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HMSA Akamai Advantage Standard (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HMSA Akamai Advantage Standard (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HMSA Akamai Advantage Standard (PPO) in 2025, please refer to our full plan details page.
HMSA Akamai Advantage Standard (PPO) is a PPO plan offered by Hawaii Medical Service Association available for enrollment in 2025 to people living in Hawaii, Kalawao, Kauai and Maui counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HMSA Akamai Advantage Standard (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HMSA Akamai Advantage Standard (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For HMSA Akamai Advantage Standard (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $6.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $400.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The HMSA Akamai Advantage Standard (PPO) plan has a $400 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions. The cost of your prescriptions will vary depending on the drug tier and whether you use a preferred or standard pharmacy. For example, in the initial coverage phase, you will pay a $20 copay for preferred generic drugs at a standard pharmacy and a $100 copay for preferred brand drugs. Non-preferred drugs have a 27% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs.
Additional Benefits
The HMSA Akamai Advantage Standard (PPO) plan offers a range of benefits, including coverage for inpatient hospital stays with varying copays, and outpatient services with copays or coinsurance depending on the service. This plan also includes coverage for preventive services, hearing and vision services, dental services, and home infusion services. You'll find no copays for primary care, many preventive services, and home health services, but you'll encounter copays for specialist visits, and some outpatient services.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a copay of $370 for days 1-6, $50 for days 7-60, and no copay for days 61-90, and other services are not covered. For Inpatient Hospital Psychiatric, you will pay a copay of $320 for days 1-6 and no copay for days 7-90, and other services are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a 0% to 20% coinsurance, Observation Services with a $100 copay, Ambulatory Surgical Center (ASC) Services with 0% to 20% coinsurance, Outpatient Substance Abuse Services with a $50 copay for both individual and group sessions, and Outpatient Blood Services.
Partial Hospitalization See details
Partial Hospitalization is covered by the HMSA Akamai Advantage Standard (PPO) plan, with a $50 copay. There is no coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $250 copay for both ground and air ambulance services and no coinsurance. Transportation Services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by HMSA Akamai Advantage Standard (PPO). Emergency Services have a $100 copay, and Urgently Needed Services have a $50 copay, and both have no coinsurance. Worldwide Emergency Services have a 10% coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
For the HMSA Akamai Advantage Standard (PPO) plan, primary care physician services have no copay, while chiropractic services have a $15 copay. Occupational therapy services have a $35 copay, and physician specialist services have a $50 copay. Mental health and psychiatric services have a $40 copay for both individual and group sessions. Physical therapy and speech-language pathology services have a $35 copay, and opioid treatment program services have a $50 copay. Other health care professional services have no copay or coinsurance. Additional telehealth benefits have no copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The HMSA Akamai Advantage Standard (PPO) plan covers preventive services, including Medicare-covered preventive services with prior authorization, with no copay. Additional preventive services like Health Education, Fitness Benefits, Enhanced Disease Management, Home-Based Palliative Care, Kidney Disease Education Services, and other services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay. However, services like Annual Physical Exams, In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, and others are not covered.
Hearing Services See details
Hearing services with the HMSA Akamai Advantage Standard (PPO) plan include hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a copay between $195 and $1395, and are limited to one hearing aid per ear per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $10 copay, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HMSA Akamai Advantage Standard (PPO) plan covers Medicare dental services with a $50 copay, while oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, other preventive dental services, periodontics, and oral and maxillofacial surgery have no copay. Adjunctive general services, endodontics, prosthodontics, maxillofacial prosthetics, implant services, orthodontics, and prosthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the HMSA Akamai Advantage Standard (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the HMSA Akamai Advantage Standard (PPO) plan. The plan has a coinsurance of 20% for this benefit.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment (DME) with 20% coinsurance and authorization required, and prosthetic devices and medical supplies with 20% coinsurance. Diabetic supplies have no copay, and diabetic therapeutic shoes/inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, lab services, all radiological services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services are covered. Lab services have no copay, while diagnostic procedures/tests have a coinsurance of at most 20%, diagnostic radiological services have a coinsurance of at most 25%, therapeutic radiological services have a coinsurance of at most 20%, and outpatient X-ray services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by HMSA Akamai Advantage Standard (PPO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the HMSA Akamai Advantage Standard (PPO) plan. Prior authorization is required for these services if they were covered, but they are not.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. There is no copay for days 1-20 and days 61-100, and a $200 copay for days 21-60.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items with a maximum benefit of $200 every three months; however, acupuncture, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and several other services are not covered. Other 1 has a 20% coinsurance for Ambulatory Infusion Suite (AIS) Drug Administration and Nursing Services.
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