Alyssa Lane
Hawaii offers a range of health insurance options, including employer-sponsored plans, government plans, and individual market coverage. The state's open enrollment period for individual and family health coverage is from November 1 to January 15, allowing residents to sign up for or change plans for the following year. Outside of this period, special enrollment periods are available for those who qualify, such as Native Americans, individuals eligible for premium tax credits with income below 150% of the poverty level, and those eligible for Medicaid/CHIP (Med-QUEST in Hawaii). Hawaii utilizes a federally-facilitated health insurance marketplace, with residents enrolling through HealthCare.gov, where they can explore plans offered by two private insurers. The Hawaii Insurance Division oversees the exchange, ensuring compliance with approved rates and facilitating access to financial assistance through premium subsidies.
| Characteristics | Values |
|---|---|
| Open enrollment period for individual and family health coverage | November 1 to January 15 |
| Last day to change plans or enroll for coverage to begin on January 1 | December 15 |
| Any changes or new plans after December 15 start on | February 1 |
| Eligibility for subsidies | Not eligible for Med-QUEST (Medicaid/CHIP), premium-free Medicare Part A, or an employer’s plan that’s considered affordable and comprehensive |
| Special Enrollment Period (SEP) | Qualifying life event, Native American, eligible for premium tax credits with income not more than 150% of the poverty level, eligible for Medicaid/CHIP (Med-QUEST in Hawaii) |
| Ways to sign up for ACA Marketplace plan | Online via HealthCare.gov, by phone, 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 |
| Common ways to get health insurance | Through an employer, through the government, or on your own |
| Health insurance | A contract that requires your health insurer to pay some or all of your health care costs and medical expenses in exchange for a premium |
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What You'll Learn
Hawaii's open enrollment period (November 1 to January 15)
Hawaii's open enrollment period for individual and family health coverage is from November 1 to January 15. This is set by the federal government as Hawaii uses a federally-facilitated exchange. During this period, you can sign up for or change plans for the following year.
If you enroll by December 15, your coverage will begin on January 1. After this date, any changes or new plans will start on February 1. Hawaii's open enrollment period gives individuals and families the opportunity to obtain health insurance that best suits their needs. It is important to understand your options and choose a plan that provides adequate coverage for potential medical expenses.
There are various ways to obtain health insurance in Hawaii. Some people have health insurance through their employer, which is often an employer-sponsored group plan. If you do not have insurance through your job, you can purchase an individual health plan during the annual Open Enrollment period. Hawaii residents can enroll through HealthCare.gov, where two private insurers offer individual and family health plans.
Additionally, Hawaii has a Medicaid program called QUEST Integration, which provides health coverage for those with low incomes or resources. If you qualify for an ACA Marketplace plan, you can enroll during the open enrollment period or during a special enrollment period if you meet certain criteria, such as being a Native American or having a qualifying life event.
It is worth noting that most Marketplace enrollees in Hawaii qualify for premium subsidies, which can significantly offset the cost of premiums. These subsidy amounts change annually to keep pace with the cost of the benchmark Silver plan.
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Special Enrollment Period (SEP)
In Hawaii, outside of the open enrollment period, you can still enroll in or change a Marketplace plan if you qualify for a Special Enrollment Period (SEP). This is usually due to a qualifying life event, although some SEPs don't depend on this. For example, if you are a Native American, you can enroll at any time. Similarly, if you are eligible for premium tax credits and your income is not more than 150% of the poverty level, you can also enroll at any time.
In response to the COVID-19 public health emergency, President Biden's Executive Order provided a Special Enrollment Period for the Health Insurance Marketplace, which began on February 15, 2021, and ended on May 15, 2021. This allowed individuals and families to get comprehensive health insurance coverage if they qualified. This SEP did not involve any new application questions or require consumers to provide any new information other than what was required to determine eligibility and enroll in coverage.
You may qualify for a SEP if you or anyone in your household lost qualifying health coverage in the past 60 days or expects to lose coverage in the next 60 days. Losing coverage could be due to losing health insurance through your employer, or through the employer of a family member, including a parent or guardian because you are no longer a dependent. If you lose coverage due to a divorce or legal separation, this does not qualify you for a SEP, unless you also had a decrease in household income or a change in your previous coverage that makes you qualify for savings on a Marketplace plan.
If you are submitting a new application or updating an existing one, you can access the special enrollment through HealthCare.gov or the Marketplace call center at (800) 318-2596.
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ACA Marketplace plan
The Affordable Care Act (ACA) Marketplace plan, also known as Obamacare or an exchange plan, is a cost-effective option for individuals seeking health insurance in Hawaii. The state of Hawaii has fully implemented the Affordable Care Act, expanding Medicaid eligibility to a larger population.
Hawaii's open enrollment period for individual and family health coverage is from November 1 to January 15. This period is set by the federal government as Hawaii utilizes the federally-run exchange, HealthCare.gov. During this time, individuals can sign up for or change plans for the following year. To have coverage start on January 1, enrollment must be completed by December 15. After this date, any changes or new plans will take effect on February 1.
There are various ways to enroll in an ACA Marketplace plan. Enrollment can be completed online via HealthCare.gov, over the phone, or in person with the assistance of an agent, broker, Navigator, certified application counselor, or an approved enhanced direct enrollment entity. Additionally, Native Americans, individuals eligible for premium tax credits with an income not exceeding 150% of the poverty level, and those eligible for Medicaid/CHIP (Med-QUEST in Hawaii) can enroll at any time.
It is important to note that eligibility for financial assistance in the form of premium subsidies is dependent on the comparison between the cost of coverage in an individual's area and their household income. As of early 2024, subsidies were provided to 84% of Hawaii Marketplace enrollees.
Hawaii residents have multiple options for obtaining health insurance. Aside from the ACA Marketplace plans, individuals can explore employer-sponsored group plans, Medicare, or short-term health plans, depending on their specific needs and circumstances.
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Short-term health plans
Short-term health insurance plans are designed to provide temporary coverage and can be useful in a variety of situations. For example, if you are between jobs and waiting for new employer-based coverage to begin, have missed the Open Enrollment period for Affordable Care Act (ACA) plans, or are waiting for Medicare eligibility. Short-term plans are also an option for new college graduates or those who have retired early.
Short-term health insurance covers basic medical services related to unexpected illnesses or injuries. However, short-term plans do not cover all medical needs and typically exclude certain services. They are not as comprehensive as ACA-compliant major medical plans and are not required to follow all ACA coverage mandates. Short-term plans may not cover pre-existing conditions or health benefits such as hospitalization, emergency services, maternity care, preventive care, prescription drugs, and mental health services.
In Hawaii, short-term health insurance provides temporary coverage for individuals facing a gap in their regular health insurance. These plans offer essential health coverage for a limited period, up to three months, with the option to renew for one additional month. However, it is important to note that Hawaii has strict regulations for short-term health plans. Since 2018, the sale or renewal of short-term plans has been prohibited for those who were eligible to purchase an ACA-compliant plan in the exchange during the previous calendar year. This essentially eliminates the market for short-term plans in Hawaii, as almost everyone is eligible to purchase coverage in the exchange annually.
While short-term health plans are not available in Hawaii, there are other ways to obtain affordable health insurance. Residents can explore employer-sponsored coverage, Medicaid/CHIP (Med-QUEST), or the Hawaii marketplace/exchange. Hawaii has strong employee protections, requiring employers to provide health insurance to employees working at least 20 hours per week, regardless of business size. Additionally, ACA-compliant plans can be purchased on a month-to-month basis, allowing for flexible coverage options.
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Employer-provided health insurance
In Hawaii, employer-provided health insurance is a common way for individuals to obtain health coverage. The state's laws and regulations regarding employer-sponsored health plans are outlined in the Hawaii Prepaid Health Care Act (PHC Act).
Eligibility for Employer-Provided Health Insurance in Hawaii
According to the PHC Act, employers in Hawaii with one or more employees, regardless of full-time or part-time status, permanent or temporary employment, are mandated to provide health insurance coverage to their eligible employees. However, certain categories of workers are excluded from this requirement, including individuals working less than twenty hours per week, agricultural seasonal workers, and insurance or real estate salespersons paid solely by commission.
To be deemed eligible for employer-provided health insurance, employees must work at least twenty hours per week for four consecutive weeks and earn a monthly wage equivalent to at least 86.67 times the current Hawaii minimum hourly wage.
Enrollment in Employer-Provided Health Insurance
Enrollment in employer-provided health insurance in Hawaii typically occurs through the employer's selected health care contractor or insurance carrier. The coverage commencement date is dependent on the earliest enrollment date offered by the chosen health care contractor.
Cost of Employer-Provided Health Insurance
The cost of employer-provided health insurance in Hawaii is shared between the employer and the employee. Employers are required to contribute at least half of the premium cost for single coverage, while employees cover the remaining portion, provided it does not exceed 1.5% of their wages.
Plan Options for Employer-Provided Health Insurance
Employers in Hawaii have the flexibility to choose from various plan options for their employees. They may purchase a DLIR-approved health care plan or a Qualified Health Plan from HealthCare.gov. Alternatively, employers can adopt a self-insured plan, which requires audit information and bonding, or select an insured plan of their choice.
Additional Considerations for Employers
Small employers with fewer than 25 full-time equivalent employees and an average wage of less than $50,000 per year may be eligible for tax credits to offset the cost of health insurance premiums. Additionally, under state law, certain employers may qualify for premium supplementation.
It is important to note that while employers may offer family coverage, they are not mandated to do so under the PHCA or ACA. If family coverage is provided, employees may be responsible for paying either 50% or 100% of the family premium, depending on the plan offered by the employer.
In conclusion, employer-provided health insurance in Hawaii is a comprehensive system regulated by the PHC Act. Employers are required to provide coverage to eligible employees, and the cost and plan options vary depending on the employer's choices and eligibility for subsidies.
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Frequently asked questions
Hawaii's open enrollment period for individual and family health coverage is from November 1 to January 15.
After open enrollment, you can still 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.
The most common ways to get health insurance are through an employer, through the government, or on your own. If you have health insurance through your job, your employer will provide you with an employer-sponsored group plan.
