Hawaii Health Insurance Marketplace Guide

Virtually all residents of Hawaii are eligible to buy Marketplace health insurance with the following exceptions:³ 

• People who are not legally in the U.S.
• People already enrolled in Medicare
• People who are incarcerated

But eligibility for financial assistance in the Marketplace is a bit more involved. Eligibility for premium subsidies depends on how the cost of coverage in your area compares with your household income.

And to be eligible for subsidies you must not be eligible for Hawaii Med-QUEST (Medicaid/CHIP), premium-free Medicare Part A,⁴ or an employer’s plan that’s considered affordable and comprehensive.

Most Marketplace enrollees do qualify for premium subsidies, even after the “subsidy cliff” returned in 2026. During the open enrollment period for 2026 coverage, 71% of Hawaii Marketplace enrollees qualified for premium subsidies.⁵

The next open enrollment period for individual and family health coverage in Hawaii starts on November 1, 2026, for coverage effective on January 1, 2027. 

A federal rule change called for a shorter open enrollment period starting in the fall of 2026, with an end date of December 15. But a judge vacated this rule change in June 2026.⁶ The ruling could be appealed, or open enrollment could continue until January 15 as it did in recent years. Enrollees should pay close attention to deadlines communicated by the exchange as open enrollment approaches.

After open enrollment, you can sign up for or make changes to individual market coverage if you qualify for a special enrollment period (SEP). To be eligible for a SEP, you’ll usually need a qualifying life event. But American Indians and Alaska Natives can enroll anytime.

People eligible for Medicaid/CHIP (Med-QUEST in Hawaii) can enroll in that coverage anytime.

If you qualify for an ACA Marketplace plan, there are a variety of ways you can sign up, either during open enrollment or during a special enrollment period:

1. Enroll online via HealthCare.gov.
2. Enroll by phone at (800) 318-2596.
3. Enroll in person, over the phone, or online with the help of an agent/broker, Navigator, certified application counselor, or an approved enhanced direct enrollment entity.⁷

Hawaii’s uninsured rate has long been lower than the national average, due in large part to the state’s Prepaid Health Care Law, which has been in effect for nearly half a century.⁸

Under this law, Hawaii’s employers must provide coverage to employees who work at least 20 hours per week, and the employee’s portion of the premiums can’t be more than 1.5% of their gross wages. So employer-sponsored health coverage is more accessible in Hawaii than it is in most of the rest of the country.

(A note about small group health insurance: Hawaii was the first state to receive approval for a 1332 waiver, which allowed Hawaii to no longer have a SHOP exchange.⁹ Small businesses in Hawaii purchase small group health plans directly from the insurers that sell these plans.)

But for those who aren’t eligible for an employer’s health plan or Medicare, coverage is available through the Marketplace (HealthCare.gov) or Med-QUEST (Medicaid/CHIP).

ACA Marketplace plans (on HealthCare.gov)

• 71% of the people who enrolled through the Hawaii Marketplace during the open enrollment period for 2026 coverage were eligible for premium subsidies (advance premium tax credits, or APTC). This means they didn’t have to pay the full cost of their coverage.
• For the 2026 enrollees who qualified for premium subsidies, the average subsidy amount was $568/month, bringing their average net premium to $243/month. Even accounting for the enrollees who paid full price, the average net premium paid by all enrollees was $372/month.⁵
  
• For 2026, most people are still eligible for premium subsidies, but the subsidies don’t cover as much of enrollees’ total premiums, and are available to fewer people. This is because federal subsidy enhancements were allowed to expire at the end of 2025.

If your income is no more than 250% of the federal poverty level, you may qualify for cost-sharing reductions (CSR) to reduce your deductibles and out-of-pocket expenses, as long as you select a silver plan through the Marketplace.¹⁰

• As of 2026, about 22% of Hawaii Marketplace enrollees were receiving CSR benefits.⁵

Source: CMS.gov⁵

Medicaid 

Hawaiians may find affordable coverage through Medicaid (Med-QUEST) if eligible.

Two private insurance companies offer individual/family health coverage through Hawaii’s health insurance Marketplace:¹¹

• Hawaii Medical Service Association (HMSA)
• Kaiser Foundation Health Plan, Inc.

According to Hawaii SERFF filings, the following average pre-subsidy rate changes have been proposed by Hawaii’s Marketplace insurers for 2027¹² 

Source: Hawaii SERFF¹² 

According to its filings, HMSA has about 19,000 enrollees in 2026, although Kaiser’s filing doesn’t include its enrollment numbers (the year before, Kaiser had 10,439).¹³

As is always the case, these average proposed premium changes are based on full-price premiums, but the majority of enrollees are eligible for subsidies and thus do not pay full price. However, coverage became less affordable in 2026, due to the expiration of federal subsidy enhancements at the end of 2025.

For perspective, here’s a summary of how average pre-subsidy premiums for ACA-compliant individual/family plans have changed each year in Hawaii:

• 2015: 7.8% increase¹⁴
• 2016: 30% increase¹⁵
• 2017: 30.7% increase¹⁶
• 2018: 32.8% increase¹⁷
• 2019: 5.3% increase¹⁸
• 2020: 4% decrease¹⁹
• 2021: 2.4% decrease²⁰
• 2022: 1.6% increase²¹
• 2023: 2% increase²²
• 2024: 8.8% increase²³
• 2025: 6.7% increase²⁴
• 2026: 12% increase²⁵

23,380 people selected coverage through the Hawaii exchange during the open enrollment period for 2026 coverage.⁵

This was down from the record high the year before, when 24,606 people enrolled during the open enrollment period for 2025 coverage.²⁶

Although nationwide Marketplace enrollment had reached new record highs in 2022, 2023, 2024,²⁷ and again in 2025, Hawaii didn’t exceed its 2021 enrollment until 2025.

The drop-off in enrollment in 2026 is not surprising, given the expiration of federal subsidy enhancements at the end of 2025, and the resulting sharp increase in after-subsidy premiums.

Here’s a summary of how enrollment has changed over time in Hawaii’s Marketplace:

Source: 2014,²⁸ 2015,²⁹ 2016,³⁰ 2017,³¹ 2018,³² 2019,³³ 2020,³⁴ 2021,³⁵ 2022,³⁶ 2023,³⁷ 2024,³⁸ 2025³⁹ 2026⁵

HealthCare.gov
This is the ACA Marketplace, where you can enroll in a health insurance plan online. You may also get help by calling (800) 318-2596. 

Hawaii’s Insurance Division of the Department of Commerce and Consumer Affairs
Licenses and regulates health insurers, agents, and brokers. They also handle consumer questions and complaints about insurance.

Legal Aid Society of Hawaii
The Navigator organization funded by the federal government in Hawaii.

Hawaii Medicaid (Med-QUEST)
This program provides health coverage for eligible residents.

Hawaii Prepaid Health Care Law information
This law helps ensure that many workers in Hawaii have access to health coverage through their jobs.