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HMSA Akamai Advantage Complete Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HMSA Akamai Advantage Complete 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 Complete Plus (PPO) in 2025, please refer to our full plan details page.
HMSA Akamai Advantage Complete Plus (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 2025.
It's important to know that HMSA Akamai Advantage Complete 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 Complete 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 Complete Plus (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $113.00. 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 Complete Plus (PPO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, standard generic drugs have a $45 copay, while non-preferred drugs have a 33% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, you will pay $33.40 for Part D.
Additional Benefits
The HMSA Akamai Advantage Complete Plus (PPO) plan offers a variety of benefits, including no copays for primary care, preventive services, and home health services. The plan covers inpatient hospital stays, outpatient services, and emergency services, with varying copays and coinsurance depending on the specific service. You'll also find coverage for hearing, vision, and dental services, with no copays for routine exams and cleanings.
Inpatient Hospital See details
Inpatient Hospital coverage includes both acute and psychiatric services. For Inpatient Hospital-Acute, you will pay a $300 copay for days 1-4, and no copay for days 5-90, with additional days covered at no copay; non-Medicare covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, you will pay a $300 copay for days 1-4, and no copay for days 5-90; additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a coinsurance between 0% and 20% and observation services with a $100 copay. Outpatient substance abuse services are covered, with individual and group sessions with a $30 copay. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the HMSA Akamai Advantage Complete Plus (PPO) plan with a $30 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the HMSA Akamai Advantage Complete Plus (PPO) plan. Both ground and air ambulance services have a $225 copay with no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $100 copay, and no coinsurance. Urgently Needed Services have a $30 copay, and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have 10% coinsurance.
Primary Care See details
The HMSA Akamai Advantage Complete Plus (PPO) plan covers primary care services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $30 copay. Additionally, the plan covers physician specialist services, physical therapy and speech-language pathology services, and additional telehealth benefits with a $30 copay, and other health care professional services with no copay. Mental health and psychiatric services have a $30 copay for individual and group sessions, and opioid treatment program services have a $30 copay.
Preventive Services See details
Preventive services are covered, but annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, telemonitoring services, home and bathroom safety devices and modifications, counseling services, and additional sessions of smoking and tobacco cessation counseling are not covered. Health education, home-based palliative care, and remote access technologies have no copay. Fitness benefits have a copay of $0 - $250, and Enhanced Disease Management has no copay. Kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) have a copay between $195 and $1395. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams and eyewear. Eye exams and eyewear have no copay, and the plan covers one routine eye exam per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include Medicare dental services with a $30 copay, 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. Orthodontic services, adjunctive general services, prosthodontics (both removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the HMSA Akamai Advantage Complete Plus (PPO) plan. There is a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance, and Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by HMSA Akamai Advantage Complete Plus (PPO), including Diagnostic Procedures/Tests with a coinsurance of at most 20%, Lab Services with no copay, Diagnostic Radiological Services with a copay of at most $50 and a coinsurance of at most 20%, Therapeutic Radiological Services with a copay of at most $50, and Outpatient X-Ray Services with a coinsurance of at most 20%. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the HMSA Akamai Advantage Complete Plus (PPO) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the following sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HMSA Akamai Advantage Complete Plus (PPO) plan, but require prior authorization. For days 1-20, the copay is $20, for days 21-40 the copay is $190, and for days 41-100, there is no copay. Additional days beyond Medicare coverage and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for over-the-counter (OTC) items with a $200 maximum benefit every three months, and other services with 20% coinsurance for Ambulatory Infusion Suite (AIS) Drug Administration and Nursing Services. Acupuncture, meal benefits, 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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