General information, not insurance advice or medical advice. This page compares Hawaii’s two largest health insurers using published 2026 figures. It is not a quote and not advice about what coverage you should buy. Confirm plan prices and networks with a licensed insurance agent, hmsa.com, kp.org, or HealthCare.gov.
Last verified: 12 November 2026.
The short answer
HMSA is the widest network in Hawaii — you keep your own doctor and see any participating specialist without a referral. Kaiser is one integrated system — Kaiser doctors, Kaiser facilities, one record, one pharmacy — and it usually costs less.
Kaiser runs about $25–$40 a month lower than HMSA at every metal tier on the marketplace. For a family of four on a Silver plan, the Kaiser–HMSA gap is roughly $360–$500 a year before subsidies.
Which one is better depends mostly on where you live and how you like to get care.
Two different models
HMSA (Hawaii Medical Service Association) is the Blue Cross Blue Shield licensee in Hawaii and holds about 50% of the commercial market. It is a traditional payer: it reimburses independent doctors and hospitals. You get a Blue Cross Blue Shield card and can see any participating doctor. Its PPO plans need no referral to see a specialist. It also offers an HMO (HMSA Health Plan Hawaii Plus) that works a bit like Kaiser at a lower price. Pharmacy benefits are managed by CVS Caremark (works at Longs Drugs, Walmart, Costco, and Times).
Kaiser Permanente Hawaii holds about 25% of the commercial market. It is a closed, integrated staff model: Kaiser-employed doctors at Kaiser-owned facilities, one electronic record, Kaiser pharmacies. It entered Hawaii in 1958 and now has 23 medical facilities, more than 248,000 members, and more than 700 providers. Together, HMSA and Kaiser hold roughly 90% of the commercial book.
What it costs (marketplace, 2026)
Approximate monthly premiums for a 40-year-old non-smoker in Honolulu County, before tax credits. These are secondary-source estimates — exact quotes vary by plan variant.
| Metal tier | Kaiser (HMO) | HMSA (PPO) | Deductible | Out-of-pocket max |
|---|---|---|---|---|
| Bronze | ~$420 | ~$450 | ~$7,500 | ~$9,450 |
| Silver | ~$545 | ~$575–$695 | ~$3,100–$4,500 | ~$5,656–$9,450 |
| Gold | ~$670 | ~$710 | ~$1,500 | ~$7,800 |
| Platinum | ~$790 | ~$835 | ~$250 | ~$4,500 |
Sources: howtoliveinhawaii.com and moneygeek.com. Note: the HMSA Silver figure is reported as both $575 and $695 by different sources, and the deductible and out-of-pocket-maximum figures also differ — different HMSA Silver plan variants are being quoted. The authoritative anchor is the Hawaii DCCA official table for a 45-year-old non-smoker, which lists HMSA Silver PPO at $785.39 a month and Kaiser Silver plans at $602.18–$632.07. See the full table in Hawaii ACA Marketplace Guide.
The age gradient is real: at age 18, Kaiser Silver is about $389 a month and HMSA Silver about $497. At age 40, it is about $545 vs $695. The HMO–PPO gap widens with age, from $108 at 18 to $318 at 60 (MoneyGeek, Silver tier).
For everyday care, a primary-care visit on an HMSA PPO runs about $20–$35, urgent care $40–$75, and an ER copay $150–$300 before deductible (howtoliveinhawaii.com, approximate).
Networks and hospitals
HMSA’s network includes The Queen’s Medical Center, Straub, Kapiolani, Adventist Health Castle, Wilcox (Kauai), Maui Memorial, Hilo Medical Center, and Kona Community Hospital. It contracts directly with Molokai General Hospital and Lanai Community Hospital, and covers all six main islands.
Kaiser’s facilities are on Oahu, Maui, Hawaii Island, and Kauai. Its flagship is Moanalua Medical Center (293-bed hospital, Salt Lake, Oahu) with 24/7 emergency, labor and delivery, cardiac care, and imaging. Additional Oahu clinics are in Honolulu, Waipio, Koolau, and Hawaii Kai, plus neighbor-island clinics on Maui, Big Island, and Kauai. Moanalua is Kaiser’s only inpatient facility in Hawaii.
Neighbor-island access — the deciding factor
Hawaii is about 800 physicians short of what its population needs. Oahu holds most doctors, the state’s only Level 1 adult trauma center (The Queen’s Medical Center), and most subspecialties. Serious trauma or complex surgery on any neighbor island usually means an air transfer to Honolulu.
- Kaiser members on neighbor islands get primary care at Kaiser clinics (Maui, Big Island, Kauai). Complex care flies to Moanalua, and Kaiser pays medically necessary inter-island travel for the member plus one companion, with a free shuttle from Honolulu Airport’s interisland terminal to Moanalua. Kaiser has no clinics on Molokai or Lanai — members there use federally qualified health centers plus telehealth for routine visits, then fly to Oahu for anything beyond primary care.
- HMSA members on neighbor islands use local hospitals directly: Maui Memorial for cardiology, orthopedics, and obstetrics; Wilcox and Kauai Veterans Memorial for general acute care; Hilo and Kona split the Big Island; Molokai General and Lanai Community Hospital are in-network. Subspecialties such as pediatric neurology, radiation oncology, and complex spine surgery still route to Oahu.
Bottom line: island of residence is a first-order decision factor. A Molokai or Lanai household should default to HMSA. A Maui, Big Island, or Kauai household should weigh Kaiser’s travel benefit against HMSA’s local-hospital access.
Who should pick which
Choose Kaiser if: you live on Oahu, Maui, Big Island, or Kauai near a Kaiser clinic; you like one system, one record, and one pharmacy; you want the lowest premium; and you rarely need care outside Kaiser or outside Hawaii.
Choose HMSA if: you live on Molokai or Lanai; you want to keep your own doctor; you want the widest network of independent doctors and hospitals; you travel to the mainland often and want in-network flexibility (PPO); or you want Medigap-style freedom as you age.
For retirees (Medicare)
The same split applies on Medicare. Kaiser Senior Advantage runs $0–$60 a month and holds a 5-star CMS rating, the highest possible. HMSA Akamai Advantage runs $0–$75 a month with a 3.5-star rating. A third option is Original Medicare plus Medigap Plan G (about $175 a month on average in Hawaii) plus a standalone Part D drug plan (about $35 a month) — more expensive each month, but you can see any doctor who takes Medicare nationwide. Rule of thumb: stay local and healthy → Medicare Advantage; travel often or want any doctor → Original + Medigap. Read more in Medicare Advantage in Hawaii.
Note: HMSA Akamai Advantage Complete Plus and Standard Plus close December 31, 2026. Members must pick a new plan by December 7, 2026.
A note on UHA
UHA Health Insurance is a Hawaii-based insurer that offers employer group plans only — no individual plans. It has no HMO — all plans are open-access (choose from its provider list; UHA claims the largest provider network in Hawaii). It matters to small-business owners shopping for a group plan, not to individual shoppers.
Check before you enroll
- Is your doctor in-network? Check the plan’s directory, not just the carrier name.
- Are your prescriptions on the formulary, and at what tier? Drug tiers decide what you pay at the pharmacy.
- What is the out-of-pocket maximum? This is the most you will pay in a year for covered care.
- Does the plan cover care on the mainland or while traveling? HMSA PPO plans offer more flexibility here; Kaiser covers emergencies only outside its facilities.
- For Medicare Advantage: what is the plan’s CMS star rating?
FAQ
Can I keep my doctor if I switch to Kaiser?
No — with Kaiser you see Kaiser doctors, except in emergencies. If keeping your current doctor matters to you, HMSA is the better fit, because its PPO lets you see any participating doctor without a referral.
Which one is cheaper?
Kaiser, usually — about $25–$40 a month less than HMSA at every metal tier on the marketplace, and $0–$60 a month vs $0–$75 a month for Medicare Advantage. But the cheapest plan is not always the cheapest care: check the deductible, copays, and out-of-pocket maximum, not just the monthly premium.
What if I live on Molokai or Lanai?
Choose HMSA. Kaiser has no clinics on either island, so routine care means federally qualified health centers and telehealth, with flights to Oahu for anything beyond primary care. HMSA covers Molokai General Hospital and Lanai Community Hospital directly.
Sources
- 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)”
- Hawaii DCCA Insurance Division, “Hawaii Health Plans (Plans Offered ON Exchange), Plan Effective Dates 1/1/2026–12/31/2026” (PDF, Nov 2025) — https://cca.hawaii.gov/ins/files/2025/11/PY26-Individual-On-Exchange-Premium-Comparison.pdf
- Kaiser Permanente Hawaii, 2026 new-member guides (Hawaii Island, Kauai; current as of Nov 2025) — healthy.kaiserpermanente.org
- HMSA, Akamai Advantage re-enrollment notice (2027 plan closures) — https://hmsa.com/help-center/re-enrolling-hmsa-medicare-advantage-plan/
- UHA Health Insurance, FAQs — http://www.uhahealth.com/faqs
- policymage.com (2027 marketplace data)
Plan prices and networks change every year. Verify the current premium and whether your doctor is in-network before you enroll.