Who Should Enroll?
- People who don’t have insurance
- People who aren’t insured by their employer
- People with pre-existing conditions who may have had trouble getting insurance before
- Small businesses
Hawaii is running its own insurance Marketplace, which is called the Hawaii Health Connector.
When You Can Enroll: From Oct. 1, 2013, to March 31, 2014. Coverage will begin in 2014.
Hawaii Plans, Benefits, and Costs
Companies can offer four levels of plans: bronze, silver, gold, and platinum. These “metal level” plans all cover the essential health benefits in your state. What differs is how much they pay on average toward the costs of the services the plan covers. Here’s how it works:
- Bronze Plan: You pay 40% and the plan pays 60%.
- Silver Plan: You pay 30% and the plan pays 70%.
- Gold Plan: You pay 20% and the plan pays 80%.
- Platinum Plan: You pay 10% and the plan pays 90%.
Catastrophic plans may be available, especially for people who are under 30 and healthy. These plans cost less up front, but they don't give you as much coverage. They generally require you to pay more out-of-pocket costs.
You must have at least a bronze-level plan to meet minimum requirements for insurance under the Affordable Care Act and avoid the penalty for not having health insurance.
Who Will Sell Insurance in Hawaii's Marketplace? The state is reviewing applications for insurance companies interested in selling insurance in the Hawaii Marketplace.
Costs: Hawaii has released preliminary, sample premium rates. According to the Department of Commerce and Consumer Affairs, the average monthly premium for a silver plan for a 21-year-old non-smoker would be $169. For a 30-year-old, a silver plan will cost an average of $192 per month, for a 50-year-old the cost will be $302, and for a 60-year-old the cost $458.
Hawaii allows insurance companies to charge tobacco users 50% more than non-tobacco users.
What's covered: All approved plans in the state must cover the same package of benefits, called essential health benefits. In Hawaii, the benefits include:
- Outpatient services, including acne treatment, joint injections, voluntary sterilization, termination of pregnancy, hearing aids, and allergy testing and treatment. Non-emergency care provided outside the U.S. is also covered.
- Emergency services
- Hospital stays, including for weight loss surgery
- Pregnancy and baby care, including diagnosis and treatment of infertility. One session of in vitro fertilization is covered if couples meet qualifying criteria.
- Mental health and substance abuse services, including behavioral health treatment
- Prescription drugs, including generic and certain brand-name drugs
- Rehab and habilitative services, those that help people recover from an accident or injury and those that help people with developmental issues such as children with autism
- Lab services
- Preventive and wellness services, along with those that help people manage chronic conditions
- Services for children, including dental and eye care
Some services not included: acupuncture, chiropractic care, and weight loss programs.
Will These Services Be in All Plans? Although all health insurance policies have to follow the state’s benchmark plan, many states will allow insurance companies to substitute a service that has the same value. For example, one type of lab test may be substituted for another. Make sure to read the summary of benefits of the plans you are considering to see if they include the coverage you need.