Frequently asked questions about health insurance
coverage options in Hawaii
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 open enrollment period that began in the fall of 2015. At that point, the state had what’s called a state-run marketplace using the federal enrollment platform, or SBM-FP.
In November 2016, Hawaii switched to a fully federally run health insurance marketplace, or FFM, although that state still oversees the plans that are sold in the exchange. And consumers only really noticed a difference in the fall of 2015, when Hawaii transitioned from using its own enrollment platform to using HealthCare.gov. Hawaii residents have continued to use HealthCare.gov ever since.
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.
The open enrollment period for individual/family health coverage runs from November 1 through January 15 in Hawaii. This enrollment window is set by the federal government, and Hawaii does not have the option to modify it since the state uses the federally-run exchange.
Outside of open enrollment, a qualifying event is necessary to enroll or make changes to your coverage. But there are some exceptions: Native Americans can enroll year-round, as can subsidy-eligible applicants with household income up to 150% of the poverty level. And Medicaid/CHIP enrollment is also available year-round.
Hawaii’s health insurance marketplace has two insurers that offer individual and family health plans for 2023:
For 2023, for the third year in a row, average premium changes were modest in Hawaii. HMSA and Kaiser both filed a 2% average rate increase for 2023, and the rates were approved. So the overall average rate increase was 2%.
For 2020 and 2021, average premiums had decreased slightly in Hawaii. For 2022, they had increased by less than 2%.
During the open enrollment period for 2022 coverage, 22,327 people enrolled in private plans (QHPs) through Hawaii’s exchange. That was a little lower than the year before, when 22,903 people had signed up for coverage during open enrollment. Nationwide, 2022 enrollment set a new record high, but Hawaii was one of the few states where enrollment was lower in 2022 than it had been in 2021.
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 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% in 2013 (far lower than the national average of 14.5%), and had fallen to 4% by 2015 (again, less than half the national average of 9.4% by that point). It had climbed slightly, to 4.%, 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%.
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.
As of August 2022, there were 293,951 Hawaii residents enrolled in Medicare coverage. Roughly 48% had coverage under Original Medicare, while 52% had coverage under Medicare Advantage (nationwide, about 46% of Medicare beneficiaries had coverage under Advantage plans in 2022, but Hawaii is among the states where the majority of beneficiaries have selected private plans).
Hawaii has the smallest percentage of Medicare enrollment as a result of a disability, at less than 7%. The other 93% of recipients qualify for Hawaii Medicare plans based on age alone (ie, being at least 65).
Learn more about Medicare enrollment in Hawaii, including the state’s rules for Medigap plans.
- 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.
- Legal Aid Society of Hawaii (the federally-funded Navigator organization in the state)
- Hawaii Medicaid
- Hawaii Prepaid Health Care Law information
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.