Availability of short-term health insurance in Hawaii

No. Hawaii enacted legislation in 2018 that mostly prohibits the sale of short-term plans,¹ and insurers stopped offering short-term health insurance in Hawaii.

There are other types of non-ACA-compliant health coverage available in Hawaii, however, including fixed indemnity plans and health care sharing ministry plans. But plans like these are not major medical health insurance, and it’s a much better option to obtain coverage from an employer, Medicaid/CHIP (Med-QUEST) or through Hawaii’s marketplace/exchange.

Hawaii enacted HB1520 (Act 192) in July 2018. The legislation prohibits the sale or renewal of a short-term plan to anyone who was eligible to purchase a plan in the exchange during the previous calendar year, either during open enrollment or during a special enrollment period.

The legislation also limits short-term health insurance in Hawaii to no more than 90 days in duration, and took effect immediately, in July 2018.

The legislation prohibits renewal and/or re-enrollment for anyone who was eligible to purchase a plan in the exchange during the previous year, and defines “renew or reenroll” as providing coverage (under a new plan or the renewal of an existing plan) to anyone who has had coverage under a short-term plan within the previous calendar year. So a person who was eligible to purchase a plan in the exchange cannot buy a short-term plan for the first time, and also cannot renew a short-term plan or purchase a subsequent short-term plan if they already have one.

Because HB1520 bans the sale or renewal of short-term plans to anyone who was eligible to purchase an ACA-compliant plan in the exchange during the previous calendar year, it essentially eliminates the market for short-term plans in Hawaii — because virtually everyone is eligible to purchase coverage in the exchange in any given calendar year.

The only people who aren’t eligible to purchase a plan in the exchange are undocumented immigrants, incarcerated individuals, and people who are eligible for premium-free Medicare Part A.

And although short-term health insurance in Hawaii used to be available for sale, that is no longer the case. Insurers that previously offered short-term plans in the state have stopped doing so, likely because hardly anyone was eligible to purchase the plans.

Hawaii began using the HealthCare.gov enrollment platform as of the 2016 open enrollment period. Two carriers offer coverage through the exchange.

ACA-compliant plans are purchased on a month-to-month basis, so you can enroll in coverage even for only a few months until another policy takes effect — and if you’re eligible, you may qualify for financial assistance in the form of a premium subsidy.

Hawaii residents may also be eligible for Medicaid coverage.

Short-term health insurance is not an option in Hawaii, but there are other ways of obtaining affordable health insurance, including employer-sponsored coverage, Medicaid/CHIP (Med-QUEST), and the Hawaii marketplace/exchange.

Hawaii has the nation’s strongest employee protections in terms of employer-sponsored health coverage: Under the state’s Prepaid Health Care Act, enacted in the 1970s, employers have to provide health insurance to employees who work at least 20 hours per week. The rule applies to businesses of any size, and the plan can’t cost the employee more than 1.5% of the employee’s wages for self-only coverage.

By comparison, the Affordable Care Act’s employer mandate offers far fewer protections: It only applies to businesses with at least 50 employees, it only requires them to provide coverage for workers who are employed at least 30 hours per week, and it requires the employee-only coverage to cost no more than 8.39% of the employee’s household income in 2024 (that percentage changes from one year to the next).

Hawaii expanded Medicaid under the Affordable Care Act, which means most adults under age 65 with household income up to 138% of the poverty level can qualify for Medicaid, which has no monthly premiums and low out-of-pocket medical costs.

In 2024, the income cap for eligibility under expanded Medicaid amounts to $23,887 for a single adult in Hawaii. This is higher than the limit in the continental US, because the federal government has established higher poverty levels for Hawaii.