Health insurance in Hawaii
- Hawaii uses the federally run health insurance marketplace at HealthCare.gov.
- Open enrollment for 2021 health plans ended on December 15, 2020. Hawaii residents with qualifying events can enroll outside of that window.
- Two carriers offer coverage through the Hawaii health insurance marketplace; both plan to decrease their premiums for 2021.
- Average pre-subsidy premiums in the individual marketplace also decreased in Hawaii for 2020.
- More than 20,000 people enrolled in 2020 medical insurance through the Hawaii health insurance marketplace.
- Hawaii law effectively eliminated the market for short-term insurance plans in the state.
- Hawaii is allowing small group transitional health insurance plans (but not individual plans) to remain in force through 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 several different types of coverage, including marketplace insurance for people who buy their own coverage, short-term health insurance, Medicare (for residents who are disabled or age 65+), and Medicaid (for low-income residents).
Hawaii’s health insurance marketplace
Most non-elderly Americans get their health coverage from an employer, but for people who have 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 marketplace in Hawaii.
After two years of using a technologically troubled state-based enrollment system, Hawaii began using the HealthCare.gov enrollment platform for the 2016 open enrollment period. In November 2016, Hawaii switched to a federally run health insurance marketplace, although that state still oversees the plans that are sold in the exchange.
Hawaii’s health insurance marketplace has two insurers that offer individual and family health plans: Kaiser and HMSA. Average full-price premiums decreased in Hawaii’s individual marketplace for 2020, for the first time since ACA-compliant plans debuted. And both insurers plan to decrease their premiums again for 2021. Rates increased sharply in 2016, 2017, and 2018, but only grew by about 5 percent in 2019 and then declined by about 4 percent for 2020, bringing the weighted average back to just slightly higher than it was in 2018. The premium decreases for 2021 will bring additional premium relief to people who aren’t eligible for premium subsidies and thus have to pay the full cost of the monthly premiums.
20,073 people enrolled in 2020 coverage through Hawaii’s health insurance marketplace during the open enrollment period. Hawaii is one of just a few states where enrollment in the marketplace grew each year from 2014 through 2019, although it dropped slightly for 2020.
As described below, Hawaii no longer has a SHOP exchange for small businesses. But employees receive stronger consumer protections for health coverage in Hawaii than they do in other states under federal rules.
Read more about Hawaii’s health insurance marketplace.
Hawaii open enrollment period and dates
Open enrollment in Hawaii for 2021 health plans ran from November 1 through December 15, 2020. The open enrollment period allows people to newly enroll in individual and family health plans, and it’s an opportunity for existing enrollees to renew or change their coverage for the coming year.
The open enrollment period applies both on-exchange and outside the exchange (directly through the health insurance companies). Outside of the open enrollment period, Hawaiians can only enroll in individual major 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 as of May 2020. About 110,089 people had gained coverage in the state by 2019 as a result of Medicaid coverage expansion. Nationwide, Medicaid enrollment has increased in 2020 as a result of the widespread job and income losses caused by the COVID pandemic.
Medicaid coverage expansion has certainly benefited low-income Hawaii residents, particularly those with low or no employment and no access to the employer-based health insurance that most Hawaii residents enjoy (in Hawaii, people employed at least 20 hours per week get very affordable health coverage through their employers). Medicaid expansion is particularly important during the COVID pandemic, as it provides a true safety net for people who lose their jobs, and in many cases, also lose their employer-sponsored health insurance.
Read more about Medicaid coverage in Hawaii.
Short-term health insurance in Hawaii
A 2018 Hawaii law prohibits the purchase of a short-term health insurance plan by anyone eligible to buy a plan in the state’s health insurance marketplace during the previous calendar year.
The law effectively eliminated the market for short-term health insurance plans in Hawaii, and they are no longer for sale in the state.
Read more about short-term health insurance in Hawaii.
How did Obamacare help Hawaii?
Hawaii has long supported broad access to medical insurance. The state’s historically low uninsured rate 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 stronger requirements for employer-provided coverage than the ACA. Hawaii’s 1332 waiver to eliminate the SHOP exchange (which was the first 1332 waiver approved 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 (far lower than 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 by that point). It had climbed slightly, to 4.2 percent, by 2019, mirroring the nationwide trend of increasing uninsured rates under the Trump administration.
Many states had much more significant drops in 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 national average uninsured rate at that point was 9.2 percent.
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 as a result of a disability — just 9 percent. The other 91 percent of recipients qualify for Hawaii Medicare plans based on age alone (ie, being at least 65).
As of 2018, per-beneficiary Medicare spending in Hawaii was $ $6,971 – the lowest in the nation. (The national average was $10,096.)
Learn more about Medicare enrollment in Hawaii, including the state’s rules for Medigap plans.
Transitional (grandmothered) health insurance plans in Hawaii
Transitional (grandmothered) health insurance plans are those that took effect after the ACA was signed into law in March 2010, but before the bulk of its provisions went into effect in 2014. These plans were initially slated to terminate at the end of 2013 or at their renewal dates in 2014, but a series of federal extensions have allowed them to continue to renew, at each state’s discretion.
As recently as the regulation they published in 2018 (which allowed transitional plans to extend through the end of 2019), Hawaii was going along with the federal extensions, allowing transitional plans in both the individual and small group markets to remain in force .
But the state’s extension for 2020 and for 2021 only apply to small group plans. Although individual market transitional plans were allowed to remain in force in Hawaii in 2019, HMSA opted to terminate all of their individual market transitional plans at the end of 2018 (see SERFF filing HMSA-131977825; the insurer clarifies that about two-thirds of their transitional plan enrollees subsequently enrolled in ACA-compliant HMSA plans for 2019).
Hawaii health insurance resources
- Hawaii health insurance information (Insurance Division of the Department of Commerce and Consumer Affairs) — Licenses and regulates health insurers, agents, and brokers. Addresses consumer questions and complaints related to insurance.
- Hawaii Medicaid
Health reform legislation in Hawaii
Here’s a look at recent state-level health care reform in Hawaii:
Hawaii partially addressed this issue many years ago, when the state required all state-regulated employer-sponsored health plans 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 took effect immediately, allows pharmacists to dispense up to 12 months of contraceptives, even if the patient does not have a prescription from a physician. The pharmacist must have the patient complete a “self-screening risk assessment tool” and refer the patient to a primary care physician, but must also provide the contraceptives regardless of whether the patient follows through on the referral.
Hawaii law, along with the ACA, requires health plans to cover contraceptives, but S.B.513 extends the coverage to include reimbursement for pharmacists who prescribe and dispense contraceptives.
During the legislative session, H.B.513 received widespread support, but also some opposition. The Hawaii section of the American College of Obstetricians and Gynecologists (ACOG) opposed the legislation because they felt that it didn’t go far enough in terms of expanding access to contraceptives. ACOG felt that birth control should be available over-the-counter, and that even requiring a visit with a pharmacist was too restrictive.
Hawaii enacted legislation in 2017 that created a working group that was tasked with making recommendations for codifying ACA protections into state law. In 2018, acting on the recommendations of the working group, Hawaii enacted legislation that prohibits gender rating, pre-existing condition exclusions, and application denials based on medical history. The legislation also protects parents’ ability to keep their children on their health plan until age 26.
In addition, Hawaii enacted legislation in 2018 that sharply limited the short-term insurance market. As a result, there were no longer any insurers offering short-term plans in Hawaii as of late 2018.
Scroll to the bottom of this page for a summary of other recent state-level health reform legislation in Hawaii.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.