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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 2026, 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 2026.
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 $160.00. 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. 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 $7200.00 (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 $7200.00 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) prescription drug plan has an annual drug deductible of $200. Under this plan, Tier 1 preferred generic drugs feature no copay for one-month, two-month, and three-month supplies at standard pharmacies and through standard mail order. Tier 2 generic drugs require an $11 copay per month at standard pharmacies, but standard mail order offers a cost-saving flat $11 copay for up to a three-month supply. For higher-tier medications, costs are based on coinsurance rather than set copays. Tier 3 preferred brand drugs require a 20% coinsurance, and Tier 4 non-preferred drugs have a 30% coinsurance for standard pharmacy and mail order purchases. Tier 5 specialty tier drugs carry a 29% coinsurance across all supply durations for standard retail and standard mail-order fills.
Additional Benefits
The HMSA Akamai Advantage Complete Plus (PPO) plan offers comprehensive coverage with no copay or coinsurance for primary care, telehealth, and preventive services. If you need specialist care, mental health visits, or physical therapy, you will pay a copay of $30 to $35 per visit. For inpatient hospital stays, members pay a $450 daily copay for the first four days and no copay for days five through ninety. Routine dental, vision, and hearing exams are covered with no copay, and the plan provides a $300 annual allowance for eyewear. While diagnostic lab work and home health services also feature no copay, outpatient diagnostics, dialysis, and durable medical equipment generally require a 20% coinsurance. Emergency care is accessible with a $115 copay, which is waived if you are admitted to the hospital within 24 hours.
Inpatient Hospital See details
HMSA Akamai Advantage Complete Plus (PPO) covers inpatient acute and psychiatric hospital stays with prior authorization and no coinsurance, requiring a $450 daily copay for days 1 to 4 and no copay for days 5 to 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HMSA Akamai Advantage Complete Plus (PPO) covers outpatient hospital and ambulatory surgical center services with a 0% to 20% coinsurance and no copay, while observation services require a $100 daily copay and coinsurance. Outpatient substance abuse services require a $35 copay per session with no coinsurance, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
HMSA Akamai Advantage Complete Plus (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HMSA Akamai Advantage Complete Plus (PPO), which features a $300 copay and no coinsurance for both ground and air ambulance services, subject to prior authorization. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
HMSA Akamai Advantage Complete Plus (PPO) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $35 copay and no coinsurance, with 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 Plus (PPO) offers primary care and telehealth services with no copay and no coinsurance, while specialist, mental health, psychiatric, and opioid treatment visits require a $35 copay and no coinsurance. Physical, occupational, and speech therapies have a $30 copay and no coinsurance, whereas podiatry is not covered and chiropractic services are only partially covered.
Preventive Services See details
Preventive services are partially covered by HMSA Akamai Advantage Complete Plus (PPO) with no copay and no coinsurance, although prior authorization is required for certain services. Covered benefits include Medicare-covered preventive care and kidney disease education, while annual physical exams, fitness benefits, and health education are not covered.
Hearing Services See details
HMSA Akamai Advantage Complete Plus (PPO) offers hearing exams with no copay and no coinsurance, which includes one routine exam annually and unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $195 to $1,395 (limited to one aid per ear per year), though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are covered by HMSA Akamai Advantage Complete Plus (PPO) with no copay and no coinsurance for eye exams and eyewear. Coverage includes one routine and one non-routine exam per year, plus a $300 annual maximum benefit for contact lenses, eyeglasses, and upgrades.
Dental Services See details
Dental services are partially covered by HMSA Akamai Advantage Complete Plus (PPO), with Medicare-covered dental services requiring a $35 copay and no coinsurance. Covered preventive and comprehensive services—including oral exams, cleanings, x-rays, fluoride, restorative, endodontics, periodontics, and oral surgery—have no copay and no coinsurance, while other diagnostic, adjunctive general, prosthodontics (fixed and removable), maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HMSA Akamai Advantage Complete Plus (PPO) with no copay, subject to prior authorization. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by HMSA Akamai Advantage Complete Plus (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
HMSA Akamai Advantage Complete Plus (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, with prior authorization required for certain items. Diabetic supplies are covered with no copay from specified manufacturers, while diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
HMSA Akamai Advantage Complete Plus (PPO) covers diagnostic and radiological services with prior authorization, offering lab services with no copay. Diagnostic procedures, radiological services, and outpatient X-rays require a minimum 20% coinsurance and copayments starting at $50.
Home Health Services See details
HMSA Akamai Advantage Complete 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 Complete Plus (PPO) does not cover cardiac rehabilitation services. This includes cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services, which are all not covered by the plan.
Skilled Nursing Facility (SNF) See details
HMSA Akamai Advantage Complete Plus (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1-20, a $210 daily copay for days 21-40, and no copay for days 41-100. Prior authorization is required, a 3-day prior inpatient hospital stay is not required, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
HMSA Akamai Advantage Complete Plus (PPO) partially covers other services, offering coverage for 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.
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