Haris Ashley
Hawaii's health insurance landscape can be confusing to navigate, with various options and eligibility criteria. The state has a low uninsured rate, and its Prepaid Health Care Act has ensured that most residents have insurance coverage. Hawaii's Medicaid/CHIP programme is called Med-QUEST, and it has expanded its coverage over the years, including extending postpartum coverage and adding adult dental benefits. To qualify for Medicaid, factors such as income, assets, household size, and citizenship status are considered. The Hawaii Health Access Program is another option, but it has specific eligibility requirements, including residency in a Kaiser Permanente service area. With the complexity of health insurance in the US, it is essential to understand the different programmes and their criteria to make an informed decision.
| Characteristics | Values |
|---|---|
| Program Name | Med-QUEST (Hawaii Medicaid Program and Children's Health Insurance Program) |
| Contact | 1-877-628-5076 |
| Website | mybenefits.hawaii.gov |
| Eligibility | Income, assets, household size, and other rules |
| Required Documents | Immigration or naturalization documents, income verifications for each household member |
| Kaiser Permanente's Hawaii Health Access Program Contact | 8 a.m. to 5 p.m. Hawaii time, Monday–Friday, Saturday from 8 a.m. – 12 p.m. Hawaii time (closed on major holidays) |
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What You'll Learn
Income and asset limits
For income limits, eligibility for Med-QUEST/QUEST is generally determined by the Federal Poverty Level (FPL) guidelines. In 2024, the FPL for Hawaii was set at an annual income of up to $51,930 for an individual and $107,640 for a household of four. Those with limited household incomes may qualify for QUEST (Medicaid). Additionally, Hawaii's Medicaid eligibility levels for children are higher than the national average, and they are about average for pregnant women and parents.
Regarding asset limits, Med-QUEST/QUEST typically considers the value of assets owned by the applicant. In the past, Hawaii has considered removing the $2,000 Medicaid asset limit for individuals enrolled simultaneously in Medicare, but this legislation did not advance. It's important to note that eligibility requirements are subject to change, and specific details should be confirmed with official sources.
The Hawaii Health Access Program, offered by Kaiser Permanente, also considers income and asset limits for eligibility. However, this program is specific to residents living in Kaiser Permanente service areas. While this program does not require U.S. citizenship, it is not available to those eligible for QUEST (Medicaid).
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Non-US citizens eligibility
Hawaii has a state-run health insurance marketplace, and its Medicaid/CHIP is called Med-QUEST (Quality care, Universal access, Efficient utilization, Stabilizing costs, and Transforming the way health care is provided to recipients).
Medicaid eligibility in Hawaii is based on income, assets, the number of people in your household, and other rules. Hawaii residents with low incomes and low asset/resource levels can qualify for Medicaid if they're 65 or older, or if they're blind or disabled. Hawaii also uses Medicaid funds to help cover premium costs for Hawaii residents who aren't US citizens but are citizens of nations that have entered into the Compact of Free Association (COFA) with the US.
Hawaii's Med-QUEST and Medicaid health insurance plans are only available to qualifying individuals and families. To be eligible, you must be a Hawaii resident or a US citizen, national, permanent resident, or legal alien. You must also be in need of healthcare coverage and meet the household income limits (before taxes).
The Hawaii Health Access Program is another option for non-US citizens. You must live in a Kaiser Permanente service area to qualify for this program. Your total household income must meet the restrictions and be at or under the Federal Poverty Level (FPL) criteria.
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Medicaid and CHIP
Hawaii's Medicaid/CHIP program is called Med-QUEST, which stands for Quality care, Universal access, Efficient utilization, Stabilizing costs, and Transforming the way health care is provided to recipients. Hawaii's Medicaid eligibility levels for children are much higher than the national average and about average for pregnant women and parents. These eligibility limits include a built-in 5% income disregard that's used for income-based (MAGI) Medicaid eligibility determinations.
Children aged 0-18 qualify for Med-QUEST with family income levels up to 313% of the federal poverty level (FPL). This includes new provisions, approved by the federal government in late 2024, which allow children to have continuous coverage, meaning they don't need to have their eligibility redetermined each year. Children who are determined to be eligible before the age of 6 are continuously eligible until they turn 6.
Hawaii's CHIP program has no cost-sharing or premiums. Hawaii reported on 13 measures for the federal fiscal year 2018, including access to primary care providers. The measure is for the percentage of children ages 12 to 24 months and 25 months to 6 years who visited a primary care provider within the past year; and every two years for children ages 7 to 11 years and 12 to 19 years. States may implement waiting periods of up to 90 days in CHIP.
In 2017, Hawaii submitted a waiver amendment to CMS to gain federal approval to use Medicaid funding to provide housing services to qualified Medicaid enrollees who are homeless and also have behavioral health and/or substance abuse problems. This waiver request was approved in 2020.
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Employer-provided insurance
Hawaii's Prepaid Healthcare Act, enacted in 1974, mandates that private employers in the state provide approved health insurance for their employees working a minimum of 20 hours per week for four consecutive weeks. Employers have the option to pay the entire premium or share the cost with their employees, provided they contribute at least half of the premium cost for single coverage. Employees cover the remaining cost, ensuring their share doesn't exceed 1.5% of their wages.
Employers can purchase a DLIR-approved healthcare plan or a Qualified Health Plan from HealthCare.gov. Alternatively, they may adopt a self-insured plan, which necessitates audit information and bonding. Small employers with fewer than 25 full-time equivalent employees and an average wage of less than $50,000 annually may be eligible for tax credits to offset premium costs.
If an employee wishes to decline medical coverage, they must submit an HC-5 Waiver form to their employer, available on the State of Hawaii Disability Compensation Division website. This exemption is valid until the end of the calendar year and must be renewed annually by December 31st.
For employers headquartered outside of Hawaii, HMSA offers a dedicated National Account team to assist with navigating the Hawaii Prepaid Health Care Act. They serve both large and small employers conducting business across the country.
If you have any questions or concerns about employer-provided insurance in Hawaii, you can contact the Hawaii Department of Commerce and Consumer Affairs at (808) 586-2790 or the U.S. Department of Labor Employee Benefits Security Administration at (866) 444-3272.
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Medicare
In Hawaii, there are two types of Medicare plans available: Original Medicare (Parts A and B) and Medicare Advantage (Part C) plans. Original Medicare is provided and administered by the federal government, while Medicare Advantage is a private insurance option that covers hospital and medical costs. In 2025, there were 40 Medicare Advantage plans available statewide in Hawaii, with more than half of Hawaii's Medicare beneficiaries enrolled in one.
If you are turning 65, you can sign up for Medicare during the 7-month Initial Enrollment Period, which starts 3 months before the month you turn 65 and ends 3 months after your birthday. If you miss this period, you can still enroll during the General Enrollment Period, which occurs between January 1 and March 31 each year.
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Frequently asked questions
The eligibility criteria for medical insurance in Hawaii depends on your income, assets, the number of people in your household, and other rules.
The 2024 FPL for Hawaii is $51,930 for an individual and $107,640 for a household of 4.
If you have a hard time affording health coverage, you can contact Med-QUEST (Hawaii Medicaid Program) to understand your eligibility. You may also be eligible for the Children's Health Insurance Program.
You can apply for medical insurance in Hawaii through websites such as My Medical Benefits, Healthcare.gov, or Hawaii.gov.
You can contact the Hawaii Department of Commerce and Consumer Affairs at (808) 586-2790 or Med-QUEST at 1-877-628-5076 for assistance with medical insurance in Hawaii.
