Hawaii utilizes a federally run health insurance Marketplace, which means residents enroll through HealthCare.gov, where two private insurers offer individual/family health plans for Hawaii residents. But Hawaii still oversees the plans sold in the exchange.
Rates have been approved for both carriers for 2025, amounting to an overall weighted average increase of about 6.7% (details below). However, most enrollees get subsidies that offset a significant portion of their premiums, and the subsidy amounts change each year to keep pace with the cost of the benchmark Silver plan.
For many people, an Affordable Care Act (ACA) Marketplace plan – called Obamacare or an exchange plan – may be a cost-effective choice. But finding the right plan can be tricky. This guide, including the FAQs below, is designed to help you understand how Hawaii health insurance options work, including the financial assistance that may be available to you through Hawaii’s health insurance Marketplace.
(In 2014 and 2015, Hawaii ran its own exchange, but transitioned to HealthCare.gov in the fall of 2015 and has continued to use the federally-run platform ever since.)
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Virtually all residents of Hawaii are eligible to buy Marketplace health insurance with the following exceptions: 1
But eligibility for financial assistance in the Marketplace is a bit more involved. Eligibility for premium subsidies depends on how the cost of coverage in your area compares with your household income.
And to be eligible for subsidies you must not be eligible for Med-QUEST (Medicaid/CHIP), premium-free Medicare Part A, 2 or an employer’s plan that’s considered affordable and comprehensive. However, most Marketplace enrollees do qualify for premium subsidies.
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 since Hawaii uses the federal exchange.
Here are some key dates to remember: 3
After open enrollment, you can sign up for or make changes to an ACA Marketplace health through a special enrollment period (SEP). To be eligible for a SEP, you’ll usually need a qualifying life event.
Some SEPs don’t depend on a qualifying life event. For example:
If you qualify for an ACA Marketplace plan, there are a variety of ways you can sign up, either during open enrollment or during a special enrollment period:
Hawaii’s uninsured rate has long been lower than the national average, due in large part to the state’s Prepaid Health Care Law, which has been in effect for nearly half a century.
Under this law, Hawaii’s employers must provide coverage to employees who work at least 20 hours per week, and the employee’s portion of the premiums can’t be more than 1.5% of their gross wages. 6 So employer-sponsored health coverage is more accessible in Hawaii than it is in most of the rest of the country.
(A note about small group health insurance: Hawaii was the first state to receive approval for a 1332 waiver, which allowed Hawaii to no longer have a SHOP exchange. 7 Small businesses in Hawaii purchase small group health plans directly from the insurers that sell these plans.)
But for those who aren’t eligible for an employer’s health plan or Medicare, coverage is available through the Marketplace (HealthCare.gov) or Med-QUEST (Medicaid/CHIP).
ACA Marketplace plans (on HealthCare.gov)
Source: CMS.gov 10 (Note that the graphic is based on total enrollment during the open enrollment period and includes different metrics than the bullets above, which are based on effectuated enrollment in early 2024.)
Hawaiians may find affordable coverage through Medicaid (Med-QUEST) if eligible.
Two private insurance companies offer individual/family health coverage through Hawaii’s health insurance Marketplace. 11
According to Hawaii SERFF filings, the following average pre-subsidy rate changes were approved for 2025: 12
Source: Hawaii SERFF 12
According to the approved filings, HMSA has 21,605 enrollees, and Kaiser has 10,996. So the weighted average rate increase for 2025 is about 6.7%. 12
As is always the case, these average premium changes are based on full-price premiums, but most enrollees are eligible for subsidies and thus do not pay full price. The subsidies are designed to keep pace with the cost of the benchmark plan in each area, so they grow when average benchmark premiums grow.
For perspective, here’s a summary of how average pre-subsidy premiums for ACA-compliant individual/family plans have changed each year in Hawaii:
During the open enrollment period for 2024 coverage, 22,170 people enrolled in private health insurance plans through the Hawaii Marketplace. 23
Although nationwide Marketplace enrollment set a significant new record high in 2024, Hawaii’s enrollment was still a little lower than it had been in 2021 24 and 2022. 25 But it was higher than 2023, when 21,645 people enrolled. 26
Here’s a summary of how enrollment has changed over time in Hawaii’s Marketplace:
Source: 2014, 27 2015, 28 2016, 29 2017, 30 2018, 31 2019, 32 2020, 33 2021, 24 2022, 25 2023, 34 2024 35
HealthCare.gov
This is the ACA Marketplace, where you can enroll in a health insurance plan online. You may also get help by calling (800) 318-2596.
Hawaii’s Insurance Division of the Department of Commerce and Consumer Affairs
Licenses and regulates health insurers, agents, and brokers. They also handle consumer questions and complaints about insurance.
Legal Aid Society of Hawaii
The Navigator organization funded by the federal government in Hawaii.
Hawaii Medicaid (Med-QUEST)
This program provides health coverage for eligible residents.
Hawaii Prepaid Health Care Law information
This law helps ensure that many workers in Hawaii have access to health coverage through their jobs.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.
