Hospital & Medical Cost in Hawaii (2026)

Hospital costs in Hawaii typically run $2,200–$4,900 for an uninsured moderate-acuity Level-3 ER visit, with ACA Medicaid expanded. Hawaii's combination of UNIQUE Hawaii Prepaid Health Care Act (1974 — the first state-mandated employer health insurance in the U.S., grandfathered from ERISA preemption), Kaiser Permanente Hawaii dominant integrated-delivery system (one of only 2 states alongside CA), inter-island geography requiring medevac transport between Oahu and the neighbor islands, $54.20/hr BLS RN mean (second-highest in the country after CA), Honolulu Oahu concentration of 80%+ of state hospital capacity, and SHPDA extensive CON program under HRS § 323D.

State Hawaii
Cities Covered 0
Typical uninsured moderate-acuity Level-3 ER visit $2,200 – $4,900
BLS Registered Nurse wage $54.20/hr

Hawaii payer mix, regulation & malpractice drivers

  • Surprise billing protection: Moderate state statute — partial state-level surprise billing protection alongside federal NSA
  • Certificate of Need (CON) status: Extensive Certificate of Need — broad CON program covering hospitals, ASCs, imaging, and surgical capacity
  • Medicaid expansion status: ACA Medicaid expanded — coverage to 138% federal poverty level
  • Malpractice non-economic damages cap: No enforceable malpractice non-economic damages cap — no cap
  • Hospital price transparency mandate: Federal CMS Hospital Price Transparency Rule (45 CFR Part 180) only — no state-level supplement
  • Dominant health insurance market structure: Kaiser-dominant — Kaiser Permanente integrated-delivery system holds dominant market share

Hawaii medical board & physician licensing

  • License status: Statewide license required
  • License board: Hawaii Medical Board — Hawaii Department of Commerce and Consumer Affairs (DCCA) (official site)
  • Permit: Hawaii Medical Board MD/DO license required; DEA Schedule II-V + Hawaii Prescription Drug Monitoring Program (PDMP); hospital privileging at Hawaii Pacific Health / Queen's Health Systems / Kaiser Permanente Hawaii; CON required under HRS § 323D administered by Hawaii State Health Planning and Development Agency (SHPDA); Hawaii Prepaid Health Care Act (1974) — first state-mandated employer health insurance

How medical care costs vary in Hawaii

State-specific code or insurance rule: Hawaii enacted the Hawaii Prepaid Health Care Act (HRS Chapter 393) in 1974 — the FIRST state-mandated employer health insurance law in the United States — requiring every Hawaii employer to provide health insurance to employees working 20+ hours per week, predating ERISA preemption due to its 1974 enactment under a Hawaii ERISA exemption (HRS § 393 was specifically grandfathered out of ERISA preemption by federal statute), and Hawaii is the only U.S. state operating under this employer-mandate model with employer-provided coverage reaching 95%+ of the working-age population, plus Hawaii is one of only 2 U.S. states (alongside CA) where Kaiser Permanente operates as a dominant integrated-delivery system.

Cities in Hawaii

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