For the past two years, some people who live in Hawaii have used the Hawaii Health Connector website to enroll in health insurance plans for themselves and their families. For 2016 coverage, they’ll now use HealthCare.gov; this is the website where Marketplace health plans can be purchased.
The Marketplace can help you get covered if you don’t have coverage through a job, Medicare, Medicaid (Quest), the Hawaii Children’s Health Insurance Program, or any other source of qualifying coverage.
Open enrollment for the Marketplace is underway now. You‘ll need to enroll by Dec. 15, if you want coverage to begin on Jan. 1, 2016. The final deadline for 2016 coverage is Jan. 31.
All Hawaii residents who obtained health insurance through the Connector must re-enroll through HealthCare.gov, since Connector policies won’t automatically roll over to HealthCare.gov. If you don’t re-enroll, coverage will end Dec. 31.
Sold by private insurance companies, Marketplace plans have a range of prices and benefits. All plans cover:
» Essential health benefits, such as emergency care, hospitalization, prescription drugs, lab tests, and pregnancy and newborn care.
» Pre-existing conditions, including pregnancy.
» Preventive care, such as flu shots and other vaccinations and screening tests for cancer, diabetes, and Hepatitis C.
If this is the first year applying, you’ll need to create a Healthcare.gov account, fill out an application, pick a health plan and enroll.
At HealthCare.gov, 2016 plans can be previewed before an account is created, in order to see prices based on your income. What one pays for Marketplace insurance depends on income, and many people qualify for savings on their monthly premiums and out-of-pocket costs like deductibles and copayments. Savings depend on estimated income for 2016, and qualifications for savings based on income can be quickly checked on HealthCare.gov.
Beware that if you don’t have health insurance, you may have to pay a penalty. If you don’t have qualifying coverage in 2016, you’ll pay a tax penalty of the higher of 2.5 percent of your household income, or $695 per uncovered adult and $347.50 per uncovered child in your household. (The maximum household fee is $2,085.)
In some cases, you might qualify for an exemption from the requirement to have health insurance. Exemptions include homelessness and bankruptcy.
Also, small businesses in Hawaii can offer their employees a variety of Marketplace insurance options. The Small Business Health Options Program (SHOP) enables small businesses with up to 50 full-time equivalent employees to purchase a qualified health plan. For small-business owners, federal tax credits of up to 50 percent of contribution toward employees’ health premium costs are available if the business has fewer than 25 full-time-equivalent employees with an average wage of $50,000 or less.
David Sayen is Medicare’s regional administrator for Hawaii, Arizona, California, Nevada and the Pacific Territories.
