Health Insurance in Hawaii

Medicaid in Hawaii

Hawaii expanded Medicaid in 2014, though the state already had broad public coverage before the ACA. Hawaii's Medicaid program, called Med-QUEST, covers adults up to 138% FPL (about $21,597 for a single person in 2026, using Hawaii's higher poverty guidelines). Med-QUEST uses managed care, with enrollees choosing between health plans that coordinate their care.

Hawaii has special federal poverty level guidelines that are higher than the contiguous states (similar to Alaska). This means income thresholds for Medicaid and marketplace subsidies are correspondingly higher for Hawaii residents.

Between the Prepaid Health Care Act requiring employer coverage, Medicaid expansion, and marketplace subsidies, Hawaii's uninsured rate is about 3 to 4%, the lowest in the nation. Roughly 50,000 to 60,000 residents remain uninsured, many of whom are undocumented immigrants, recent arrivals, or people between jobs.

What plans cost in 2026

Hawaii's marketplace premiums are among the highest in the country, driven by high healthcare costs, geographic isolation, and a small individual market. A 40-year-old in Honolulu can expect a benchmark Silver plan in the range of $550 to $700 per month before subsidies. Like Alaska, the high benchmark means larger subsidies for those who qualify.

Hawaii's individual marketplace is relatively small, with about 23,000 enrollees for 2025. This is because the employer mandate means most working residents already have coverage through their jobs. The marketplace primarily serves self-employed individuals, part-time workers below 20 hours, and those between jobs.

With enhanced subsidies expiring for 2026, people above 400% FPL will face full premiums. Given Hawaii's high cost of living, the 400% FPL threshold (about $72,520 for an individual in Hawaii, using the state's higher guidelines) may still leave middle-income residents paying substantial premiums without help.

Carriers in Hawaii (2026)

Two carriers offer individual marketplace plans in Hawaii for 2026:

• Kaiser Permanente Hawaii is the dominant health plan in Hawaii, covering a large share of both the employer and individual markets. Kaiser operates an integrated model with its own physicians, clinics, and hospital (Moanalua Medical Center on Oahu). Kaiser's network is limited to Kaiser facilities and affiliated providers, but the system is comprehensive on Oahu and has clinics on Maui and the Big Island. If you live on a smaller island, access to Kaiser facilities may require travel to Oahu.
• HMSA (Hawaii Medical Service Association) is the Blue Cross Blue Shield affiliate in Hawaii and the state's largest health insurer overall. HMSA's provider network is the broadest in Hawaii, including most hospitals and physicians across all islands. For residents on neighbor islands (Maui, Big Island, Kauai, Molokai, Lanai), HMSA generally provides better local access than Kaiser.

Both carriers have been in the Hawaii market for decades. Competition between Kaiser and HMSA is the defining feature of Hawaii's insurance landscape. The choice often comes down to whether you prefer Kaiser's integrated model or HMSA's broader independent provider network.

Key regions

Oahu (Honolulu)

About 70% of Hawaii's population lives on Oahu. The Queen's Medical Center in Honolulu is the state's largest hospital and primary trauma center. Straub Medical Center, Kapiolani Medical Center (for women and children), and Tripler Army Medical Center (for military families) are other major facilities. Both Kaiser and HMSA have strong networks on Oahu, giving residents the most plan choice.

Maui County

Maui Memorial Medical Center is the primary hospital for Maui island. Residents on Molokai and Lanai have very limited local facilities and often require medevac to Maui or Oahu for serious care. HMSA typically provides broader access on Maui than Kaiser, though Kaiser has a clinic presence on the island.

Big Island (Hawaii County)

Hilo Medical Center on the east side and Kona Community Hospital on the west side are the two main hospitals. The Big Island's large geographic area means travel times to care can be significant. Both carriers offer coverage, but verify which hospitals and specialists are in your plan's network, particularly on the west side.

Kauai

Wilcox Medical Center in Lihue is the primary hospital for Kauai. Specialty care often requires travel to Oahu. HMSA plans generally provide more local provider options on Kauai than Kaiser.

Estimate your subsidy

Hawaii-specific things to know

The Prepaid Health Care Act is unique. Hawaii is the only state that mandates employer-provided health insurance for employees working 20+ hours per week. This law predates the ACA by 40 years and is the primary reason Hawaii has such a low uninsured rate. If you work 20 or more hours weekly, your employer is required to offer you coverage. This means the individual marketplace is primarily for the self-employed, part-timers, and people between jobs.

Hawaii uses higher poverty guidelines. Like Alaska, Hawaii has its own federal poverty level figures that are about 15% higher than the contiguous states. This means you can earn more and still qualify for Medicaid or larger marketplace subsidies than you would in most other states.

Inter-island travel for care is common. If you live on a neighbor island, factor in the possibility of traveling to Oahu for specialty care. Some plans cover inter-island medical travel, but policies vary. Ask about travel benefits when comparing plans.

Resources

• HealthCare.gov for marketplace enrollment (Hawaii uses the federal marketplace)
• Med-QUEST Division for Medicaid eligibility and enrollment
• Hawaii Insurance Division for consumer assistance and insurance complaints