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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

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 244,364, which is about 17 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: 10 percent. The other 90 percent of recipients qualify for Hawaii Medicare based on age alone.

In 2009, the Aloha State ranked 43rd in overall Medicare spending with $1.5 billion per year. As of 2014, CMS reported Hawaii’s annual per enrollee spending to be $5,967, well under the national average of $8970.

Hawaii Medicare beneficiaries can select a Medicare Advantage plan instead of original Medicare if they want to gain some additional benefits. 46 percent of Hawaii Medicare recipients selected a Medicare Advantage plan in 2016 — the same percentage as 2015. Nationwide, 12 percent of Medicare recipients were enrolled in a Medicare Advantage plan.

Medicare Part D plans are also available to Hawaii Medicare beneficiaries who want stand-alone prescription drug coverage. About 26 percent have a stand-alone Rx plan compared with an average of 45 percent nationally.

Hawaii health insurance resources

State-level health reform in Hawaii

Here’s what’s happening in Hawaii at the state level with healthcare reform:

  • HB 552 would preserve the ACA in Hawaii. Senate amendments to the bill would also expand Medicaid to 250 percent of the poverty level. The bill passed the House in March 2017, passed the Senate with amendments in April, and was then sent back to the House for reconsideration with the Senate’s amendments.
  • SB 1120 would establish a single-payer system in Hawaii and prevent private insurance from duplicating the benefits of the single-payer system.

Other state-level health reform legislation includes: