General information, not insurance advice or medical advice. This page explains how health insurance works in Hawaii using published figures. It is not a quote and not advice about what coverage you should buy. Confirm your coverage with a licensed insurance agent or the official sources listed below.
Last verified: 12 November 2026.
The short answer
Hawaii is different from every other state when it comes to health insurance. Almost every employer must offer coverage by law, two carriers — HMSA and Kaiser — cover about 90% of the commercial market, and only about 3–4% of residents have no insurance at all, one of the lowest rates in the country.
Most people in Hawaii get covered in one of three ways: through a job, through the federal marketplace at HealthCare.gov, or through a government program — Med-QUEST (Hawaii’s Medicaid) or Medicare (for people 65 and older, and some younger people with disabilities).
Start here
- Turning 65 or already on Medicare? Start with Medicare in Hawaii.
- Comparing the two big carriers? Read HMSA vs Kaiser in Hawaii.
- Buying your own plan? Read Hawaii ACA Marketplace Guide.
- Low income or between jobs? Read Med-QUEST (Hawaii Medicaid).
- An employee or small employer? Read Hawaii’s Prepaid Health Care Act.
Why Hawaii is different
Hawaii is the only state with a universal employer health-insurance mandate. The Prepaid Health Care Act (HRS Chapter 393), passed in 1974, requires nearly every private employer — even a business with one employee — to offer health coverage to workers who put in 20 or more hours a week for 4 weeks in a row and earn at least $1,386.72 a month (86.67 times the $16.00 minimum wage in 2026).
The employer must pay at least half the premium. The worker’s share cannot be more than the smaller of 50% of the premium or 1.5% of monthly gross wages.
The result: 97% of Hawaii employers offer health coverage — the highest rate of any state (AHIP analysis, July 20, 2026). Washington, D.C. is second at 93% and Massachusetts third at 90%. Hawaii’s uninsured rate is about 3–4% — about 2.8% per the Hawaii State Legislature (S.C.R. 50, 2026 session, about 38,400 residents) and 3.5–3.6% per Census ACS 2024 data.
Hawaii is also the only state that requires both an employer health mandate and a Temporary Disability Insurance (TDI) program (HRS Chapter 392, in effect since 1969). Read more in Hawaii’s Prepaid Health Care Act.
The two carriers that dominate Hawaii
HMSA (Hawaii Medical Service Association) is the Blue Cross Blue Shield licensee in Hawaii and holds about two-thirds (~66%) of the commercial market (AMA, 2026 report, 2024 data). It is a traditional payer: it reimburses independent doctors and hospitals across all four counties, and on all six main islands, including Molokai and Lanai. Its PPO plans let you see any participating doctor without a referral. It is also the only PPO carrier on the ACA marketplace.
Kaiser Permanente Hawaii holds about 25% of the commercial market. It is a closed, integrated system: Kaiser-employed doctors at Kaiser-owned facilities, one electronic record, Kaiser pharmacies. It entered Hawaii in 1958 and has 23 medical facilities, more than 248,000 members, and more than 700 providers. Its flagship hospital is Moanalua Medical Center on Oahu (293 beds). Kaiser has no clinics on Molokai or Lanai.
Together, HMSA and Kaiser hold roughly 90% of the commercial book. UnitedHealthcare and Aetna also write commercial and group business in Hawaii, but they are much smaller in the individual market.
UHA Health Insurance is a Hawaii-based insurer that offers employer group plans only — no individual plans. It is relevant to small-business owners, not to individual shoppers.
Read the full comparison in HMSA vs Kaiser in Hawaii.
The three ways most residents get covered
1. Through a job
This is how most working-age people in Hawaii get coverage — through the Prepaid Health Care Act, explained in Why Hawaii is different above. The typical employee share for an employer plan is about $140–$240 a month (approximate, per howtoliveinhawaii.com).
2. Through the marketplace (HealthCare.gov)
If you do not get coverage through a job, you can buy a plan on the federal marketplace at HealthCare.gov. Only HMSA and Kaiser sell individual plans in Hawaii. The benchmark Silver plan for a 40-year-old costs about $541 a month before tax credits (KFF, 2026). Premium tax credits lower the cost for many households. Open enrollment for 2027 coverage runs November 1, 2026 – January 15, 2027. Read more in Hawaii ACA Marketplace Guide.
3. Through Med-QUEST or Medicare
Med-QUEST is Hawaii’s Medicaid program. It covers about 390,000 residents — roughly 27% of the state. Adults ages 19–64 qualify with income up to 138% of the federal poverty level ($2,112 a month for one person in 2026). Children qualify up to 313% of the poverty level. There is no enrollment window — you can apply any time. Read more in Med-QUEST (Hawaii Medicaid).
Medicare covers people 65 and older, and some younger people with disabilities. In 2026, the standard Part B premium is $202.90 a month and the Part B deductible is $283 a year. Read more in Medicare in Hawaii and Medicare Advantage in Hawaii.
What it costs — at a glance
| Coverage | Typical cost (2026) |
|---|---|
| Benchmark Silver plan, age 40 (marketplace, before tax credits) | $541/month (KFF) |
| Cheapest Bronze plan, age 40 (marketplace, before tax credits) | $414/month (KFF) |
| Employer plan, employee share | About $140–$240/month (approximate) |
| Medicare Part B premium (standard) | $202.90/month |
| Medicare Part B deductible | $283/year |
| Medigap Plan G, Hawaii average | About $175/month (range $134–$259 in Honolulu at age 65) |
| Med-QUEST (Medicaid) | $0 premium for people who qualify |
All marketplace figures are before premium tax credits, which lower the cost for many households.
FAQ
Do I have to buy health insurance in Hawaii?
No state law requires an individual to buy health insurance. But if you work 20 or more hours a week for 4 straight weeks and earn at least $1,386.72 a month, your employer must offer you coverage under the Prepaid Health Care Act. If you do not get coverage through a job, you can buy a plan on HealthCare.gov or apply for Med-QUEST if your income qualifies.
Which is better, HMSA or Kaiser?
It depends on where you live and how you like to get care. Kaiser usually costs less — about $25–$40 a month less than HMSA at every metal tier — and works well if you live near a Kaiser clinic and like one system for everything. HMSA has the widest network of independent doctors and hospitals, covers all six main islands, and lets you keep your own doctor. Read the full comparison in HMSA vs Kaiser in Hawaii.
What if I cannot afford health insurance?
Check the marketplace at HealthCare.gov first — premium tax credits lower the monthly cost for many households. If your income is low, you may qualify for Med-QUEST (Medicaid), which has no premium. If you are on Medicare, Extra Help and Medicare Savings Programs can help pay premiums and drug costs. Apply for Med-QUEST any time at mybenefits.hawaii.gov or by phone at 1-800-316-8005.
Sources
- Hawaii Department of Labor and Industrial Relations, Prepaid Health Care Act (HRS Chapter 393) — via legalclarity.org and statewagetools.com
- AHIP, July 20, 2026 analysis (97% employer offer rate) — via liveinsurancenews.com
- Hawaii State Legislature, S.C.R. No. 50, S.D. 1 (2026 session) — uninsured estimate 38,400 / 2.8% — https://data.capitol.hawaii.gov/sessions/session2026/commreports/SCR50_SD1_SSCR3530_.PDF
- KFF, 2026 Average Marketplace Premiums by Metal Tier (benchmark Silver Hawaii $541) — via healthinsurancefinders.com, insurancequotes.com, visheshhealth.com
- CMS, “2026 Medicare Parts A & B Premiums and Deductibles,” Nov 14, 2025 (updated Mar 3, 2026) — https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles
- howtoliveinhawaii.com, “Kaiser vs HMSA in Hawaii: 2026 Health Plan Comparison” and “Cost of Healthcare in Hawaii” (updated Oct–Nov 2026)
- moneygeek.com, “Best Health Insurance in Hawaii (2026)”
- UHA Health Insurance, FAQs — http://www.uhahealth.com/faqs
- Hawaii Med-QUEST Division, 2026 MAGI Income Standards Chart (effective Jan 13, 2026) — via checkmedicaid.com and legalclarity.org
- AMA, “10 states with the least competitive health insurance markets” (2026 report, 2024 data) — https://www.ama-assn.org/health-care-advocacy/access-care/10-states-least-competitive-health-insurance-markets — source for the HMSA ~66% commercial-market share figure.
Health insurance rules and prices change often. Verify current premiums and eligibility with a licensed agent, the Hawaii DCCA Insurance Division (cca.hawaii.gov/ins), or the official program websites before you enroll.