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Hawaii health insurance

Two insurers offer 2019 individual market coverage through state's exchange.

Health insurance in Hawaii

Hawaii’s health marketplace

State legislative efforts to preserve or strengthen provisions of the Affordable Care Act

How hard is Hawaii fighting to preserve the Affordable Care Act’s provisions? Compare to other states’ efforts.

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 exchange, although that state still oversees the plans that are sold in the exchange.

Open enrollment for 2019 coverage ended on December 15, 2018 in Hawaii – including plans sold in the exchange as well as plans purchased outside the exchange. But enrollment is still possible for Hawaiians who have qualifying events.

Hawaii’s exchange has two insurers that offer individual market coverage for 2019. The weighted average approved rate increase for 2019 plans is about 5.3 percent.

In 2017, 19,799 people enrolled in 2018 coverage through Hawaii’s exchange – a 4.5 percent increase over the 18,938 people who enrolled for 2017.

Read more about Hawaii’s exchange, carriers and rate increases.

Medicaid expansion in Hawaii

Prior to 2014, Kaiser estimated that 74 percent of the 102,000 uninsured, nonelderly Hawaiians would qualify for financial assistance under the Affordable Care Act. About 58,000 of the uninsured were expected to qualify for Hawaii Medicaid or the Children’s Health Insurance Program (CHIP).

A total of 347,439 people – about 25 percent of Hawaii’s population – were enrolled in Medicaid/CHIP in Hawaii as of November 2017, with about 100,000 people having gained coverage as a result of Medicaid expansion.

Medicaid 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. From late 2013 to July 2018, the number of Hawaiians covered by Medicaid/CHIP increased by 49, 145.

Read more about Medicaid in Hawaii.

Short-term health insurance in Hawaii

A 2018 Hawaii law prohibits the purchase of a short-term plan by anyone eligible to buy a plan in the state’s exchange during the previous calendar year.

The law effectively eliminates the market for short-term plans in Hawaii.

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 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).

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 2015, only Massachusetts, Vermont, and the District of Columbia had lower uninsured rates than Hawaii.

Hawaii Medicare enrollment

In 2015, Hawaii Medicare enrollment reached 267,831 – about 19 percent of the state’s population and on par with the percentage of the U.S. population enrolled in Medicare.

Hawaii has the smallest percentage of Medicare recipients who are on Medicare as the result of a disability:just 9 percent. The other 91 percent of recipients qualify for Hawaii Medicare based on age alone.

As of 2016, per-beneficiary Medicare spending in Hawaii was $ $6,441 – the lowest in the nation. (The national average was $9,533.)

Hawaii Medicare beneficiaries can select a Medicare Advantage plan instead of original Medicare if they want to gain some additional benefits. In 2017, 45 percent of Hawaii Medicare recipients selected a Medicare Advantage plan.

Medicare Part D plans are also available to Hawaii Medicare beneficiaries who want stand-alone prescription drug coverage. As of November 2018, there were 71,138 Hawaii Medicare beneficiaries who had a stand-alone Rx plan.

Hawaii health insurance resources

State-level health reform in Hawaii

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

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 enhance the contraceptive benefits that the ACA conferred.

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.

Other state-level health reform legislation includes: