Is HMSA considered private insurance?
Yes, the Hawaii Medical Service Association (HMSA) is a private, non-profit mutual benefit health insurer.
Key Details About HMSA
- Nonprofit Status: HMSA operates as a nonprofit health insurer in Hawaii, meaning it is not run for public or shareholder profit, but it is still a private entity rather than a government-owned program.
- Blue Cross Blue Shield: It is an independent licensee of the Blue Cross Blue Shield Association.
- Offerings: It provides private individual, family, and employer-sponsored group health plans, alongside administering public programs like QUEST Integration (Medicaid) and Medicare Advantage plans under state contracts.
What counts as private insurance?
Private health insurance is any health coverage that is funded and administered by a private organization (such as a commercial insurance company or a private employer) rather than run directly by the government.
If your plan is not a public social program, it counts as private insurance.
The Core Types of Private Insurance
Private health insurance is generally categorized by how you obtain it:
- Employer-Sponsored Insurance (Group Plans): This is the most common form of private coverage. It includes health benefits provided by private companies, unions, or organizations to their employees. These plans can be fully insured (the employer buys coverage from an insurer) or self-insured (the employer pays the medical claims directly from its own fund).
- Individual & Family Marketplace Plans (ACA / On-Exchange): Plans purchased directly by individuals through federal or state platforms like HealthCare.gov. Even though the government regulates these platforms and may offer premium tax subsidies, the plans themselves are run by private companies (e.g., UnitedHealthcare, Anthem, Cigna) and are strictly considered private coverage.
- Off-Exchange Private Plans: Plans purchased directly from an insurance company, broker, or private marketplace without using a government exchange.
- Alternative / Supplemental Private Insurance: Short-term health plans, dental, vision, catastrophic coverage, and gap-filler policies sold by private insurers.
Common Network Layouts
Within private insurance, plans are structured into different managed care network types:
- PPO (Preferred Provider Organization)
- HMO (Health Maintenance Organization)
- EPO (Exclusive Provider Organization)
- POS (Point of Service)
What Does Not Count as Private Insurance?
Private insurance stands in contrast to public health insurance, which is funded through government taxes and administered by public entities.
| Public Insurance (Not Private) | Definition |
|---|---|
| Medicare | The federal program primarily for adults aged 65 and older and people with specific disabilities. (Note: While private companies sell Medicare Advantage plans, they are government-funded public Medicare benefits). |
| Medicaid | A joint state and federal program providing health coverage to low-income individuals, families, pregnant women, and people with disabilities. |
| CHIP | The Children's Health Insurance Program, targeting children in families whose income is too high for Medicaid but who cannot afford private plans. |
| VA / TRICARE | Direct military healthcare systems or coverage managed by the Department of Veterans Affairs or Department of Defense. |
Which is better, HMSA, PPO or HMO?
Neither plan is objectively better; an HMO is better if you want lower costs and coordinated care, while a PPO is better if you want freedom to choose doctors and see specialists without referrals.
HMSA (Hawaii Medical Service Association) offers both options, and the right choice depends on your budget and medical needs. You can review specific plan structures on the HMSA Types of Plans page.
HMO (Health Maintenance Organization)
- Cost: Lower monthly premiums and lower out-of-pocket costs (copays).
- Primary Doctor: You must choose a Primary Care Physician (PCP).
- Referrals: You need a referral from your PCP to see a specialist.
- Network: Restricted strictly to in-network doctors (except for emergencies).
- Best for: People who want predictable, lower costs and have routine care needs.
PPO (Preferred Provider Organization)
- Cost: Higher monthly premiums and higher out-of-pocket costs.
- Primary Doctor: No primary care doctor selection required.
- Referrals: You can see any specialist directly without a referral.
- Network: Gives you the freedom to see out-of-network providers, though at a higher cost.
- Best for: People who value doctor choice, travel frequently, or want flexibility without referral hurdles.
Is HMSA considered Blue Cross Blue Shield?
Yes, HMSA (Hawaii Medical Service Association) is considered Hawaii's Blue Cross Blue Shield plan.
How HMSA and BCBS Relate
- Independent Licensee: HMSA is an independent, nonprofit licensee of the Blue Cross and Blue Shield Association.
- National Network: Because of this connection, HMSA participates in the BlueCard program, which lets members use their coverage with participating Blue Cross Blue Shield providers on the U.S. mainland.
- Global Coverage: Members also have access to care worldwide through Blue Cross Blue Shield Global Core.
Can I use my HMSA insurance in another state?
Yes, you can use your HMSA insurance in another U.S. state, but your coverage depends heavily on whether you have a PPO or HMO plan. Through the BlueCard Program, HMSA partners with other Blue Cross and Blue Shield networks nationwide.
PPO Plans
- Routine and Care: Covered when you visit a participating BlueCard participating provider on the U.S. mainland.
- Benefits: You receive the same benefit levels as you would with an HMSA provider in Hawaii.
HMO Plans
- Emergency/Urgent Care: Covered for true emergencies or urgent care if you follow instructions and arrange appointments through BlueCard.
- Routine Care: Generally not covered for brief mainland travel.
- Extended Stays: If you live away from Hawaii for more than 90 days, you may qualify for the Guest Membership program to access a local primary care physician.
Kaiser VS. HMSA: Health Insurance Options for New Hawaii Residents
What are examples of private insurances?
Private insurance is coverage provided by non-governmental, commercial companies rather than public programs.
Examples of Private Insurance Companies and Networks
- Blue Cross Blue Shield
- UnitedHealthcare
- Anthem
- Kaiser Permanente
- Cigna
- Humana
Types of Private Insurance Plans
- Employer-Sponsored Plans: Coverage provided or subsidized by a job.
- ACA Marketplace Plans: Individual or family policies bought on public exchanges.
- Health Maintenance Organization (HMO): A plan requiring in-network doctors and primary care referrals.
- Preferred Provider Organization (PPO): A plan allowing out-of-network care at a higher cost.
- Exclusive Provider Organization (EPO): A plan covering only in-network care without requiring referrals.
What happens if I don't have private health insurance?
If you do not have private health insurance in Australia, you can still rely on the public healthcare system via Medicare for essential medical care, but you may face specific tax surcharges or future premium loadings depending on your income and age.
Public Healthcare Access
- Medicare Coverage: You are fully covered for free or subsidised treatment as a public patient in a public hospital, plus rebates for doctor and GP visits.
- Public Wait Times: Non-emergency or elective surgeries in public hospitals involve waiting lists rather than scheduled private care.
- Out-of-Pocket Costs: Everyday services like dental, optical, and physio are generally not covered by Medicare unless specific conditions are met.
Financial Penalties and Surcharges
- Medicare Levy Surcharge (MLS): If you earn above the income threshold (over $105,000 for singles or $210,000 for families as of 2026–27) and do not hold appropriate hospital cover, you pay an extra 1% to 1.5% tax on your income.
- Lifetime Health Cover (LHC) Loading: If you do not join private hospital cover by July 1 following your 31st birthday, a 2% loading is added to your future premiums for every year you delay, up to a maximum of 70%. Learn more through Medibank's guide on health insurance.
Do doctors prefer HMO or PPO?
Doctors do not universally prefer either an HMO or a PPO, as their preference depends on their practice model, administrative capacity, and financial goals.
Why Doctors Like PPO Plans
- Higher Reimbursement: PPO plans typically pay higher reimbursement rates for medical services than HMO plans.
- Clinical Autonomy: Doctors often experience fewer treatment restrictions, less pre-authorization bureaucracy, and more freedom to recommend treatments they think are best.
- Larger Patient Pool: Broad PPO networks can bring a larger, more diverse volume of patients to a practice.
Why Doctors Like HMO Plans
- Steady Patient Flow: Primary Care Physicians (PCPs) act as gatekeepers, creating a reliable, consistent stream of referred patients within the network.
- Predictable Revenue: Capitation or steady HMO panel structures can offer consistent, predictable monthly revenue for primary care clinics.
- Simpler Billing: Streamlined administrative and billing rules in some HMO structures can reduce office overhead.
Which health insurance company is better for Hawaii, HMSA or Kaiser Permanente?
Neither HMSA nor Kaiser Permanente is universally "better"; HMSA works best for statewide coverage and flexibility, while Kaiser Permanente excels at integrated, under-one-roof care on Oahu.
📊 Comparison of HMSA and Kaiser in Hawaii
| Feature | 🏥 HMSA (Hawaii Medical Service Association) | 🏢 Kaiser Permanente |
|---|---|---|
| Network Type | PPO and HMO options | HMO (Integrated system) |
| Geographic Reach | Available on all islands (Oahu, Maui, Kauai, Big Island, etc.) | Mostly Oahu; very limited or absent on neighbor islands |
| Mainland Coverage | BlueCard PPO network covers all 50 states | Emergency only outside Hawaii |
| Referrals | Not required for PPO plans | Required to see specialists |
| Care Experience | Choose private practice doctors | Doctors, labs, and pharmacies in one facility |
✅ When to Choose HMSA
- Living on neighbor islands: HMSA operates on every major Hawaiian island.
- Traveling frequently: The BlueCard network lets you see mainland doctors in-network.
- Wanting provider choice: You can visit private practice doctors and specialists without a referral on PPO plans.
✅ When to Choose Kaiser Permanente
- Living on Oahu: Most Kaiser facilities, pharmacies, and hospitals concentrate there.
- Preferring coordinated care: Doctors, lab work, and prescriptions happen under one roof with a unified app.
- Lower routine costs: Monthly premiums for basic care tend to run slightly lower than HMSA PPO plans.
How can I check my HMSA coverage?
You can check your Hawaii Medical Service Association (HMSA) coverage online through the HMSA My Account Portal or by reviewing your membership card.
Check Online
- Log in: Go to HMSA My Account to view your benefits, plan details, and claims history.
- Register: If you do not have an account, click Create an Account with your name, birth date, email, and subscriber ID number.
Check Your Membership Card
- Plan Type: Look at the front of your card to see if you have a Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), or Medicare/QUEST plan.
- Coverage Details: Check for specific codes or labels for medical, dental, or drug coverage.
- Contact Numbers: Call the customer relations phone number listed on the back of your card for direct help.