A non-government entity
HMSA Akamai Advantage Complete (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HMSA Akamai Advantage Complete (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 Complete (PPO) in 2026, please refer to our full plan details page.
HMSA Akamai Advantage Complete (PPO) is a PPO plan offered by Hawaii Medical Service Association available for enrollment in 2025 to people living in Honolulu County. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HMSA Akamai Advantage Complete (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 Complete (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 Complete (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:
Sign up for HMSA Akamai Advantage Complete (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HMSA Akamai Advantage Complete (PPO) Medicare plan features an annual drug deductible of $300. For Tier 1 preferred generic drugs, members pay no copay for up to a three-month supply at standard pharmacies and through standard mail order. Tier 2 generic drugs are available at standard pharmacies for an $11 copay per month, while utilizing standard mail order keeps the copay at a flat $11 for up to a three-month supply. For brand-name and specialty medications, costs transition to coinsurance percentages. Tier 3 preferred brand drugs require a 20% coinsurance, and Tier 4 non-preferred drugs carry a 30% coinsurance at standard pharmacies and standard mail order. Tier 5 specialty drugs are covered with a 29% coinsurance for all supply durations.
Additional Benefits
The HMSA Akamai Advantage Complete (PPO) plan provides affordable healthcare coverage, featuring no copay for primary care visits, telehealth services, and home health care. Specialist visits require a $55 copay, while emergency room services carry a $115 copay that is waived upon hospital admission. For inpatient hospital stays, members pay daily copays for the first five days, after which there is no copay for the remainder of the covered stay. Routine vision and hearing exams are covered with no copay, and the plan provides up to a $300 annual benefit for eyewear. Preventive dental services also require no copay, while Medicare-covered dental care is available for a $55 copay. Durable medical equipment, prosthetics, and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
HMSA Akamai Advantage Complete (PPO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $475 copay for days 1-5, a $50 copay for days 6-60, and no copay for days 61-90, while psychiatric stays require a $415 copay for days 1-5 and no copay for days 6-90. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HMSA Akamai Advantage Complete (PPO) covers outpatient hospital services with 0% to 20% coinsurance and observation services with a $100 daily copay. Ambulatory surgical center services feature no copay and 0% to 20% coinsurance, while outpatient substance abuse sessions require a $55 copay with no coinsurance, and blood services have no copay or coinsurance.
Partial Hospitalization See details
HMSA Akamai Advantage Complete (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance.
Ambulance and Transportation Services See details
HMSA Akamai Advantage Complete (PPO) covers Medicare-approved ground and air ambulance services with a $350 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
HMSA Akamai Advantage Complete (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 a 10% coinsurance.
Primary Care See details
HMSA Akamai Advantage Complete (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 cost a $35 copay with no coinsurance, and mental health or psychiatric sessions require a $50 copay with no coinsurance. Podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered under HMSA Akamai Advantage Complete (PPO) with no copay and no coinsurance for covered services, though prior authorization is required for some benefits. Covered options include Medicare-covered zero-dollar preventive services, kidney disease education, and remote access technologies, while an annual physical exam, fitness benefits, health education, and in-home safety assessments are not covered.
Hearing Services See details
HMSA Akamai Advantage Complete (PPO) partially covers hearing services, offering Medicare-covered exams, annual routine exams, and fitting evaluations with no copay and no coinsurance. Prescription hearing aids require no coinsurance with copays ranging from $195 to $1,395, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
HMSA Akamai Advantage Complete (PPO) covers vision services with no deductibles, offering annual routine and non-routine eye exams for a $10 copay and no coinsurance. Eyewear, including contact lenses, frames, lenses, and upgrades, is covered with no copay and no coinsurance up to a $300 annual combined maximum benefit.
Dental Services See details
HMSA Akamai Advantage Complete (PPO) provides partially covered dental services, with a $55 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for covered preventive and select restorative services. Sub-services that are not covered under this plan include other diagnostic services, adjunctive general services, endodontics, fixed and removable prosthodontics, maxillofacial prosthetics, implants, and orthodontics.
Home Infusion bundled Services See details
HMSA Akamai Advantage Complete (PPO) covers home infusion bundled services with no copay, while associated Medicare Part B chemotherapy, radiation, and other drugs require 0% to 20% coinsurance and no copay. Covered Part B insulin has a $35 copay and no coinsurance, and prior authorization is required for home infusion services.
Dialysis Services See details
HMSA Akamai Advantage Complete (PPO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
HMSA Akamai Advantage Complete (PPO) covers durable medical equipment (DME), prosthetics, and medical supplies with no copay and a 20% coinsurance, though prior authorization is required. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HMSA Akamai Advantage Complete (PPO), with prior authorization required for all services. Lab services require coinsurance with no copay, diagnostic procedures require both a copay and a minimum 20% coinsurance, and radiological, therapeutic, and X-ray services carry a minimum 20% coinsurance with no copay.
Home Health Services See details
Home health services are covered under the HMSA Akamai Advantage Complete (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HMSA Akamai Advantage Complete (PPO) covers Cardiac Rehabilitation Services with no coinsurance, though copayments apply and prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HMSA Akamai Advantage Complete (PPO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and days 61 through 100, a $218 daily copay for days 21 through 60, and additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
HMSA Akamai Advantage Complete (PPO) provides partial coverage for other services, specifically covering 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 under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved