David Sayen

Courtesy: Medicare

For the past two years, Hawai‘i residents have used the Hawai‘i Health Connector website to enroll in health insurance plans for themselves and their families.

For 2016 coverage, you will use HealthCare.gov. This website is where Marketplace health plans can be purchased.

The Marketplace can help you get covered if you do not have coverage through a job, Medicare, Medicaid (Quest), the Hawai‘i Children’s Health Insurance Program or any other source of qualifying coverage.

Open enrollment for the Marketplace is underway now. You must enroll by Dec. 15, 2015, if you want your coverage to begin on Jan. 1, 2016. The final deadline for 2016 coverage is Jan. 31, 2016.

All Hawai‘i residents who previously obtained health insurance through the Connector must re-enroll through HealthCare.gov. Connector policies will not automatically roll over to HealthCare.gov. If you do not re-enroll, your coverage will end Dec. 31, 2015.

Marketplace plans are sold by private insurance companies and 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 that you are applying, you will create a Healthcare.gov account, fill out an application, pick a health plan and enroll.

At HealthCare.gov, you can preview 2016 plans before you create an account and see prices based on your income.

What you pay for Marketplace insurance depends on your income. Many people qualify for savings on their monthly premiums and out-of-pocket costs such as deductibles and co-payments. Your savings depend on your estimate of your income for 2016. Visit HealthCare.gov to quickly check whether you qualify for savings based on your income.

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 Hawai‘i can offer their employees a variety of Marketplace insurance options.

The Small Business Health Options Program enables small businesses with up to 50 full-time equivalent employees to purchase a qualified health plan. Federal tax credits of up to 50 percent of your contribution toward your employees’ health premium costs are available if your 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 Hawai‘i, California, Nevada, Arizona and the Pacific Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).


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