How to Get Health Insurance
There are three main ways to get health insurance – through an employer, on your own, or from the government.
Through an Employer (or your Spouse's Employer)
Many people in Hawaii have health insurance through their job or their spouse's job. This is because Hawaii is the only state in the nation with a nifty law requiring employers to offer health insurance to employees who work more than 20 hours a week and earn at least $628 per month after four weeks on the job. (Learn more about the Hawaii Prepaid Health Care Act.) Lucky you live Hawaii!
If you have health insurance through your job, your employer chooses the coverage options available to you. They might also offer more than one type of plan or your choice of insurer. The amount that your employer will pay for your insurance will vary.
Sign Me Up
If you get married or have a baby, there's usually a short window of time (usually 30 days) to add your spouse or child to your plan. Make sure you don't miss the deadline and leave your loved one uninsured! Check with your employer to see when and how to change your plan benefits.
Lost your job? COBRA lets you stay on your employer's health plan for a while.
COBRA lets you (and your dependents) stay insured, temporarily and at your own expense, after any of the following:
- Loss of job for reasons other than gross misconduct.
- Reduced work hours below the minimum required for coverage.
- The employee covered under the plan dies.
- Enrollment in Medicare.
- Divorce or legal separation.
- A child no longer meets the plan's eligibility rules.
- The employer sponsoring a retiree's plan goes bankrupt.
COBRA is only available at companies with 20 or more full-time employees, and can be used for up to 18 months. Contact your employer to find out how to enroll in COBRA.
Interview Questions About Benefits
You got a job offer – congratulations! One of the first things you'll want to know about your potential employer is whether or not they provide health care coverage. It's an important part of your compensation package, so consider these questions before you accept the job:
- When does coverage begin?
- Who pays for coverage? If the employer and employee share costs, how is it split up?
- Are family plans available? Do they cover domestic partners? Who pays for family or dependent coverage?
- What health plans are offered?
- Can you review the health plan options and premium costs? Are there any deductibles, restrictions, or limitations? Are dental, vision, or other supplemental insurance options available?
- Is there coverage to treat the medical conditions you have?
- Are FSA, HRA, or HSA benefits available?
Directly Through a Health Insurer
Not everyone has health insurance through their job or the government. Many people buy health insurance on their own.
Paying for an individual health plan can put a squeeze on your budget, especially if your family members also need coverage. That's because you pay for the monthly premiums on your own without anyone (like an employer) to share the cost.
But health insurance gives you a safety net to protect you from the total cost of health care. Let's say you fall off a bike and need to go to the emergency room because you broke your leg. The cost of the ER visit, seeing a doctor, X-rays, a cast and crutches, pain medication, and follow-up doctor visits could cost you $5,000. If you didn't have health insurance, you'd end up paying the entire $5,000. With health insurance, you might only have to pay $100 and your health plan would pay the remaining $4,900. That's big savings.
Through the Government
On a limited income? You don't have to go without insurance.
QUEST is Hawaii's Medicaid program in which the state pays a health plan to provide medical and mental health coverage. Medicaid is a joint federal/state program that's available to low-income families and children, pregnant women, the elderly, and people with disabilities. If you qualify for QUEST, you pick a plan from a private health insurer.
Medicare is a federal program that provides basic health benefits to people 65 years or older and to certain disabled individuals. Medicare has four parts:
- Medicare Part A. Covers hospital stays and emergency care.
- Medicare Part B. Covers doctor's office visits. Together, Part A and Part B are often referred to as Original Medicare.
- Medicare Part C. Known as Medicare Advantage, it provides all the benefits of Part A and Part B and may include Part D prescription drug coverage. Medicare Advantage plans are offered by private health insurance companies.
- Medicare Part D. Prescription drug coverage.
Keep in mind that Medicare does not cover all of your medical costs. You will still have to pay a portion of expenses out of your own pocket, such as premiums, copayments, coinsurance, and deductibles.
Fight Medicare Fraud!
Fraud costs us all. Learn how to detect, prevent, and report Medicare fraud, abuse, and waste from the Department of Health.