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HMSA Akamai Advantage Dual Care (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HMSA Akamai Advantage Dual Care (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HMSA Akamai Advantage Dual Care (PPO D-SNP) in 2026, please refer to our full plan details page.
HMSA Akamai Advantage Dual Care (PPO D-SNP) is a PPO D-SNP plan offered by Hawaii Medical Service Association available for enrollment in 2026 to people living in Hawaii,Kalawao, Kauai, Maui and Honolulu counties. The overall rating for this plan is not yet available for 2026.
It's important to know that HMSA Akamai Advantage Dual Care (PPO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
HMSA Akamai Advantage Dual Care (PPO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HMSA Akamai Advantage Dual Care (PPO D-SNP).
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 Dual Care (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $42.30. 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 $615.00 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 $13900.00 (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 $13900.00 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 Dual Care (PPO D-SNP) plan features an annual drug deductible of $615. For Tier 1 Preferred Generic and Tier 2 Generic medications, members enjoy no copay for one-month, two-month, and three-month supplies at standard pharmacies and standard mail order. This makes managing everyday prescriptions affordable and predictable. Higher-tier medications require coinsurance rather than flat copays at standard pharmacies and standard mail order services. Tier 3 Preferred Brand and Tier 5 Specialty Tier drugs both carry a 25% coinsurance for one-month, two-month, and three-month supplies. Tier 4 Non-Preferred Drugs require a 30% coinsurance across all supply lengths.
Additional Benefits
The HMSA Akamai Advantage Dual Care (PPO D-SNP) plan offers comprehensive medical coverage featuring no copays for inpatient hospital stays, home health, and skilled nursing facility services. Outpatient services, primary care visits, specialist consultations, and emergency care are also available with no copays, though they typically require a 20% coinsurance. Additionally, diagnostic tests, medical equipment, and dialysis are covered with no copay and a 20% coinsurance. For supplemental care, the plan provides preventive and comprehensive dental services, diagnostic hearing exams, and routine eye exams with no copays. Vision benefits also include no copay for eyewear, featuring a $300 annual maximum benefit and no deductible. Members can also take advantage of an over-the-counter allowance of up to $125 per month with no copay or coinsurance.
Inpatient Hospital See details
HMSA Akamai Advantage Dual Care (PPO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay or coinsurance, though prior authorization is required. However, some services are not covered, including additional days, room upgrades, and non-Medicare-covered stays.
Outpatient Services See details
HMSA Akamai Advantage Dual Care (PPO D-SNP) covers outpatient hospital and ambulatory surgical center services with no copay and coinsurance ranging from no coinsurance to 20%. Outpatient substance abuse and blood services are also covered with no copay and 20% coinsurance, with the deductible waived for the first three pints of blood.
Partial Hospitalization See details
HMSA Akamai Advantage Dual Care (PPO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by HMSA Akamai Advantage Dual Care (PPO D-SNP), featuring ground and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
HMSA Akamai Advantage Dual Care (PPO D-SNP) covers emergency services with a 20% coinsurance and no copay, and urgently needed services with a 20% coinsurance and no copay, with coinsurance waived if admitted to the hospital within 24 hours. For worldwide emergency services, some services are covered but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
HMSA Akamai Advantage Dual Care (PPO D-SNP) covers primary care, specialist, mental health, psychiatric, and therapy services with no copay and a 20% coinsurance, though prior authorization is required for physical, occupational, and speech therapies. Additional telehealth services are covered with no copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services under the HMSA Akamai Advantage Dual Care (PPO D-SNP) plan are partially covered, featuring no copay and no coinsurance for annual physical exams, and no copay with 20% coinsurance for kidney disease education and other screenings. Covered supplemental benefits include remote access technologies, home-based palliative care, and fitness programs with copays ranging from no copay to $580 and no coinsurance. However, several services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, caregiver support, smoking cessation, disease management, telemonitoring, home modifications, and counseling.
Hearing Services See details
HMSA Akamai Advantage Dual Care (PPO D-SNP) covers diagnostic hearing exams with no copay, no coinsurance, and no deductible. Routine hearing exams, fitting evaluations, and both prescription and over-the-counter hearing aids are not covered.
Vision Services See details
Vision services are covered with no deductible by HMSA Akamai Advantage Dual Care (PPO D-SNP), including one annual routine eye exam with no copay and 20% coinsurance, and non-routine exams with no copay and no coinsurance. Eyewear is also covered with no copay, featuring a 20% coinsurance for contact lenses, no coinsurance for eyeglasses, and a $300 combined annual maximum benefit.
Dental Services See details
HMSA Akamai Advantage Dual Care (PPO D-SNP) partially covers dental services, offering Medicare-covered dental care with no copay and a 20% coinsurance, alongside other preventive and comprehensive dental benefits with no copay and no coinsurance. Non-covered services include other diagnostic services, adjunctive general services, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
HMSA Akamai Advantage Dual Care (PPO D-SNP) covers home infusion bundled services with no copay and no coinsurance, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by HMSA Akamai Advantage Dual Care (PPO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
HMSA Akamai Advantage Dual Care (PPO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment and prosthetics, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HMSA Akamai Advantage Dual Care (PPO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required. This coverage includes outpatient diagnostic procedures, lab services, therapeutic radiological services, and X-rays.
Home Health Services See details
HMSA Akamai Advantage Dual Care (PPO D-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required to receive this benefit.
Cardiac Rehabilitation Services See details
HMSA Akamai Advantage Dual Care (PPO D-SNP) offers Cardiac Rehabilitation Services with no copay and prior authorization, but only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HMSA Akamai Advantage Dual Care (PPO D-SNP) with no copay and no coinsurance, and a prior three-day inpatient hospital stay is not required for admission. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by HMSA Akamai Advantage Dual Care (PPO D-SNP), which provides over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $125 per month. Acupuncture, meal benefits, and highly integrated services are not covered under this benefit.
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