Quick Look: The Best Hawaii Health Insurance
Did you know that the average hospital stay costs over $15,000 without health insurance? You could be stuck with a massive bill if you’re ever involved in an accident. Use our guide and enroll in a health insurance plan in Hawaii today to protect your health — and your wallet.
Best Hawaii Health Insurance
Now that you understand how health plans work, let’s take a closer look at the companies that provide plans on the Marketplace. Here are a few of the plan choices you’ll see when you shop for Hawaii health insurance.
1. Hawaii Medical Service Association
The Hawaii Medical Service Association (HMSA) offers some of the best health insurance plans in Hawaii with plenty of options to choose from. Finding local coverage can be difficult for Hawaiians because of the spread-out nature of the population — which is why HMSA offers both HMO and PPO choices. Its plans are also exceptionally affordable compared to other ACA options as well. For example, a 40-year-old can secure a plan for about $350 a month. Many plans also include vision coverage and $0 copays for annual physicals.
2. Kaiser Permanente
Kaiser Permanente is one of the largest and most highly-rated health insurance providers in Hawaii. Its plans have received high scores from the National Committee for Quality Assurance for 10 consecutive years and its network of doctors received the Women’s Choice Award for cancer, obstetric, and bariatric care in 2018.
Its network includes over 600 doctors and specialists across Hawaii which offers assistance if you need to switch your plan. Kaiser Permanente offers a number of plan options and some of the most highly-rated doctors in the country. It’s an excellent choice for anyone who needs insurance.
UnitedHealthcare is one of the largest health insurance providers in the United States. It offers everything from ACA-approved plans to Medicare supplemental plans. UnitedHealthcare doesn’t currently offer long-term health insurance solutions in Hawaii but it does make it easy to get dental and vision coverage.
Choose from 1 of 10 dental plans and 1 of 2 vision plans and adjust your coverage and costs to fit your budget. UnitedHealthcare’s vision plans start at just $12 a month in most parts of Hawaii and you can add dental coverage for as little as $24 a month.
Another affordable and comprehensive dental insurance provider, Ameritas offers a wide range of coverage for Hawaii residents. Its dental plan selections are particularly impressive because most options include orthodontic coverage for children under the age of 19.
Dental insurance plans are available from $30 a month in most parts of Hawaii and vision options start at $11 a month. Like UnitedHealthcare, Ameritas allows you to add both dental and vision plans to your cart with just a few clicks so you don’t need to spend all day searching for insurance.
What is Health Insurance?
Health insurance is a type of protection that pays a percentage of your medical care costs. You aren’t required to have health insurance as a resident of Hawaii but it’s not a good idea to go very long without medical coverage. You’ll be responsible for 100% of your medical bills — which can quickly total tens of thousands of dollars. Healthcare coverage may not cover everything, but it’s far more effective than assuming it’s not needed.
Let’s go over how medical plans work. Each month, you pay a set dollar amount to your insurance company called a premium. Your premium keeps health care plans current and is due every month. Before you can use your benefits, you must also meet your deductible. A deductible is a set dollar amount you need to pay for your medical care costs before your insurance begins footing the bill. For example, let’s say your plan has a $900 deductible and you receive a doctor’s bill for $1,000. You won’t get to use your insurance until your $900 deductible out of pocket. Your insurance will assist you with a percentage of the remaining $100. You only need to pay your deductible once a year.
After you pay your deductible, you’re only responsible for your coinsurance percentage. Coinsurance is the percentage of your medical care bill you must cover (for example, the amount you pay upfront for doctor visits) — your insurance covers anything that’s leftover. For example, imagine that you have a plan with a 10% coinsurance percentage. You’ve already met your deductible and you receive a $1,000 hospital bill. In this case, you’d pay $100 (10% of your bill) and your insurance covers the remaining $900. This continues until you hit your out-of-pocket maximum, which is the maximum dollar amount you’ll pay for health care in a given year. Your insurance will cover 100% of any bills you receive if you hit your maximum.
Most people get their health insurance through their employers. You might qualify for a plan through Medicaid, a government-sponsored plan if you have a very low income. You can get your health coverage through Medicare when you’re over 65. You can buy a long-term plan through the Affordable Care Act (ACA) Marketplace if you don’t qualify for insurance through your employer or you’re self-employed.
Average Cost of Health Insurance in Hawaii
You’re in luck if you’re looking for a private insurance plan in the Aloha State. Residents of Hawaii have access to some of the most affordable ACA-compliant (health insurance marketplace) plans in the country. The average Hawaiian pays about $300 monthly in health insurance premium costs. Compare this with the national average spent per month ($470) and you’re likely to save over $2,000 a year. Remember, short-term plans will likely be a little less expensive.
If you live in a low-income household but you don’t qualify for Medicaid, you may be able to get a subsidy through the Marketplace. Family medical plans are also available through Medicaid, and additional health insurance may also be needed depending on your medical status or that of a family member. Begin by creating a profile on Healthcare.gov to learn what you qualify for.
Types of Health Coverage
Once you create an account on Healthcare.gov, you’ll be able to view plans on the Marketplace immediately. Here you’ll see health care benefits options, complete with information on each plan’s deductible, coinsurance rate and premium.
One of the first things you’ll need to choose when you pick a health insurance plan is your plan type. There are a few different types of health insurance plans, and the differences between plans typically has to do with which doctors you can see. Let’s take a look at a few of the most common types of health insurance plans in the ACA Marketplace.
- Health maintenance organizations (HMOs): HMO plans typically afford you fewer choices when you use your insurance. You must choose a primary care provider within your plan network when you use an HMO. You can only see doctors and specialists in your network except in the event of an emergency. You also need to get a referral from your primary doctor before you see a specialist like a dermatologist or a psychiatrist.
- Preferred provider organizations (PPOs): Want more freedom to choose which doctors you see? Consider a PPO plan. A PPO plan will allow you to use your insurance to see both in-network health care providers and out-of-network doctors and specialists. You also don’t need a referral to make an appointment with a specialist. PPOs are more expensive than HMOs but can be worth the extra cost if you already have an out-of-network doctor you want to continue seeing.
- Point-of-service (POS) plans: POS plans blend the affordability of an HMO with a range of doctor choices, like a PPO plan. A POS plan allows you to see any doctor you choose — but you save more if you pick an in-network doctor. POS plans also typically require a referral to see a specialist.
What Does Health Insurance Cover?
Prior to the Affordable Care Act, finding a health insurance plan meant searching through an endless list of coverages and exclusions for every single plan choice. Now, there is a set list of essential benefits every plan provider that offers insurance on the Marketplace must cover. Every plan you see available on the ACA Marketplace includes coverage for the following treatments and services:
- Preventive and wellness care: This includes preventive screenings (like your annual physical and bloodwork) and chronic disease management.
- Ambulatory patient services: This is care that you receive without being admitted to a hospital. For example, being treated for a urinary tract infection at an urgent care facility.
- Hospitalization: This includes overnight stays at a hospital before and after surgery or other intensive treatment.
- Laboratory services: This includes diagnostic tests and scans you receive at a specialized facility. For example, an upper GI scan to detect throat cancer.
- Emergency services: Your insurance needs to cover care and treatment at both an in-network and out-of-network emergency room — no matter which type of plan you have.
- Mental health and substance use disorder services: This includes both inpatient and outpatient treatments for behavioral health disorders, mental illness and substance use disorders (addiction).
- Maternity care: This includes all the treatments and services you need before, during and after you give birth. It also extends to breastfeeding services.
- Prescription drugs: Your insurance must provide some form of coverage for all major classes of prescription drugs.
- Rehabilitative and habilitative services: Includes treatments and devices intended to help you regain physical and mental capacity after an accident or illness. For example, occupational therapy after breaking your hand in a car accident.
- Female birth control: Your ACA Marketplace plan provider must offer coverage for most methods of birth control if you’re a woman.
- Pediatric services, plus vision and dental benefits. Your insurance provider must offer all of the above-listed services for any children on your plan. They must also include dental and vision benefits for children only.
Keep in mind that these essential benefits only apply to ACA-compliant long-term plans you purchase through the Marketplace. You may buy a short term health insurance plan outside of the Marketplace but you may not receive all of the benefits above.
What Does Health Insurance Not Cover?
No health insurance covers everything. Here are a few of the most common plan restrictions you’ll see when you shop.
- Cosmetic surgery: Your insurance will only cover a surgery if your doctor says it’s medically necessary.
- Male birth control: The ACA’s birth control requirement only extends to females. Male methods of birth control (including condoms and vasectomies) typically aren’t covered.
- Travel vaccinations: The ACA only requires insurance providers to cover standard and routine vaccinations included on the CDC’s recommended schedule. Travel vaccinations are immunizations for diseases that have been eradicated or largely eradicated in the U.S. but are still a threat in other parts of the world. You may need a travel vaccination if you plan to visit certain South American or African countries. However, the CDC considers these vaccines to be elective and most insurance plans choose not to cover them.
- Adult dental and vision services: Dental and vision coverage is only a requirement for children included on your plan. You can buy a separate plan from a third-party provider if you want coverage for adults.
- Bariatric surgery: There’s no federal requirement that insurance companies cover bariatric surgery. However, some insurance providers elect to offer this coverage voluntarily.
- Abortion: Hawaii imposes no restrictions on insurance providers’ ability to include abortion services in its list of covered services. However, there is no federal requirement that includes abortion as an essential benefit. As a result, your plan may or may not include coverage for these services, depending on your plan provider.
Understand Your Insurance Options
From comparing deductibles to researching health care providers in your plan’s network, figuring out how to get health insurance can be difficult. The best way to ensure that you don’t overpay for coverage and fully understand all of your options is to leave plenty of time to compare plans.
Do you know that you’ll lose your current insurance soon (for example, if you’re leaving your job or turning 26)? If so, start researching plans. Create an account at Healthcare.gov to get started on your way to great insurance.
Frequently Asked Questions
Does health insurance pay for dental care?
Health insurance generally does not pay for dental care aside from a few allowances. You need a unique dental insurance policy.
Will health insurance cover pre-existing conditions?
Check with your health insurance carrier to learn how pre-existing conditions are handled.