Hawaii Health Insurance Guide

Health Insurance Overview in Hawaii

Hawaii has a unique health insurance environment. The state's Prepaid Health Care Act (1974) requires employers with employees working 20+ hours per week to provide health insurance — predating the ACA by decades. Hawaii has very high employer coverage rates as a result. Hawaii expanded Medicaid (Med-QUEST) and has among the lowest uninsured rates in the nation.

Average Health Insurance Costs in Hawaii

Marketplace Enrollment in Hawaii

Hawaii residents can enroll in individual and family health insurance plans through HealthCare.gov (Federal). Open enrollment runs November 1 – January 15.

Average Premiums by City in Hawaii

Medicaid in Hawaii

Med-QUEST (Hawaii Medicaid) covers adults with incomes up to 138% of the federal poverty level. Hawaii's strong employer mandate and Medicaid expansion have produced very low uninsured rates.

Children's Health Insurance (CHIP) in Hawaii

Hawaii CHIP covers children up to 312% of the federal poverty level through the Med-QUEST program.

What Makes Hawaii Unique

Hawaii's Prepaid Health Care Act — enacted in 1974 — makes Hawaii unique among all states in requiring employer-sponsored health insurance for employees working 20 or more hours per week. This law, combined with Medicaid expansion, has given Hawaii one of the lowest uninsured rates in the nation and a fundamentally different health insurance market than other states.

ACA Subsidies: What Hawaii Residents Should Know

The enhanced subsidies first enacted in the American Rescue Plan expired at the end of 2025. For 2026, premium tax credits follow the original ACA rules: there is no credit above 400% (the “subsidy cliff”), and enrollees are expected to pay up to 9.96% of income toward the benchmark Silver plan. House in January 2026 but has not become law, so 2027 plans are being priced and subsidized under the same rules unless Congress acts.

Hawaii’s Marketplace for 2027: Insurers, Rates, and Dates

Hawaii residents enroll through HealthCare.gov. Full-price premiums rose about 12% on average for 2026, before subsidies. 2 insurers sold plans for 2026. Proposed 2027 changes average about 11% before subsidies.

About 23,000 people enrolled for 2026. About 71% received premium tax credits, and the average net premium after credits was about $372 a month.

Open enrollment for 2027: November 1, 2026 through January 15, 2027 on HealthCare.gov; enroll by December 15 for coverage starting January 1.

What’s Different About Health Coverage in Hawaii

Hawaii’s individual market is small — about 23,000 enrollees and two insurers, HMSA and Kaiser Permanente — because the Prepaid Health Care Act requires most employers to provide coverage to employees working 20 or more hours a week. The marketplace mainly serves the self-employed, part-time workers below the 20-hour threshold, and early retirees.

Tips for Choosing Health Insurance in Hawaii

Hawaii residents benefit from the state's unique employer mandate — most workers are already covered through employment. Self-employed and part-time workers should explore the marketplace and Med-QUEST. Hawaii's low uninsured rate means the insurance pool is generally healthier, contributing to more stable premiums.

• Enroll during open enrollment (November 1 – January 15) — missing the deadline means waiting until the next open enrollment unless you have a qualifying life event.

Frequently Asked Questions

How many insurers sell marketplace plans in Hawaii?

Two insurers sold Hawaii marketplace plans for 2026, with proposed 2027 changes averaging about 11% before subsidies.

When is open enrollment in Hawaii for 2027?

November 1, 2026 through January 15, 2027 on HealthCare.gov; enroll by December 15 for coverage starting January 1.

How much do Hawaii marketplace enrollees pay after subsidies?

In 2026 about 71% of Hawaii enrollees received premium tax credits, and the average net premium was about $372 a month. There is no credit above 400% of the federal poverty level.

The information on this page is provided for general informational purposes only and reflects estimated industry averages and program eligibility rules as of 2026. Health insurance premiums, Medicaid eligibility thresholds, marketplace options, and program rules change annually. Always verify current eligibility and enrollment options at the official HealthCare.gov (Federal) or by contacting a certified navigator or broker. Premium figures shown are approximations before subsidies — actual net premiums depend on individual income, household size, and plan selection.