how-hawaiian-health-insurance-is-different

Hawaii residents shopped for Obamacare plans through the state-based health insurance exchange, Hawaii Health Connector, until the end of 2015. Now Hawaiians not insured through an employer can choose to shop for health insurance or check eligibility for programs like Medicaid through Healthcare.gov, the federal Health Insurance Marketplace. Hawaiian residents also can shop Marketplace plans via HealthSherpa.

Though Hawaii switched to using the federal Marketplace, some state-specific differences related to health insurance remain:

Higher Income Allowed

A calculation called modified adjusted gross income (MAGI) is used to determine your eligibility for tax credits, premium assistance and QUEST, Hawaii’s version of Medicaid. The amount of your MAGI is compared to the federal poverty levels (FPL) updated every year by the government.

In Hawaii, the FPL amounts are higher than the rest of the country (except Alaska). For example, the 2016 FPL for a single person in Hawaii is $13,670, which is $1,790 higher than the mainland FPL. Because Hawaii chose to expand Medicaid eligibility to adults with up to 138% of the FPL, the income limit for a single person is about $1,570 each month. If your MAGI is less than that amount, then you might qualify to receive QUEST. If your income is higher, then you might be eligible for tax credits or other cost-sharing savings through the Marketplace.

Definition of Full-Time Employee

Hawaii employers must follow the rules in the state’s Prepaid Health Care Act. This law requires most employers provide health insurance for full-time employees. Employers must pay at least half of the employee’s premium for single person coverage. The employee’s contribution to the premium is limited to 1.5 percent of his or her wages. For example, if you earn $2,000 a month, your monthly premium cannot be more than $30.

Note that the Act’s definition of a full-time employee differs from the federal definition; under the Hawaiian law, a full-time employee works at least 20 hours per week for four weeks in a row, while the federal full-time employee definition is someone who work 30 hours or more each week. This difference means the number of full-time employees a business has could be higher under the state rules. The number of full-time employees is important to small businesses hoping to purchase health insurance for their employees through the Marketplace’s Small-Business Health Options Program (SHOP) or to claim the Federal Small Business Health Care Tax Credit.

If you have questions about your current plan or want to know more about your Marketplace or SHOP options during the next Open Enrollment, then contact one of our Consumer Advocates, who are ready to answer your questions year-round.

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