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HMSA Akamai Advantage Standard Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HMSA Akamai Advantage Standard Plus (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 Plus (PPO) in 2025, please refer to our full plan details page.
HMSA Akamai Advantage Standard Plus (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 Plus (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 Plus (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 Plus (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $125.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $5750.00 (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 $5750.00 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 Plus (PPO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay for your prescriptions, with costs varying based on the drug tier and pharmacy type. For example, standard generic drugs have a $45 copay, while preferred brand drugs have a $95 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. However, if you qualify for the low-income subsidy (LIS), your monthly premium is $22.00.
Additional Benefits
The HMSA Akamai Advantage Standard Plus (PPO) plan offers comprehensive coverage with varying costs depending on the service. This plan covers inpatient hospital stays, outpatient services, and emergency services, each with associated copays or coinsurance. Many services like primary care, preventive services, hearing exams, vision exams, and dental services have no copay, but other services such as hearing aids, eyewear, and prescription drugs may have costs associated with them.
Inpatient Hospital See details
The HMSA Akamai Advantage Standard Plus (PPO) plan covers inpatient hospital stays with a copay of $350 for days 1-5 and no copay for days 6-90 for acute care, and a copay of $320 for days 1-5 and no copay for days 6-90 for psychiatric care. Additional days for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services with a $100 copay, ambulatory surgical center services with 0-20% coinsurance, outpatient substance abuse services with a $40 copay for individual and group sessions, and outpatient blood services. This plan also waives the deductible for three pints of blood.
Partial Hospitalization See details
Partial Hospitalization is covered by the HMSA Akamai Advantage Standard Plus (PPO) plan, with a $40 copay. There is no coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by HMSA Akamai Advantage Standard Plus (PPO). Ground and Air Ambulance Services have a $225 copay, and there is no coinsurance; however, Transportation Services to a health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgent and Worldwide Emergency Services, are covered by the HMSA Akamai Advantage Standard Plus (PPO) plan. Emergency Services have a $100 copay, and Urgently Needed Services have a $40 copay, both with no coinsurance. Worldwide Emergency Services have a 10% coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The HMSA Akamai Advantage Standard Plus (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $30 copay. The plan also covers physician specialist services with a $40 copay, mental health specialty services with a $40 copay for individual and group sessions, and physical therapy and speech-language pathology services with a $30 copay. Additionally, additional telehealth benefits and opioid treatment program services are covered with a $40 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with prior authorization, and additional preventive services, including Health Education, Home-Based Palliative Care, Fitness Benefit, Enhanced Disease Management, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Kidney Disease Education Services, and Other Preventive Services, with no copay for many services. Annual physical exams, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Telemonitoring Services are not covered.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have no copay, and routine hearing exams and fitting/evaluation for hearing aids also have no copay. Prescription hearing aids have a copay between $195 and $1395, depending on the type of hearing aid. Prescription hearing aids for the inner and outer ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear benefits. Eye exams have no copay, and eyewear has a combined maximum plan benefit coverage of $300 every year for both in-network and out-of-network services. However, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $40 copay. Other covered services include oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, endodontics, periodontics, and oral and maxillofacial surgery, all with no copay. Adjunctive general services, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the HMSA Akamai Advantage Standard Plus (PPO) plan and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while 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 under the HMSA Akamai Advantage Standard Plus (PPO) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical equipment benefits are covered by the HMSA Akamai Advantage Standard Plus (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and requires authorization, but there is no copay. Prosthetic devices and medical supplies also have a 20% coinsurance, and diabetic supplies have no copay and diabetic therapeutic shoes and inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures, lab services, and radiological services, are covered. Diagnostic Procedures/Tests have a coinsurance of at most 20%, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $100 and a coinsurance of at most 20%, and Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the HMSA Akamai Advantage Standard Plus (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the HMSA Akamai Advantage Standard Plus (PPO) plan. While the plan covers Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HMSA Akamai Advantage Standard Plus (PPO), with a copay of $20 for days 1-20, $190 for days 21-40, and no copay for days 41-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services offered by HMSA Akamai Advantage Standard Plus (PPO) include Over-the-Counter (OTC) Items, with a maximum benefit of $200 every three months, and Other 1, which covers Ambulatory Infusion Suite (AIS) Drug Administration and Nursing Services with a 20% coinsurance. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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