HMSA Gold PPO II
Starting at
$621
/month before subsidy
HMSA Gold PPO II is a 2026 Gold PPO health insurance plan from HMSA, sold on the ACA Marketplace in Hawaii under plan ID 18350HI0880013. The monthly premium starts at $621 before subsidies, based on a 40-year-old in the plan's lowest-cost rating area. The individual medical deductible is $2,000 ($4,000 for a family), and the individual out-of-pocket maximum is $8,200 ($16,400 for a family). After the deductible, coinsurance is 25% for covered in-network care. The plan is not HSA-eligible.
- Plan ID
- 18350HI0880013
- Plan year
- 2026
- State
- Hawaii
- Metal level
- Gold
- Plan type
- PPO
- HSA-eligible
- No
Individual Deductible
$2,000
Family: $4,000
Out-of-Pocket Max
$8,200
Family: $16,400
Coinsurance
25%
You pay after deductible
Network Type
PPO
HIN003
Medical Services
Prescription Drugs
- Medical care
- Member experience
- Plan administration
How well doctors manage and coordinate care
Member-survey satisfaction with the plan
Customer service, billing, and access to information
Having a baby
Normal delivery
$4,430
your estimated cost
- Deductible
- $2,000
- Copays
- $70
- Coinsurance
- $2,300
Managing type 2 diabetes
A year of routine care
$1,620
your estimated cost
- Deductible
- $900
- Copays
- $700
- Coinsurance
- $0
A simple fracture
ER visit + follow-up
$2,100
your estimated cost
- Deductible
- $1,700
- Copays
- $400
- Coinsurance
- $0
Enter your ZIP code first to search nearby doctors.
This Gold PPO plan is designed for people who use healthcare frequently and want predictable costs when they visit the doctor.
Consider this plan if you:
- Have ongoing health conditions requiring regular care
- Take multiple prescription medications
- Prefer lower costs at the time of service
- Want peace of mind with comprehensive coverage
This summary is generated based on plan attributes for educational purposes only.
If you max out this year
$1,304/month
Annual Premium
$7,452
OOP Maximum
$8,200
💡 What this means:
With a $2,000 deductible, you pay 100% of costs until you've spent that much. After that, you pay 25% (coinsurance) until you hit $8,200 total. Then insurance covers everything else for the year.
More plans from HMSA in Hawaii
Frequently asked questions about HMSA Gold PPO II
How much does HMSA Gold PPO II cost per month?
HMSA Gold PPO II from HMSA starts at $621 per month before any subsidy in Hawaii. Most Marketplace enrollees qualify for a premium tax credit that lowers what they actually pay — estimate your subsidy to see your net premium.
What is the deductible for HMSA Gold PPO II?
The individual medical deductible is $2,000, and the family deductible is $4,000. You pay for covered care out of pocket until you meet the deductible, after which the plan shares costs with you.
What is the out-of-pocket maximum for HMSA Gold PPO II?
The most you would pay in a year for covered in-network care is $8,200 for an individual and $16,400 for a family. Once you reach it, the plan pays 100% of covered services for the rest of the year.
Is HMSA Gold PPO II HSA-eligible?
No. HMSA Gold PPO II is not classified as an HSA-eligible high-deductible health plan, so it cannot be paired with a Health Savings Account.
What type of network does HMSA Gold PPO II use?
HMSA Gold PPO II is a PPO plan. PPO plans let you see specialists without a referral and use out-of-network providers (at higher cost), offering the most flexibility.
Understand what you'd actually pay
- 2026 Federal Poverty Level (FPL) chart
The income table behind subsidy and Medicaid eligibility
- How ACA subsidies work
Premium tax credits and who qualifies
- The 2026 subsidy cliff
Why income near 400% FPL matters again this year
Important Notice
Plan details and costs shown are estimates for educational purposes only. Actual costs, coverage, and availability may vary. Always verify plan details and enroll through official channels at HealthCare.gov or your state marketplace.