2018, acting on the working group's recommendations, Hawaii enacted legislation prohibiting gender classification, pre-existing condition exclusions, and denials of applications based on medical history. The legislation also protects parents' ability to keep their children in their health plan until the age of 26.

In addition, Hawaii enacted legislation in 2018 that severely limited the short-term insurance marketplace. As a result, at the end of 2018 there were no more insurers offering short-term plans to Hawaii.