Hawaii Health Insurance Marketplace

In Hawaii, the federal government operates the health insurance Marketplace.

Hawaii now has its own Marketplace for health insurance, where you can shop for and buy insurance in person, online, or by phone.

Hawaii Plans, Benefits, and Costs

Last year average total cost for Health Insurance for a 40 Year Old Non-Smoker in your state was $0 per month after tax subsidies. See if you qualify for a free or low cost plan.

Companies can offer four types of plans: bronze, silver, gold, and platinum. These “metal level” plans all cover the same benefits in your state. What differs is how much they pay on average toward the costs of the services the plan covers.

Tobacco Surcharge: Hawaii allows insurance companies to charge tobacco users 50% more than non-tobacco users.

Who Is Selling Insurance in the Hawaii Marketplace?

On exchange plans in Hawaii

Off exchange plans in Hawaii

  • n/a

What’s Covered:

All approved plans in the state must cover the same package of benefits, called essential health benefits. In Hawaii, the benefits include:

  1. Outpatient services, including acne treatment, joint injections, voluntary sterilization, termination of pregnancy, hearing aids, and allergy testing and treatment. Non-emergency care provided outside the U.S. is also covered.
  2. Emergency services
  3. Hospital stays, including for weight loss surgery
  4. Pregnancy and baby care, including diagnosis and treatment of infertility. One session of in vitro fertilization is covered if couples meet qualifying criteria.
  5. Mental health and substance abuse services, including behavioral health treatment
  6. Prescription drugs, including generic and certain brand-name drugs
  7. Rehab and habilitative services, those that help people recover from an accident or injury and those that help people with evelopmental issues such as children with autism
  8. Lab services
  9. Preventive and wellness services, along with those that help people manage chronic conditions
  10. Services for children, including dental and eye care

Some services not included: acupuncture, chiropractic care, and weight loss programs.

Will These Benefits Be in All Plans?

Although all health insurance policies have to follow the state’s benchmark plan, many states will allow insurance companies to substitute a service that has the same value. For example, one type of lab test may be substituted for another. Make sure to read the summary of benefits of the plans you are considering to see if they include the coverage you need.

Financial Aid

You may be eligible for financial aid to help pay for insurance. Here’s what Hawaii will offer:

Medicaid Expansion: Some states expanded their Medicaid programs so more people can get health insurance coverage. Because Hawaii is one of them, you may be eligible if your annual income is no more than about $18,000 for one person and about $38,000 for a family of four.

Premium Subsidies (also known as Tax Credits ): You may qualify for a federal subsidy to help lower your monthly premium. The subsidy is available only if you buy your insurance in the Marketplace. In general, you’ll be eligible if you’re single and make between $13,420 and $53,680 a year, or if you have a family of four and make between $27,430 and $109,720 a year. Subsidies are based on your estimated household income for 2015. You can use your 2014 tax return to estimate your 2015 income. When you file taxes for 2015, the IRS will adjust your subsidy based on your actual income.

Cost-sharing subsidies: Depending on your income, you may also qualify for cost-sharing subsidies that will reduce your costs when you receive medical care. Cost-sharing subsidies are available only with silver-level plans.

Calculator: You can also use our calculator to learn about costs and whether you’ll qualify for subsidies or other financial aid.

CHIP: The Children’s Health Insurance Program, called QUEST in Hawaii, provides coverage for children of some families who have a low income but are not eligible for Medicaid.