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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 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
HMSA Akamai Advantage Standard Plus (PPO) is a PPO plan offered by Hawaii Medical Service Association available for the 2026 plan year 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 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 $151.00. 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 $200.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5100.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $5100.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $7200.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $7200.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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:
Sign up for HMSA Akamai Advantage Standard Plus (PPO)
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Drug Coverage
The HMSA Akamai Advantage Standard Plus (PPO) plan features a $200 annual drug deductible. Under this plan, you will pay no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through standard mail order for up to a three-month supply. For Tier 2 generic drugs, standard pharmacy copays range from $11 to $33 depending on the supply duration, while standard mail order offers a flat $11 copay for one, two, or three-month fills. Higher-tier prescription drugs require coinsurance rather than flat copays for both standard pharmacy and standard mail-order services. Tier 3 preferred brand drugs carry a 20% coinsurance, Tier 4 non-preferred drugs carry a 30% coinsurance, and Tier 5 specialty drugs require a 29% coinsurance. These coinsurance percentages remain the same regardless of whether you choose a one, two, or three-month supply.
Additional Benefits
The HMSA Akamai Advantage Standard Plus (PPO) plan offers comprehensive medical coverage with no copay or coinsurance for primary care, home health, and routine preventive services. For specialized care, members pay a $40 copay for specialists, while inpatient hospital stays require a $450 daily copay for the first four days and no copay for days five through ninety. Emergency room visits carry a $115 copay, and urgent care services are available for a $40 copay, with both options featuring no coinsurance. Routine dental, vision, and hearing exams are also covered with no copay or coinsurance, and the plan includes a $300 annual allowance for eyewear. Prescription hearing aids require a copay ranging from $195 to $1,395, while durable medical equipment and dialysis services generally require a 20% coinsurance with no copay. This plan provides a balanced approach to healthcare costs, combining no-copay routine services with predictable cost-sharing for advanced medical needs.
Inpatient Hospital See details
HMSA Akamai Advantage Standard Plus (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $450 daily copay for days 1 through 4 and no copay for days 5 through 90. Unlimited additional acute care days are covered at no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HMSA Akamai Advantage Standard Plus (PPO) covers outpatient hospital services with 0% to 20% coinsurance and a $100 daily copay for observation services, and ambulatory surgical center services with no copay and 0% to 20% coinsurance. Outpatient substance abuse services require a $40 copay per session with no coinsurance, while outpatient blood services are provided with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by HMSA Akamai Advantage Standard Plus (PPO) with a $40.00 copay and no coinsurance.
Ambulance and Transportation Services See details
HMSA Akamai Advantage Standard Plus (PPO) covers Medicare-approved ground and air ambulance services with a $300 copay and no coinsurance, with prior authorization required. Routine transportation services to health-related locations are not covered.
Emergency Services See details
HMSA Akamai Advantage Standard Plus (PPO) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both featuring no coinsurance and waived fees if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are covered with no copay and a 10% coinsurance.
Primary Care See details
HMSA Akamai Advantage Standard Plus (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist, psychiatric, mental health, and opioid treatment services require a $40 copay and no coinsurance. Physical and occupational therapies are covered with a $30 copay and no coinsurance, but podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by HMSA Akamai Advantage Standard Plus (PPO) with no copay and no coinsurance for covered options, though prior authorization is required for certain services. Not covered services include annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, in-home support, caregiver support, additional smoking cessation, fitness benefits, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by HMSA Akamai Advantage Standard Plus (PPO), which offers routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and a copay ranging from $195.00 to $1,395.00, but OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are covered by HMSA Akamai Advantage Standard Plus (PPO) with no copay and no coinsurance, which includes one routine eye exam and one non-routine eye exam every year. Eyewear, including contact lenses, eyeglasses, and upgrades, is also covered with no copay or coinsurance up to a combined maximum benefit of $300 per year.
Dental Services See details
HMSA Akamai Advantage Standard Plus (PPO) partially covers dental services, offering Medicare-covered dental for a $40 copay and no coinsurance, and preventive and select comprehensive care with no copay and no coinsurance. Non-covered sub-services include other diagnostic services, adjunctive general services, removable and fixed prosthodontics, implants, maxillofacial prosthetics, and orthodontics.
Home Infusion bundled Services See details
HMSA Akamai Advantage Standard Plus (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs carry a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis services are covered by HMSA Akamai Advantage Standard Plus (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
HMSA Akamai Advantage Standard Plus (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes or inserts carry a 20% coinsurance.
Diagnostic and Radiological Services See details
HMSA Akamai Advantage Standard Plus (PPO) covers diagnostic and radiological services with prior authorization, generally requiring a 20% minimum coinsurance. There is no copay for lab services and outpatient X-rays, while diagnostic procedures, therapeutic radiology, and diagnostic radiology (which has a minimum $100 copay) require copayments.
Home Health Services See details
HMSA Akamai Advantage Standard Plus (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HMSA Akamai Advantage Standard Plus (PPO) covers Cardiac Rehabilitation Services with no coinsurance and prior authorization required, but only some services are covered as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by HMSA Akamai Advantage Standard Plus (PPO) with no coinsurance, requiring a $10 daily copay for days 1 through 20, a $210 daily copay for days 21 through 40, and no copay for days 41 through 100. Prior authorization is required, and additional days beyond the standard 100-day Medicare benefit period are not covered.
Other Services See details
HMSA Akamai Advantage Standard Plus (PPO) partially covers other services, with acupuncture, over-the-counter items, and meal benefits excluded from coverage. Covered services, specifically Ambulatory Infusion Suite (AIS) Drug Administration and Nursing Services, require no copay and a 20% coinsurance.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
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