Not only are Hawaii residents surrounded by stunning scenery, they’re also spoiled when it comes to health care. According to a study by US News, HI has the best health care in the country. That study looks at access, quality, and overall public health. Congratulations, Hawaii!
Health insurance options in Hawaii
According to HI’s insurance department, there are several ways for state residents to access health care:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most Hawaii residents get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 55% | ||
| Individual or family | 5% | ||
| Medicaid | 17% | ||
| Medicare | 15% | ||
| Military | 5% | ||
| Uninsured | 4% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
Four percent of HI residents are uninsured, less than the national average. That’s great for policyholders. A low rate of uninsured people helps lower insurance premiums.
Hawaii health insurance companies
These companies offer both individual and family health insurance plans in Hawaii:
- HMSA
- Kaiser Permanente
Hawaii health insurance costs and rate factors
Hawaiians spend an average of $7,299 per year on health care, which is less than the national average. So, what influences your health care costs in the Aloha State? Prices vary person to person, based primarily on these factors:
Health insurance plan type
The more health care coverage you want, the more you’ll have to pay. Marketplace plans come in metal tiers: bronze, silver, and gold.
What should you expect to pay in Hawaii? These are the average monthly rates for a middle-aged HI resident in 2020:
| Bronze | Silver | Gold | |
|---|---|---|---|
| $363 | $460 | $455 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
Gold plans cost about 25 percent more than bronze plans. That’s because gold plans cover 80 percent of medical costs, whereas bronze plans cover 60 percent of costs.
You may also qualify for a catastrophic plan, the lowest level of coverage available. Catastrophic plans have low monthly premiums but a high yearly deductible of $8,150. That deductible may mean you’ll save money with a gold or silver plan when you need to use your insurance.
Body mass index
According to the CDC, a high body mass often leads to several serious health conditions. That’s why insurance companies will look at your BMI to determine your risk-level. A higher BMI means higher insurance rates.
In 2019, HI had a 25 percent obesity rate, the third lowest rate in the country. Of the Hawaiians who used QuoteWizard to compare health insurance plans, 25 percent have a BMI in the obese range.
Tobacco use
Smokers pay more for health care because of the high risk from tobacco use. About 13.1 percent of HI residents are smokers, the third lowest rate in the country.
Age
According to HealthCare.gov, older people pay up to three times more for health care than younger people. HI residents who used QuoteWizard to shop for health insurance plans are, on average, 33 years old.
Location
You zip code plays a big role in your rates. That’s because every state has different rules, regulations, and providers surrounding their health insurance marketplace.
Insurance companies also use community-rating to determine your prices. Rates are based in part on the combined claims that everyone files. If your neighbors file an unusually high number of claims, your rates will jump.
That means your state’s overall health level plays a role. Aloha State residents are in luck. According to America’s Health Rankings, HI is the second healthiest state in the country.
Hawaii medical insurance laws
The Affordable Care Act limits how insurance companies price your policies:
- Pre-existing conditions: Insurance companies aren’t allowed to use knowledge of your pre-existing conditions to determine your prices. Providers used to charge people with pre-existing conditions significantly more.
- Gender: The ACA mandates that providers can’t charge women and men different prices for the same plan. That’s good news, especially because women historically pay more for health care.
- Insurance and medical history: Before the ACA, insurance companies analyzed your medical history and your past insurance coverage. People with previous medical problems or lapses in insurance used to face steep premiums – if they could even get coverage to begin with.
There’s a limit to how much you’ll pay out-of-pocket for a marketplace plan. In 2020, the out-of-pocket maximum is $8,150 for an individual plan and $16,300 for a family plan.
State law requires health insurance companies to offer at least some coverage for the following services:
- Autism
- Cancer treatment
- Contraceptive services
- Hospice care
- Child health supervision services
- Chemotherapy
- Mental health and alcohol and drug abuse treatment
- Telehealth
- In-vitro fertilization procedure
There are additional services that providers need to offer coverage for. Find the whole list on cms.gov.
Medicare and Medicaid in Hawaii
Medicare and Medicaid are both federal-funded health care programs. Medicare aids seniors, whereas Medicaid covers low-income families and children.
Medicare
Seniors over 65 qualify for Medicare. There are several coverage options including Medicare parts A, B, C, D, and supplemental coverage plans. HI residents may also qualify for a savings program with these income limits:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid
Medicaid aids low-income families and children. These are the state’s Medicaid financial requirements:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $19,525 |
| 2 | $26,374 |
| 3 | $33,224 |
| 4 | $40,073 |
| 5 | $46,923 |
| 6 | $53,772 |
| 7 | $60,622 |
| 8 | $67,471 |
Hawaii Department of Commerce and Consumer Affairs - Insurance
- Website:
- Homepage
- Insurance Commissioner:
- Gordon I. Ito
- Insurance Hotline:
- (808) 586 – 2790
- Office Hours:
- Monday - Friday
7:45 am to 4:30 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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