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HMSA Akamai Advantage

Plan ID: H3832-9-0

HMSA Akamai Advantage Complete (PPO)

2024 HMSA Akamai Advantage Complete (PPO) H3832 — 009— 0 is a Medicare Advantage plan with drug coverage. It has received a 4-out-of-5 star rating from CMS for 2024.

Learn more about HMSA Akamai Advantage Complete (PPO) H3832 - 009 - 0, including the health and drug services it covers, by reading our easy-to-use guide. Or contact a licensed insurance agent for help now.

4 / 5 stars for 2024

$0 /mo

Monthly premium

$0 annual deductible

Health deductible

$380.00

Drug deductible

$6700.00

Out-of-pocket maximum

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Call to enroll

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Overview Benefits & Costs Drug Coverage Additional Benefits

Plan Overview

2024 HMSA Akamai Advantage Complete (PPO) H3832 — 009— 0 is a Local PPO offered in Honolulu County by HMSA Akamai Advantage. It has a monthly premium of $0.00.

Premium Breakdown

Standard Part B Premium

$174.80

Part B premium reduction

Part C Premium

Part D Basic Premium

Part D Supplemental Premium

Part D Total

$0.00

Monthly Premium (Parts C & D)

$0.00

Total Premium (Parts B, C, & D)

$164.90

Special needs plan type

Out-of-pocket maximum

$6700.00

Plan Organization:

HMSA Akamai Advantage

Plan Type:

Local PPO

Location:

Honolulu County

Drugs Covered:

Yes

Drug Formulary:

Formulary Link

Pharmacies:

Pharmacies Link

Doctor Choice:

Any Doctor

Doctors Link:

Doctors Link

Deductibles

The amount you must pay each year before your plan starts to pay for covered services or drugs.

Health deductible

$0 annual deductible

Drug deductible

$380

Note:

This plan does not charge an annual deductible for all drugs. The $380.00 annual deductible only applies to drugs in certain tiers.

Other Plan Notes

This plan does not charge an annual deductible for all drugs. The $380.00 annual deductible only applies to drugs on certain tiers.

Sign up for HMSA Akamai Advantage Complete (PPO)

Enroll online

Call to enroll

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Drug Coverage

HMSA Akamai Advantage Complete (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Benefit Type

Enhanced

Prescription drug deductible

$380.00

Increased initial coverage limit

Additional gap coverage

Part D Premium Reduction

This plan's premium may be reduced for you if you qualify for the low-income subsidy (also known as LIS or "Extra help"). The following is what you'll pay for with LIS.

Part D	LIS 25%	LIS 50%	LIS 75%	LIS Full
$0.00	$0.00	$0.00	$0.00	$0.00

Initial Coverage Phase

After you pay your $380.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00. Once you reach that amount, you will enter the next coverage phase.

30 Days

60 Days

90 Days

Tier	Preferred Pharmacy	Standard Pharmacy	Preferred Mail	Standard Mail
1. Preferred Generic	-	$4.50 copay	-	$4.50 copay
2. Standard Generic	-	$12.00 copay	-	$12.00 copay
3. Preferred Brand	-	$47.00 copay	-	$47.00 copay
4. Non-Preferred Drug	-	$100.00 copay	-	$100.00 copay
5. Specialty Tier	-	27%	-	27%

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.

Generic Drugs

$4.15 copay or 5% (whichever costs more)

Brand-name

$10.35 copay or 5% (whichever costs more)

Additional Benefits

HMSA Akamai Advantage Complete (PPO) also provides the following benefits.

Comprehensive dental

Non-routine services

Not covered

Diagnostic services

Not covered

Restorative services

In-Network: $0 copay

Out-Of-Network: 40% coinsurance

Endodontics

Not covered

Periodontics

Not covered

Extractions

In-Network: $0 copay

Out-Of-Network: 40% coinsurance

Prosthodontics, other oral/maxillofacial surgery, other services

Not covered

Preventive dental

Oral exam

In-Network: $0 copay

Out-Of-Network: 40% coinsurance

Cleaning

In-Network: $0 copay

Out-Of-Network: 40% coinsurance

Fluoride treatment

In-Network: $0 copay

Out-Of-Network: 40% coinsurance

Dental x-ray(s)

In-Network: $0 copay

Out-Of-Network: 40% coinsurance

Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures

In-Network: 20% coinsurance

Out-Of-Network: 40% coinsurance

Lab services

In-Network: 20% coinsurance

Out-Of-Network: 40% coinsurance

Diagnostic radiology services (eg, MRI)

In-Network: 20% coinsurance

Out-Of-Network: 40% coinsurance

Outpatient x-rays

In-Network: 20% coinsurance

Out-Of-Network: 40% coinsurance

Doctor visits

Primary

In-Network: $0 copay

Out-Of-Network: $40 copay per visit

Specialist

In-Network: $50 copay per visit

Out-Of-Network: $60 copay per visit

Emergency care/Urgent care

Emergency

$100 copay per visit (always covered)

Urgent care

$50 copay per visit (always covered)

Foot care (podiatry services)

Foot exams and treatment

In-Network: $50 copay

Out-Of-Network: 40% coinsurance

Routine foot care

Not covered

Ground ambulance

Service

In-Network: $250 copay

Out-Of-Network: $250 copay

Hearing

Hearing exam

In-Network: $50 copay

Out-Of-Network: 40% coinsurance

Fitting/evaluation

Not covered

Hearing aids - inner ear

Not covered

Hearing aids - outer ear

Not covered

Hearing aids - over the ear

Not covered

Inpatient hospital coverage

Service

In-Network: $370 per day for days 1 through 6 $50 per day for days 7 through 60 $0 per day for days 61 through 90

Out-Of-Network: $400 per day for days 1 through 14 $0 per day for days 15 through 90

Outpatient hospital coverage

Service

In-Network: 0-20% coinsurance per visit

Out-Of-Network: 0-40% coinsurance per visit

Outpatient prescription drugs

HMSA Akamai Advantage Complete (PPO) does not provide this type of benefit.

Optional benefits

HMSA Akamai Advantage Complete (PPO) does not provide this type of benefit.

Medical equipment/supplies

Durable medical equipment (eg, wheelchairs, oxygen)

In-Network: 20% coinsurance per item

Out-Of-Network: 40% coinsurance per item

Prosthetics (eg, braces, artificial limbs)

In-Network: 20% coinsurance per item

Out-Of-Network: 40% coinsurance per item

Diabetes supplies

In-Network: $0 copay per item

Out-Of-Network: 40% coinsurance per item

Medicare Part B drugs

Chemotherapy

In-Network: 0-20% coinsurance

Out-Of-Network: 40% coinsurance

Other Part B drugs

In-Network: 0-20% coinsurance

Out-Of-Network: 40% coinsurance

Part B Insulin drugs

In-Network: $35 copay

Out-Of-Network: 40% coinsurance

Mental health services

Inpatient hospital - psychiatric

In-Network: $320 per day for days 1 through 6 $0 per day for days 7 through 90

Out-Of-Network: $400 per day for days 1 through 14 $0 per day for days 15 through 90

Outpatient group therapy visit with a psychiatrist

In-Network: $40 copay

Out-Of-Network: 40% coinsurance

Outpatient individual therapy visit with a psychiatrist

In-Network: $40 copay

Out-Of-Network: 40% coinsurance

Outpatient group therapy visit

In-Network: $40 copay

Out-Of-Network: 40% coinsurance

Outpatient individual therapy visit

In-Network: $40 copay

Out-Of-Network: 40% coinsurance

Preventive care

Service

In-Network: $0 copay

Out-Of-Network: $0 copay

Rehabilitation services

Occupational therapy visit

In-Network: $35 copay

Out-Of-Network: 40% coinsurance

Physical therapy and speech and language therapy visit

In-Network: $35 copay

Out-Of-Network: 40% coinsurance

Skilled Nursing Facility

Service

In-Network: $0 per day for days 1 through 20 $200 per day for days 21 through 60 $0 per day for days 61 through 100

Out-Of-Network: $200 per day for days 1 through 50 $0 per day for days 51 through 100

Transportation

Service

Not covered

Vision

Routine eye exam

In-Network: $10 copay

Out-Of-Network: 40% coinsurance

Other

Not covered

Contact lenses

In-Network: $0 copay

Out-Of-Network: $0 copay

Eyeglasses (frames and lenses)

In-Network: $0 copay

Out-Of-Network: $0 copay

Eyeglass frames

Not covered

Eyeglass lenses

Not covered

Upgrades

Not covered

Wellness programs (eg, fitness, nursing hotline)

Service

Covered

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