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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 2026, 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 2026.
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 $20.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $300.00 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 $11000.00 (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 $11000.00 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) prescription drug plan features an annual drug deductible of $300. For Tier 1 preferred generic drugs, you will pay no copay for one, two, or three-month supplies at standard pharmacies and through standard mail order. Tier 2 generic drugs require an $11 copay for a one-month supply at standard pharmacies, while standard mail order provides savings with an $11 copay for up to a three-month supply. Higher tier medications under this plan are subject to coinsurance rather than flat copays. Tier 3 preferred brand drugs require 20% coinsurance, and Tier 4 non-preferred drugs carry a 30% coinsurance for both standard pharmacy and standard mail order. Specialty Tier 5 drugs require a 29% coinsurance for up to a three-month supply.
Additional Benefits
The HMSA Akamai Advantage Standard (PPO) plan provides comprehensive medical coverage with no copay or coinsurance for primary care and preventive services. Specialist visits require a $55 copay, while emergency room visits have a $115 copay which is waived upon hospital admission. For hospital care, inpatient stays feature daily copays for the first several days followed by no copay, whereas outpatient hospital services generally require a 0% to 20% coinsurance. Supplemental benefits include routine dental and home health services with no copay or coinsurance, alongside routine vision exams for a $10 copay and up to $300 annually for eyewear. Routine hearing exams have no copay, and prescription hearing aids are covered with copays between $195 and $1,395. Additionally, durable medical equipment and dialysis services are available with no copay and a 20% coinsurance.
Inpatient Hospital See details
HMSA Akamai Advantage Standard (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute care, you will pay a $475 copay for days 1 to 5, a $50 copay for days 6 to 60, and no copay for days 61 to 90, while psychiatric stays require a $415 copay for days 1 to 5 and no copay for days 6 to 90. Additional hospital days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by HMSA Akamai Advantage Standard (PPO), featuring a 0% to 20% coinsurance for outpatient hospital services, a $100 daily copay for observation services, and no copay with a 0% to 20% coinsurance for ambulatory surgical center services. Outpatient substance abuse sessions require a $55 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered under the HMSA Akamai Advantage Standard (PPO) plan with a $55.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by HMSA Akamai Advantage Standard (PPO), featuring a $350 copay and no coinsurance for ground and air ambulance services, which require prior authorization. However, transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
HMSA Akamai Advantage Standard (PPO) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with no copay and 10% coinsurance.
Primary Care See details
HMSA Akamai Advantage Standard (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $55 copay and no coinsurance. Physical, occupational, and speech therapy services have a $35 copay with no coinsurance, while mental health sessions cost a $50 copay with no coinsurance. Other healthcare professionals require a 20% coinsurance with no copay, but podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered under the HMSA Akamai Advantage Standard (PPO) with no copay and no coinsurance for covered care, though prior authorization is required for some services. Not covered under this benefit are annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, in-home support, caregiver support, smoking cessation counseling, fitness benefits, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by HMSA Akamai Advantage Standard (PPO), offering routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered with no coinsurance and a copay ranging from $195 to $1,395 (limited to one per ear per year), but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
HMSA Akamai Advantage Standard (PPO) covers vision services, featuring routine and non-routine eye exams for a $10 copay and no coinsurance once per year. Covered eyewear, including lenses, frames, and contacts, has no copay and no coinsurance up to a combined maximum benefit of $300 annually.
Dental Services See details
Dental services under the HMSA Akamai Advantage Standard (PPO) are partially covered, featuring Medicare-covered dental care for a $55 copay and no coinsurance, and other preventive and comprehensive services with no copay and no coinsurance. However, other diagnostic, adjunctive general, endodontic, prosthodontic, maxillofacial prosthetic, implant, and orthodontic services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HMSA Akamai Advantage Standard (PPO) with no copay and require prior authorization. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while Part B chemotherapy and other drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the HMSA Akamai Advantage Standard (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
HMSA Akamai Advantage Standard (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, with prior authorization required. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
HMSA Akamai Advantage Standard (PPO) covers diagnostic and radiological services with prior authorization, requiring a copay and a minimum 20% coinsurance for diagnostic procedures, and no copay but applicable coinsurance for lab services. Radiological services have no copay, requiring a minimum coinsurance of 20% for therapeutic and X-ray services, and 25% for diagnostic radiological services.
Home Health Services See details
Home health services are covered by HMSA Akamai Advantage Standard (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HMSA Akamai Advantage Standard (PPO) with no coinsurance, subject to prior authorization. Covered services require a copay, including $30 for standard cardiac rehabilitation, $40 for intensive cardiac rehabilitation, $15 for pulmonary rehabilitation, and $20 for supervised exercise therapy for peripheral artery disease.
Skilled Nursing Facility (SNF) See details
HMSA Akamai Advantage Standard (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20 and days 61 through 100, a $218 copay for days 21 through 60, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by HMSA Akamai Advantage Standard (PPO), which provides Ambulatory Infusion Suite (AIS) Drug Administration and Nursing Services with no copay and a 20% coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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