Hawaii Health Insurance Guide 2025

Key Facts: Hawaii Health Insurance

Medicaid Expansion Expanded (2014)
Marketplace Type Federal (HealthCare.gov)
Medicaid Program Med-QUEST
Employer Mandate Yes (Since 1974)
Open Enrollment Nov 1 - Jan 15
Uninsured Rate ~4% (Among Lowest)

Hawaii is Different: Hawaii has had universal employer-provided health insurance since 1974 - nearly 40 years before the ACA. The Prepaid Health Care Act requires all employers to provide coverage to employees working 20+ hours/week, giving Hawaii one of the lowest uninsured rates in the nation.

The Prepaid Health Care Act

Hawaii's Prepaid Health Care Act (PHCA), passed in 1974, is the nation's first and only statewide employer health insurance mandate. This landmark law is why most Hawaii residents have health coverage through their jobs.

What the Law Requires

Employers must provide health insurance to employees working 20+ hours per week
Coverage must begin after 4 consecutive weeks of employment
Employees can be required to contribute up to 1.5% of their wages
Plans must meet minimum benefit standards set by the state

Who's Covered Under the PHCA?

The employer mandate covers:

Full-time employees (20+ hours/week)
Most private-sector workers
Agricultural workers (with some modifications)

Not covered under the PHCA:

Part-time employees (under 20 hours/week)
Self-employed individuals
Federal employees (covered by federal programs)
Insurance agents paid on commission
Certain seasonal workers

Historical Note: Hawaii needed a special federal exemption from ERISA to maintain its employer mandate. The state was granted this exemption in 1983, making it the only state able to enforce an employer mandate.

Med-QUEST (Hawaii Medicaid)

Med-QUEST is Hawaii's Medicaid program, providing coverage for low-income residents. Hawaii expanded Medicaid in 2014, further reducing its already low uninsured rate.

Who Qualifies for Med-QUEST?

You may qualify if you meet these requirements:

Hawaii resident
U.S. citizen or qualified immigrant
Income at or below 138% of the Federal Poverty Level (FPL)

Income limits for 2025:

Household Size	Annual Income Limit
1 person	$20,783
2 people	$28,208
3 people	$35,632
4 people	$43,056

QUEST Integration: Hawaii's Med-QUEST program covers most Medicaid beneficiaries through managed care organizations, providing coordinated care including primary care, specialty services, and behavioral health.

How to Apply for Med-QUEST

You can apply year-round through:

Online: myBenefits.hawaii.gov
Phone: Call 1-855-643-1643 (TTY: 711)
In-person: Visit your local Department of Human Services office
Through HealthCare.gov: They'll determine if you qualify for Med-QUEST

Health Insurance Marketplace in Hawaii

Hawaii uses the federal marketplace (HealthCare.gov). Because most residents get coverage through employers or Medicaid, the individual marketplace is relatively small in Hawaii.

2025 Open Enrollment Period

Open Enrollment: November 1, 2024 - January 15, 2025
Deadline for January 1 coverage: December 15, 2024

Who Uses the Marketplace in Hawaii?

The marketplace is primarily for:

Self-employed individuals
Part-time workers not covered by the PHCA
Early retirees not yet eligible for Medicare
Those who don't qualify for Med-QUEST but lack employer coverage

Insurance Companies in Hawaii

Insurers offering marketplace plans in Hawaii:

Hawaii Medical Service Association (HMSA)
Kaiser Permanente Hawaii

Limited Competition: Hawaii's small individual market means fewer insurer choices compared to larger states. However, HMSA and Kaiser are well-established carriers with extensive provider networks throughout the islands.

Average Health Insurance Costs in Hawaii

Hawaii's healthcare costs are generally high due to its remote island location, but the employer mandate means most residents don't pay full price.

Plan Type	Average Monthly Premium
Bronze	$380 - $480
Silver (Benchmark)	$500 - $650
Gold	$580 - $750

Subsidy Impact: Most marketplace enrollees in Hawaii qualify for substantial subsidies. A 40-year-old earning $35,000 might pay $100-200/month after tax credits. Those under 150% FPL may pay $0 for Silver plans.

Cost Factors Unique to Hawaii

Island geography: Shipping medical supplies and accessing specialized care is expensive
Provider shortages: Recruiting healthcare workers to Hawaii is challenging
Inter-island care: Neighbor island residents may need to travel to Oahu for specialized services
Small market: Less competition among insurers

Frequently Asked Questions

What is the Prepaid Health Care Act in Hawaii?

Hawaii's Prepaid Health Care Act, passed in 1974, requires employers to provide health insurance to employees working 20+ hours per week after 4 consecutive weeks of employment. This was the first employer mandate in the U.S. and predates the ACA by nearly 40 years, giving Hawaii one of the lowest uninsured rates nationally.

Did Hawaii expand Medicaid?

Yes, Hawaii expanded Medicaid (called Med-QUEST) in 2014. Adults earning up to 138% of the federal poverty level ($20,783 for an individual) may qualify for free or low-cost coverage. Hawaii also offers QUEST Integration for additional populations.

How do I get health insurance in Hawaii?

Most Hawaii residents get coverage through their employer due to the Prepaid Health Care Act. Those not covered by employers can use HealthCare.gov for marketplace plans or apply for Med-QUEST (Medicaid) if income-eligible. The marketplace open enrollment runs November 1 through January 15.

Why is Hawaii's uninsured rate so low?

Hawaii has one of the lowest uninsured rates in the nation (around 4%) due to its 1974 Prepaid Health Care Act requiring employer coverage, expanded Medicaid, and comprehensive state programs. The employer mandate covers most workers, while Medicaid covers low-income residents.

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