Overview of Hawaii’s Health Insurance Exchange
In 2010, the federal healthcare law—the Affordable Care Act—was passed, giving states the opportunity to build health insurance marketplaces called exchanges. Hawaii Health Connector is Hawaii’s exchange. Details about plans and providers are available on the exchange website as of October 1, 2013.
Shopping for plans began on October 1, 2013, and open enrollment lasts until March 1, 2014. Your plan will be effective on January 1, 2014.
Learn how to register for health insurance by calling the Customer Support Center at 1-877-628-5076 (8am-8pm). Call representatives are available in several languages, including English, Hawaiian, Ilocano, Korean, Tagalog, Marshallese, Japanese, Vietnamese, Cantonese, and Chuukese. There are also services available for people with hearing and speech impairments. You can send in questions or concerns via fax, snail mail, or email.
The official FAQs on the Hawaii Health Connector website answer common questions for individuals, small businesses, and health insurance providers.
Per the Affordable Care Act, all plans must offer the following essential services:
- Ambulatory patient services (doctor visits)
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices (Habilitative services are for people with disabilities who need speech, occupational, or physical therapy.)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
There are four basic plans available with varying levels of coverage: Bronze (60 percent of expenses paid by plan), Silver (70 percent), Gold (80 percent), and Platinum (90 percent). Lower percentage plans will have lower premiums, but higher out-of-pocket costs. There will also be a catastrophic plan with a high deductible available for folks under the age of 30. Additionally, depending on your income level, you may qualify for Medicaid, tax credits, or a subsidy to help offset the costs of coverage.
Adults living at or below 133 percent of the federal poverty level (also known as the FPL, which is $11,490 a year in wages for one person and $23,550 a year in wages for a family of four), or pregnant women living at or below 191 of the FPL, will qualify for Medicaid in Hawaii, based on eligibility guidelines that take effect January 1, 2014.
Tax credits are based on the Silver Plan, so individuals can easily determine what their additional out-of-pocket costs will be if they elect a higher or lower plan compared to the silver. The Affordable Care Act (ACA) was designed so the Silver Plan would be affordable to people who had to buy their own insurance, regardless of how expensive the healthcare rates may be where they live.
A recent investigation by Government Technology found that a 35-year-old non-smoker earning $50,000 in Honolulu has 34 plans available, ranging from $139 (Kaiser Bronze) to $356 (HMSA Platinum) per month. The same number of plans was available for a 60-year-old non-smoker making the same income, but premiums ranged from $342 (Kaiser Bronze) to $874 (HMSA Platinum) per month.
Many people will want to know how much of a subsidy they qualify for, but the real question is how much will you pay? Once you figure out what the maximum healthcare percentage is for your income, then you know that's the most you'll have to pay for a Silver Plan. For example, if your income is $32,500 a year (283 percent of the poverty level), the most you’ll have to pay for insurance is 9 percent of your income. This comes out to $2,926 annually, or $244 monthly. The challenge is to compare the cost of Bronze, Silver, Gold, and Platinum, and decide which plan offers the best value for you.
The Hawaii Health Connector site contains several tools to help individuals and small businesses make health insurance decisions. The site hosts a page running the Kaiser Family Foundation's National Subsidy Calculator, which provides estimates of subsidies and health insurance premiums for different incomes, ages, and family sizes. The site also hosts its own Health Coverage Eligibility Screener, which helps customers find out if they might qualify for financial assistance for health insurance. The site also offers the embedded Small Business Health Tax Credit Calculator from the Small Business Majority.
Starting in 2015, additional federal financial protections include a maximum out-of-pocket cost of $6,350 for individuals and $12,700 for families. This financial protection will dramatically reduce the chances of someone going bankrupt due to medical bills not covered by insurance.
More information is available via the Hawaii Health Connector site about the providers and rates that are available for individuals and small businesses. To learn more about Hawaii Health Connector, please visit http://www.hawaiihealthconnector.com/, email [email protected], or call 1-877-628-5076 (8am-8pm).