Hawaii health insurance Marketplace guide

Virtually all residents of Hawaii are eligible to buy Marketplace health insurance with the following exceptions:³ 

• 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,⁴ or an employer’s plan that’s considered affordable and comprehensive.

Most Marketplace enrollees do qualify for premium subsidies. As of early 2025, subsidies were being paid on behalf of 84% of Hawaii Marketplace enrollees.⁵

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 federally-facilitated exchange.

Here are some key dates to remember:⁶

• 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. 

But open enrollment will be shorter starting in the fall of 2026. The enrollment window will end on December 15, and all policies selected during open enrollment will take effect on January 1. The shorter open enrollment period is a result of a federal rule change that was finalized in 2025.

After open enrollment, you can sign up for or make changes to individual market coverage if you qualify for a special enrollment period (SEP). To be eligible for a SEP, you’ll usually need a qualifying life event. But Native Americans can enroll anytime.

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.⁷

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.⁸

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. 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.⁹ 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)

• 83% of the people who enrolled through the Hawaii Marketplace during the open enrollment period for 2025 coverage were eligible for premium subsidies (advance premium tax credits, or APTC). This means they didn’t have to pay the full cost of their coverage.
• For the 2025 enrollees who qualified for premium subsidies, the average subsidy amount was $574/month. Even accounting for the enrollees who paid full price, the average net premium paid by enrollees was $252/month. ¹⁰
  

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.¹¹

• As of early 2025, more than a quarter of Hawaii Marketplace enrollees were receiving CSR benefits.⁵

Source: CMS.gov¹⁰

Medicaid 

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

Two private insurance companies offer individual/family health coverage through Hawaii’s health insurance Marketplace:¹²

• Hawaii Medical Service Association (HMSA)
• Kaiser Foundation Health Plan, Inc.

Both will continue to offer coverage in 2026.¹³

According to Hawaii SERFF filings, the following average pre-subsidy rate changes were approved for 2026:¹⁴ 

Source: Hawaii SERFF¹⁴ 

According to the approved filings, HMSA had 21,945 enrollees in 2024, and Kaiser had 10,439. So the weighted average rate increase for 2026 is about 12%.¹⁴

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. However, the subsidies will shrink and be available to fewer people in 2026 if Congress doesn’t extend the subsidy enhancements that have been in place since 2021.

If that happens, coverage will be less affordable, and fewer people will enroll in Marketplace plans.

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% increase¹⁵
• 2016: 30% increase¹⁶
• 2017: 30.7% increase¹⁷
• 2018: 32.8% increase¹⁸
• 2019: 5.3% increase¹⁹
• 2020: 4% decrease²⁰
• 2021: 2.4% decrease²¹
• 2022: 1.6% increase²²
• 2023: 2% increase²³
• 2024: 8.8% increase²⁴
• 2025: 6.7% increase²⁵

During the open enrollment period for 2025 coverage, 24,606 people enrolled in private health insurance plans through the Hawaii Marketplace.²⁶ This was a new record high for Hawaii.

Although nationwide Marketplace enrollment had reached new record highs in 2022, 2023, 2024,²⁷ and again in 2025, Hawaii didn’t exceed its 2021 enrollment until 2025.

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

Source: 2014,²⁸ 2015,²⁹ 2016,³⁰ 2017,³¹ 2018,³² 2019,³³ 2020,³⁴ 2021,³⁵ 2022,³⁶ 2023,³⁷ 2024,³⁸ 2025³⁹

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.