Honolulu Health Insurance

Facts and Figures

  • Insurance
    Carriers
    6
  • Number of
    General Doctors
    3758
  • Number of
    Hospitals
    50

Insurance Carriers

State Government Insurance Programs Offered

Medicaid


Medicare offers Part A, inpatient care in hospitals and rehabilitative centers; Part B, doctor and some preventive services and outpatient care; Part C allows Medicare benefits through private insurance (Medicare Advantage); Part C includes Parts A, B, and C not covered by Medicare. Part D covers prescription drugs.

Hawaii Breast and Cervical Cancer Control Program


Clinical breast and pelvic exams, mammograms, Pap tests, and follow-up diagnostic care for abnormal results. GUARANTEED COVERAGE Must be women ages 50 to 64, uninsured or under-insured, with incomes at or below 250% FPL.

Hawaii Medicare


Medicare offers Part A, inpatient care in hospitals and rehabilitative centers; Part B, doctor and some preventive services and outpatient care; Part C allows Medicare benefits through private insurance (Medicare Advantage); Part C includes Parts A, B, and C not covered by Medicare. Part D covers prescription drugs.

QUEST


QUEST: Inpatient and outpatient hospital and clinical services (including x-rays and lab exams), Physician, Nursing facility and home health services, Prescription drugs, Biological and medical supplies and equipment, Vision and dental, Family planning and maternity, Psychiatric and psychological services, Diagnostic, screening, preventive and rehabilitative services, Medical transportation, Respiratory and hospice care, Emergency and urgent care. Early Periodic Screening, Diagnosis and Treatment (EPSDT) available for enrollees under age 21.

QUEST Expanded (QExA)


Limited prescription drugs, Medical, urgery, psychiatric and substance abuse services (cataract and heart surgeries not covered). 10 inpatient, 12 outpatient, and 6 mental health visits. ER for actual emergencies. Preventive and restorative dental care. No maternity benefits for adults ages 21 or older, unless income of pregnant woman’s family is at or below 185% FPL.

Heath Care Reform

Small business tax credits.  18,600 small businesses in Hawaii could be helped by a new small business tax credit that makes it easier for businesses to provide coverage to their workers and makes premiums more affordable.1  Small businesses pay, on average, 18 percent more than large businesses for the same coverage, and health insurance premiums have gone up three times faster than wages in the past 10 years.  This tax credit is just the first step towards bringing those costs down and making coverage affordable for small businesses.

Closing the Medicare Part D donut hole. Last year, roughly 16,500 Medicare beneficiaries in Hawaii hit the donut hole, or gap in Medicare Part D drug coverage, and received no extra help to defray the cost of their prescription drugs.2 Medicare beneficiaries in Hawaii who hit the gap this year will automatically be mailed a one-time $250 rebate check. These checks will begin to be mailed to beneficiaries in mid-June and will be mailed monthly throughout the year as new beneficiaries hit the donut hole. The new law continues to provide additional discounts for seniors on Medicare in the years ahead and completely closes the donut hole by 2020. 

Support for health coverage for early retirees. An estimated 21,200 people from Hawaii retired before they were eligible for Medicare and have health coverage through their former employers. Unfortunately, the number of firms that provide health coverage to their retirees has decreased over time.3  Beginning June 1, 2010, a $5 billion temporary early retiree reinsurance program will help stabilize early retiree coverage and help ensure that firms continue to provide health coverage to their early retirees. Companies, unions, and state and local governments are eligible for these benefits.

New consumer protections in the insurance market beginning on or after September 23, 2010.

Insurance companies will no longer be able to place lifetime limits on the coverage they provide, ensuring that the 805,000 Hawaii residents with private insurance coverage never have to worry about their coverage running out and facing catastrophic out-of-pocket costs.

Insurance companies will be banned from dropping people from coverage when they get sick, protecting the 50,000 individuals who purchase insurance in the individual market from dishonest insurance practices.

Insurance companies will not be able to exclude children from coverage because of a pre-existing condition, giving parents across Hawaii peace of mind.

Insurance plans’ use of annual limits will be tightly regulated to ensure access to needed care.  This will protect the 755,000 residents of Hawaii with health insurance from their employer, along with anyone who signs up with a new insurance plan in Hawaii.

Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim.

Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care.

Extending coverage to young adults. Beginning on or after September 23, 2010, plans and issuers that offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy until they turn 26, unless the adult child has another offer of job-based coverage in some cases. This provision will bring relief to roughly 2,550 individuals in Hawaii who could now have quality affordable coverage through their parents.4  Some employers and the vast majority of insurers have agreed to cover adult children immediately.

Affordable insurance for uninsured with pre-existing conditions. $16.1 million federal dollars are available to Hawaii starting July 1 to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the Federal government. The program is a bridge to 2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the Federal government will administer the program for those residents.

Strengthening community health centers. Beginning October 1, 2010, increased funding for Community Health Centers will help nearly double the number of patients seen by the centers over the next five years. The funding could not only help the 82 Community Health Centers in Hawaii but also support the construction of new centers.

More doctors where people need them. Beginning October 1, 2010, the Act will provide funding for the National Health Service Corps ($1.5 billion over five years) for scholarships and loan repayments for doctors, nurses and other health care providers who work in areas with a shortage of health professionals. This will help the 3% of Hawaii’s population who live in an underserved area.

New Medicaid options for states. For the first time, Hawaii has the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status. 

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