Hawaii Health Insurance: 2021 Coverage Guide
If you live in Hawaii, you have a few options for health insurance. If you’re buying a plan for yourself or for a family, you’ll want to make sure you get the coverage you need. That’s why it’s important to understand how health insurance works. We want to help you make informed decisions by going over everything step-by-step. First, it’s important to buy a plan during Open Enrollment because, unless you have a qualifying event, you’ll have to wait another year to get insured.
When Is Open Enrollment in Hawaii?
November 1, 2020 - December 15, 2020. The coverage begins in January 2021.
How to Get Health Insurance in Hawaii
Before you begin shopping for a plan, you should decide how much insurance you need and how well your plan last year worked for you. It’s important to look beyond the premium price when comparing health plans. It’s also important to understand the different tiers. Begin by looking at last year’s out-of-pocket expenses. Would a higher tier plan have saved you money despite costing more each month? Create a projection of the upcoming year’s medical needs and expenses to see what works best.
Next, you’ll want to compare health insurance companies and health insurance quotes. After you submit a form to SmartFinancial you’ll get several competing health insurance rates. You also have the option of speaking with an agent about the plan(s) you’re considering.
What Types of Health Insurance Are Available in Hawaii?
HMOs, EPOs, PPOs and point-of-service plans are available in Hawaii. Most people choose between an HMO and PPO. You also can pick a tier of coverage: bronze, silver, gold or platinum. Bronze is the cheapest option but only covers 60% of costs. Silver covers 70. Gold is 80% and platinum covers 90%. If you frequently see doctors or other care providers, a higher level tier will cost more each month but it may save you much more in out-of-pocket expenses.
Does Health Insurance Cover Pre-existing Conditions?
The Affordable Care Act made it illegal for marketplace health plans to deny anyone health insurance coverage based on pre-existing conditions.
Do I Qualify for a Special Enrollment Period?
Common reasons people qualify for a special enrollment period:
- Lost or quit a job. You may have lost a job, changed jobs or even started your own business. If any of these changes left you uninsured, you may qualify to buy insurance during a special enrollment period.
- Turned 26. If you were on your parents’ health insurance plan and turned 26 outside the enrollment period, you can enroll in an individual health plan.
- Moved to another state or out of a coverage area. You may have had a health plan in one state but you moved to another. If your coverage is no longer valid, you can sign up for a new health plan.
- Cobra coverage ended. If your coverage with Cobra reached its deadline, you can enroll in a new health plan.
- Divorce. If you shared a health plan with your spouse but divorced, you can purchase a new health plan.
- Marriage. If you recently married, you may be able to add a spouse to policy or start an entirely new one together.
- Birth or adoption of a child. You have a year to buy health insurance for that child.
- Death of spouse or partner. When you share coverage and that person passes away, you can buy a new health plan.
- Spouse or partner loses coverage. When you share coverage with someone and they lose coverage for any qualifying reason, you are eligible to buy an individual plan or buy coverage with that person again.
Is Health Insurance Required in Hawaii?
No, only California, Massachusetts, New Jersey, Vermont, Rhode Island, and DC still require health insurance. Otherwise, there is a tax penalty. Even though it’s not required in Hawaii, buying health insurance is necessary to avoid medical bankruptcy.
How Much Is Health Insurance in Hawaii?
The average cost of health insurance in Hawaii for a 40 year old is around $300 a month. Health insurance is less expensive, the younger you are. Tobacco use increases health insurance rates.
How to Save on Health Insurance in Hawaii
Save on health insurance in Hawaii by comparing rates based on the tier system. Beforehand, you’ll want to estimate your medical costs to see which level is more economical.
Medicare in Hawaii
Medicare is health insurance coverage for Americans ages 65 years and older. The government also allows younger people with disabilities to enroll in the program. Individuals with End-Stage Renal Disease (a permanent kidney failure treated with dialysis or a transplant) can also sign up as can some individuals with severe mental health issues. Others who qualify for Medicare disability coverage are individuals with Amyotrophic Lateral Sclerosis (also called Lou Gehrig’s Disease). Most beneficiaries will receive Original Medicare (Parts A and B). Some people buy Medicare Advantage, which includes Part A and B as well as offering vision, dental and prescription drug coverage.
How Many People Are on Medicare in Hawaii?
19% of the people of Hawaii are on Medicare
How Much Is Medicare in Hawaii?
If you do not qualify for Medicare, you can buy it for $458 a month for Part A in 2020 and a standard monthly premium for Medicare Part B was $144.60 for 2020, or even higher depending on income. .
Original Medicare vs Medicare Advantage: What’s the Difference?
Medicare is a government subsidized health plan that is available to qualified Americans age 65 and older. Medicare Advantage is sold through private health insurance companies, but these policies are also regulated by the government. Medicare Advantage plans offer the same benefits as Medicare Parts A and B. Medicare Advantage plans also offer more coverage for dental, vision, hearing and prescription drugs. Medicare Advantage plans have a maximum out-of-pocket limit. For 2020, it was $6,700 but many plans set their maximums at a much lower cost. That is why it’s important to compare companies. People who opt for original Medicare can buy Medicare Supplements to help with out-of-pocket costs. You cannot buy both Medicare Advantage and Medicare Supplements. If you enroll in a Medicare Advantage Plan during the open enrollment, you will automatically be disenrolled from original Medicare.
How to Get Medicare Coverage in Hawaii
If you receive social security payments, you may automatically enroll in Medicare, but you may have to sign up if you do not receive payments. The easiest way to enroll in Medicare is by working with a trusted insurance agent to get the coverages you want. Just enter your zip code and answer a few simple questions.
Types of Medicare Plans Available
Original Medicare, Medicare Advantage, Medicare Cost Plans (only offered in certain areas), Demonstration/Pilot Programs (also called Research Studies; only offered in certain areas) and Programs of All-Inclusive Care for the Elderly (PACE).
How Do I Qualify for Medicare in Hawaii?
To qualify for Medicare you must be a citizen of the U.S. or have been a legal resident for at least five years. If you are age 65 or older and you/your spouse have worked for at least 10 years (40 quarters) or you have a disability, Amyotrophic Lateral Sclerosis (ALS) or end-stage renal disease (ESRD), you most likely qualify for Medicare.
How Can I Save on Medicare in Hawaii?
You can save on Medicare by signing up for Part B as soon as you’re eligible. People who enroll late must pay a penalty every year. If you’re interested in buying Medicare Advantage, you can shop and compare Medicare plans for the best value.
Hawaii State Health System Ranking
Ever wonder how your state stacks up when it comes to quality healthcare? The Commonwealth Fund published a report in 2020 on State Health System Performance. They took into consideration the access to quality care, health outcomes, and disparities in all 50 states. The scores for the Hawaii Health System are listed below:
- Hawaii: Overall Ranking: 1 of 51
- Hawaii: Overall Performance: Above U.S. Average
- Hawaii: Access and Affordability: 3
- Hawaii: Prevention and Treatment: 2
- Hawaii: Avoidable Hospital Use and Cost: 1
- Hawaii: Healthy Lives: 1
- Hawaii: Health Care Disparities: 10
Hawaii Health Insurance Coverage
The people of Hawaii have different kinds of health insurance while some Hawaii residents are not insured at all. See the breakdown below:
- Private coverage: 58%
- Medicaid: 18%
- Medicare: 19%
- Uninsured: 5%
Report: America's Health Insurance Plans
Hawaii Health Insurance Companies
- Hawaii Medical Service Association (Federal Plan 87)
- Kaiser Foundation Health Plan, Inc. - Hawaii
- Hawaii Medical Service Association (HMSA)
- Hawaii Medical Service Association (HMSA)
- Aetna Life Insurance Company (Hawaii)
- United HealthCare Services, Inc (Hawaii)
- UnitedHealthcare Insurance Company (Hawaii)
- UnitedHealthcare Military & Veterans Services, LLC
- Compass Rose Health Plan
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Choosing a higher deductible plan will help to lower your health insurance premium. So this is a smart financial move. As is keeping a small emergency fund to pay for medical expenses until you reach that deductible.
Behavioral health refers to mental health, psychiatric health, marriage and family counseling and addiction treatments. Is it covered by health insurance?
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It’s always a good idea to get acquainted with the way plans are set up and what you’re responsible to pay before open enrollment which takes place in late fall. If you have a qualifying event, like a new job or if you’ve moved, had a baby, gotten divorced or had any life change that affect your coverage, you may be able to buy a new health insurance plan today.
Like auto and homeowners insurance healthcare insurance also has a deductible which needs to be paid before insurance begins to cover expenses. However, healthcare deductibles work a little differently. For instance, your healthcare insurance will pay for some services even before you meet your deductible.
You may be shopping for health insurance because you got a new job, which doesn’t offer health insurance. Some people even prefer to have a health plan separate from their jobs. It’s usually a more expensive option to buy an individual health insurance policy when an employer offers to pay a portion of your premiums each month. However, some people prefer to choose their own insurance company and a plan that fits their needs.