A non-government entity
Hawaii Medical Service Association
Plan ID: H8481-1-0
Plan Summary PageHMSA Akamai Advantage Dual Care (PPO D-SNP)
2026 HMSA Akamai Advantage Dual Care (PPO D-SNP) H8481 — 001 — 0 is a Medicare Advantage plan with drug coverage.
Learn more about HMSA Akamai Advantage Dual Care (PPO D-SNP) H8481 - 001 - 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.
$42.30 /mo
Monthly premium
$615.00
Drug deductible
$13900.00
Out-of-pocket maximum (Combined)
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week!
About This Plan
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.
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.
Plan data sourced from the official CMS 2026 public benefit files. Reviewed by Walt Whitney. How we source and review plan information.
Plan Overview
2026 HMSA Akamai Advantage Dual Care (PPO D-SNP) H8481 — 001 — 0 is a PPO D-SNP offered in Hawaii,Kalawao, Kauai, Maui and Honolulu counties by Hawaii Medical Service Association. It has a monthly premium of $42.30.
Important:
2026 HMSA Akamai Advantage Dual Care (PPO D-SNP) H8481 — 001 — 0 is a Dual-Eligible Special Needs Type plan. You can only enroll in this plan if you meet specific criteria.
Premium Breakdown
Monthly plan premium
$42.30
Standard Part B premium
$202.90
Note:
The standard Medicare Part B premium for 2026 is $202.90. Your actual Part B premium may differ based on income (IRMAA), late enrollment penalties, Medicaid assistance, disability status, or other factors. Most people enrolled in Medicare Part B are required to pay this premium.
Special needs plan type
Yes
Out-of-pocket maximum (In-Network)
N/A
Out-of-pocket maximum (Out-of-Network)
$9250.00
Out-of-pocket maximum (Combined)
$13900.00
Conditions Covered
None
Plan Organization:
Hawaii Medical Service Association
Plan Type:
PPO D-SNP
Location:
Hawaii,Kalawao, Kauai, Maui and Honolulu counties
Drugs Covered:
Yes
Drug Formulary:
Pharmacies:
Doctors Link:
Deductibles
The amount you must pay each year before your plan starts to pay for covered services or drugs.
Drug deductible
$615
Note:
This plan does not charge an annual deductible for all drugs. The $615.00 annual deductible only applies to drugs in certain tiers.
Sign up for HMSA Akamai Advantage Dual Care (PPO D-SNP)
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
HMSA Akamai Advantage Dual Care (PPO D-SNP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Benefit Type
Enhanced Alternative
Prescription drug deductible
$615.00
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 Full |
|---|---|
$42.30 | $42.30 |
Initial Coverage Phase
After you pay your $615.00 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 $2100.00. Once you reach that amount, you will enter the next coverage phase.
Tier | Preferred Pharmacy | Standard Pharmacy | Preferred Mail | Standard Mail |
|---|---|---|---|---|
1. Preferred Generic | - | $0.00 copay | - | $0.00 copay |
2. Generic | - | $0.00 copay | - | $0.00 copay |
3. Preferred Brand | - | 25% coinsurance | - | 25% coinsurance |
4. Non-Preferred Drug | - | 30% coinsurance | - | 30% coinsurance |
5. Specialty Tier | - | 25% coinsurance | - | 25% coinsurance |
Catastrophic Coverage Phase
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2100.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
HMSA Akamai Advantage Dual Care (PPO D-SNP) also provides the following benefits.
Inpatient Hospital
Inpatient Hospital benefits are covered.
Inpatient Hospital-Acute
Inpatient Hospital-Acute benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Do you charge the Medicare-defined cost share for tier 1?
Yes
Periodicity
Per Admission or Per Stay
Do you charge cost sharing on the day of discharge?
No
Additional Days for Inpatient Hospital-Acute
Not covered.
Non-Medicare-covered Stay for Inpatient Hospital-Acute
Not covered.
Upgrades for Inpatient Hospital-Acute
Not covered.
Inpatient Hospital Psychiatric
Inpatient Hospital Psychiatric benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Do you charge the Medicare-defined cost share for tier 1?
Yes
Periodicity
Per Admission or Per Stay
Do you charge cost sharing on the day of discharge?
No
Additional Days for Inpatient Hospital Psychiatric
Not covered.
Non-Medicare-covered Stay for Inpatient Hospital Psychiatric
Not covered.
Outpatient Services
Outpatient Services benefits are covered.
All Outpatient Hospital Services
All Outpatient Hospital Services benefits are covered.
Cost Sharing:
More Details:
Which Services have a Coinsurance
Medicare-covered Outpatient Hospital Services, Medicare-covered Observation Services
Which Services have a Copayment
Medicare-covered Observation Services
Outpatient Hospital Services
Outpatient Hospital Services benefits are covered. Prior Authorization is required.
Cost Sharing:
Observation Services
Observation Services benefits are covered. Prior Authorization is required.
Cost Sharing:
Ambulatory Surgical Center (ASC) Services
Ambulatory Surgical Center (ASC) Services benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Minimum coinsurance
0
Maximum coinsurance
20
Outpatient Substance Abuse Services
Outpatient Substance Abuse Services benefits are covered.
Cost Sharing:
More Details:
Which Outpatient Substance Abuse services have a Coinsurance
Medicare-covered Individual Sessions, Medicare-covered Group Sessions
Individual Sessions for Outpatient Substance Abuse
Individual Sessions for Outpatient Substance Abuse benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Group Sessions for Outpatient Substance Abuse
Group Sessions for Outpatient Substance Abuse benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Outpatient Blood Services
Outpatient Blood Services benefits are covered.
Cost Sharing:
More Details:
Is there a deductible?
No
Do you waive the deductible for the first three pints of blood?
Yes
Partial Hospitalization
Partial Hospitalization benefits are covered.
Partial Hospitalization
Partial Hospitalization benefits are covered.
Cost Sharing:
More Details:
Coinsurance percent
20
Partial Hospitalization
Partial Hospitalization benefits are covered.
Cost Sharing:
More Details:
Coinsurance percent
20
Ambulance and Transportation Services
Ambulance and Transportation Services benefits are covered.
All Ambulance Services
All Ambulance Services benefits are covered. Prior Authorization is required.
More Details:
Is there a coinsurance?
Yes
Which Services have a Coinsurance
Medicare-covered Ground Ambulance Services, Medicare-covered Air Ambulance Services
Is this Coinsurance waived if admitted to hospital?
No
Is there a copayment ?
No
Ground Ambulance Services
Ground Ambulance Services benefits are covered.
Cost Sharing:
Air Ambulance Services
Air Ambulance Services benefits are covered.
Cost Sharing:
Transportation Services
Transportation Services benefits are covered.
Transportation Services - Plan Approved Health-related Location
Not covered.
Transportation Services - Any Health-related Location
Not covered.
Emergency Services
Emergency Services benefits are covered.
Emergency Services
Emergency Services benefits are covered.
Cost Sharing:
More Details:
Is there a coinsurance?
Yes
Is the coinsurance for Medicare-covered benefits waived if admitted to hospital?
Yes
Select either days or hours within which admission must occur for waiver
Hours
Enter number of days or hours
24
Is there a copayment?
No
Maximum per visit amount
115.00
Does the cost sharing count towards any plan-level deductible?
Yes
Urgently Needed Services
Urgently Needed Services benefits are covered.
Cost Sharing:
More Details:
Is there a coinsurance?
Yes
Is the coinsurance for Medicare-covered benefits waived if admitted to hospital?
Yes
Select either days or hours within which admission must occur for waiver
Hours
Enter number of days or hours
24
Is there a copayment?
No
Maximum per visit amount
40.00
Does the cost sharing count towards any plan-level deductible?
Yes
Worldwide Emergency Services
Worldwide Emergency Services benefits are covered.
Worldwide Emergency Coverage
Not covered.
Worldwide Urgent Coverage
Not covered.
Worldwide Emergency Transportation
Not covered.
Primary Care
Primary Care benefits are covered.
Primary Care Physician Services
Primary Care Physician Services benefits are covered.
Cost Sharing:
Chiropractic Services
Chiropractic Services benefits are covered.
Cost Sharing:
More Details:
Which Chiropractic Services have a Coinsurance
Routine Care
Routine Chiropractic Care
Not covered.
Occupational Therapy Services
Occupational Therapy Services benefits are covered. Prior Authorization is required.
Cost Sharing:
Physician Specialist Services
Physician Specialist Services benefits are covered.
Cost Sharing:
Mental Health Specialty Services
Mental Health Specialty Services benefits are covered.
Cost Sharing:
More Details:
Which Mental Health Specialty Services have a Coinsurance
Medicare-covered Individual Sessions, Medicare-covered Group Sessions
Individual Sessions for Mental Health Specialty Services
Individual Sessions for Mental Health Specialty Services benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Group Sessions for Mental Health Specialty Services
Group Sessions for Mental Health Specialty Services benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Podiatry Services
Not covered.
Other Health Care Professional
Other Health Care Professional benefits are covered.
Cost Sharing:
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Psychiatric Services
Psychiatric Services benefits are covered.
Cost Sharing:
More Details:
Which Psychiatric Services have a Coinsurance
Medicare-covered Individual Sessions, Medicare-covered Group Sessions
Individual Sessions for Psychiatric Services
Individual Sessions for Psychiatric Services benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Group Sessions for Psychiatric Services
Group Sessions for Psychiatric Services benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Physical Therapy and Speech-Language Pathology Services
Physical Therapy and Speech-Language Pathology Services benefits are covered. Prior Authorization is required.
Cost Sharing:
Additional Telehealth Benefits
Additional Telehealth Benefits benefits are covered – including services not usually covered by Medicare plans.
Cost Sharing:
More Details:
Medicare-covered benefits that may have Additional Telehealth Benefits available
7a: Primary Care Physician Services, 7d: Physician Specialist Services, 7e1: Individual Sessions for Mental Health Specialty Services, 7e2: Group Sessions for Mental Health Specialty Services, 7g: Other Health Care Professional, 7h1: Individual Sessions for Psychiatric Services, 7h2: Group Sessions for Psychiatric Services, 7k: Opioid Treatment Program Services, 9c1: Individual Sessions for Outpatient Substance Abuse, 9c2: Group Sessions for Outpatient Substance Abuse
Opioid Treatment Program Services
Opioid Treatment Program Services benefits are covered.
Cost Sharing:
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Preventive Services
Preventive Services benefits are covered.
Medicare-covered Zero Dollar Preventive Services
Medicare-covered Zero Dollar Preventive Services benefits are covered. Prior Authorization is required.
Annual Physical Exam
Annual Physical Exam benefits are covered – including services not usually covered by Medicare plans.
Cost Sharing:
More Details:
Is there a maximum plan benefit coverage amount?
No
Additional Preventive Services
Additional Preventive Services benefits are covered – including services not usually covered by Medicare plans.
Cost Sharing:
More Details:
Which Other Defined Supplemental Benefits have a Copayment
14c4: Fitness Benefit*, 14c7: Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)*, 14c20: Home-Based Palliative Care
Is there a service-specific Maximum Plan Benefit Coverage amount for Other Defined Supplemental Benefits?
No
Health Education
Not covered.
In-Home Safety Assessment
Not covered.
Personal Emergency Response System (PERS)
Not covered.
Medical Nutrition Therapy (MNT)
Not covered.
Post discharge In-Home Medication Reconciliation
Not covered.
Re-admission Prevention
Not covered.
Wigs for Hair Loss Related to Chemotherapy
Not covered.
Weight Management Programs
Not covered.
Alternative Therapies
Not covered.
Therapeutic Massage
Not covered.
Adult Day Health Services
Not covered.
Nutritional/Dietary Benefit
Not covered.
Home-Based Palliative Care
Home-Based Palliative Care benefits are covered.
More Details:
Type of benefit for Home-Based Palliative Care
Mandatory
Minimum copayment
0.00
Maximum copayment
0.00
In-Home Support Services
Not covered.
Support for Caregivers of Enrollees
Not covered.
Additional Sessions of Smoking and Tobacco Cessation Counseling
Not covered.
Fitness Benefit
Fitness Benefit benefits are covered.
More Details:
Type of Fitness Benefit offered
Physical Fitness, Memory Fitness
Minimum copayment
0.00
Maximum copayment
580.00
Enhanced Disease Management
Not covered.
Telemonitoring Services
Not covered.
Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)
Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline) benefits are covered.
More Details:
Minimum copayment
0.00
Maximum copayment
0.00
Home and Bathroom Safety Devices and Modifications
Not covered.
Counseling Services
Not covered.
Kidney Disease Education Services
Kidney Disease Education Services benefits are covered.
Cost Sharing:
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Other Preventive Services
Other Preventive Services benefits are covered.
Cost Sharing:
More Details:
Which Services have a Coinsurance
Medicare-covered Glaucoma Screening, Medicare-covered Diabetes Self-Management Training, Medicare-covered Digital Rectal Exams, Medicare-covered EKG following Welcome Visit
Is a referral required for any Services?
No
Glaucoma Screening
Glaucoma Screening benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Diabetes Self-Management Training
Diabetes Self-Management Training benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Digital Rectal Exams
Digital Rectal Exams benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
EKG following Welcome Visit
EKG following Welcome Visit benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Hearing Services
Hearing Services benefits are covered.
Hearing Exams
Hearing Exams benefits are covered.
Cost Sharing:
More Details:
Which Hearing Exam Benefits have a Coinsurance
Routine Hearing Exams
Minimum coinsurance
20
Is there a deductible?
No
Routine Hearing Exams
Not covered.
Fitting/Evaluation for Hearing Aid
Not covered.
Prescription Hearing Aids
Prescription Hearing Aids benefits are covered.
Prescription Hearing Aids (all types)
Not covered.
Prescription Hearing Aids - Inner Ear
Not covered.
Prescription Hearing Aids - Outer Ear
Not covered.
Prescription Hearing Aids - Over the Ear
Not covered.
OTC Hearing Aids
Not covered.
Vision Services
Vision Services benefits are covered.
Eye Exams
Eye Exams benefits are covered – including services not usually covered by Medicare plans.
Cost Sharing:
More Details:
Which Eye Exams have a Coinsurance
Routine Eye Exams
Which Eye Exams have a Copayment
Medicare-covered Benefits, Other
Is there a deductible?
No
Is there a deductible?
No
Is there a maximum plan benefit coverage?
No
Routine Eye Exams
Routine Eye Exams benefits are covered.
Cost Sharing:
More Details:
Is this benefit unlimited?
No, indicate number
Number of visits
1
Periodicity
Every year
Other Eye Exam Services
Other Eye Exam Services benefits are covered.
Cost Sharing:
More Details:
Is this benefit unlimited?
No, indicate number
Number of visits
1
Periodicity
Every year
Service Name
Non Routine Eye Exam Services
Eyewear
Eyewear benefits are covered – including services not usually covered by Medicare plans.
Cost Sharing:
More Details:
Which Eyewear Benefits have a Coinsurance
Contact lenses
Is there a deductible?
No
Is there a deductible?
No
Is there a maximum plan benefit coverage?
Yes
Does the Maximum Plan Benefit Coverage amount apply to In-network services only OR does it apply to both In-network and Out-of-network services?
Both In-network and Out-of-network services
Maximum plan benefit coverage type
Plan-specified amount per period
Do you offer a Combined Max Plan Benefit Coverage Amount for all Eyewear?
Yes
Combined maximum amount
300.00
Periodicity
Every year
Contact Lenses
Contact Lenses benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Eyeglasses (lenses and frames)
Eyeglasses (lenses and frames) benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Eyeglass lenses
Eyeglass lenses benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Eyeglass frames
Eyeglass frames benefits are covered.
More Details:
Is this benefit unlimited?
Yes
Upgrades
Upgrades benefits are covered.
Dental Services
Dental Services benefits are covered.
Medicare Dental Services
Medicare Dental Services benefits are covered.
Cost Sharing:
More Details:
Coinsurance percentage
20
Other Dental Services
Other Dental Services benefits are covered.
More Details:
Is there a maximum plan benefit coverage?
No
Oral Exams
Oral Exams benefits are covered.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of visits
2
Periodicity
Every year
Dental X-Rays
Dental X-Rays benefits are covered.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of X-Rays
1
Periodicity
Other, Describe
Description
The plan provides one set of bitewing X-rays every year. The plan provides one set of full mouth X-rays every 5 years.
Prophylaxis (Cleaning)
Prophylaxis (Cleaning) benefits are covered.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of visits
2
Periodicity
Every year
Fluoride Treatment
Fluoride Treatment benefits are covered.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of visits
2
Periodicity
Every year
Other Preventive Dental Services
Other Preventive Dental Services benefits are covered.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of visits
2
Periodicity
Every year
Orthodontic Services
Orthodontic Services benefits are covered.
More Details:
Is there a maximum plan benefit coverage?
No
Restorative Services
Restorative Services benefits are covered.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of visits
2
Periodicity
Every year
Adjunctive General Services
Not covered.
Endodontics
Endodontics benefits are covered.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of visits
1
Periodicity
Every year
Periodontics
Periodontics benefits are covered.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of visits
7
Periodicity
Other, Describe
Description
Deep Cleaning/Root Planing: 1 per quadrant every 24 months (Up to 4 total for 4 quadrants in mouth). Full Mouth Debridement: 1 every 3 calendar yearsTherapeutic Cleaning � Gum Inflammation: 2 per calendar year. The 2 cleaning service total is shared with the 16b4 benefit.
Prosthodontics, removable
Prosthodontics, removable benefits are covered.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of visits
10
Periodicity
Other, Describe
Description
Immediate upper complete denture - 1 per lifetimeImmediate lower complete denture - 1 /lifetimeUpper partial/denture - 1 every 5 yearsLower partial/denture - 1 every 5 yearsUpper partial/denture adjustments /repairs - 2 per calendar yearLower partial/denture adjustments /repairs - 2 per year
Maxillofacial Prosthetics
Not covered.
Implant Services
Not covered.
Prosthodontics, fixed
Not covered.
Oral and Maxillofacial Surgery
Oral and Maxillofacial Surgery benefits are covered.
Cost Sharing:
More Details:
Is this benefit unlimited?
No
Number of visits
5
Periodicity
Other, Describe
Description
Extractions (simple & surgical): 4 per calendar year. Removal of Impacted Tooth: 1 per tooth per lifetime
Orthodontics
Not covered.
Home Infusion bundled Services
Home Infusion bundled Services benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Which Medicare Part B Rx Drugs have a Coinsurance
Medicare Part B Chemotherapy/Radiation Drugs, Other Medicare Part B Drugs
Does this plan have a service specific maximum enrollee out-of-pocket cost (MOOP)?
No
Does the plan offer step therapy?
Yes
Does the benefit step from?
Part B to Part D
Insulin
Insulin benefits are covered.
Medicare Part B Insulin Drugs
Medicare Part B Insulin Drugs benefits are covered.
Cost Sharing:
More Details:
Does the Part B drugs - Insulin cost sharing count towards any plan-level deductible?
No
Medicare Part B Chemotherapy/Radiation Drugs
Medicare Part B Chemotherapy/Radiation Drugs benefits are covered.
More Details:
Minimum coinsurance
0
Maximum coinsurance
20
Other Medicare Part B Drugs
Other Medicare Part B Drugs benefits are covered.
More Details:
Minimum coinsurance
0
Maximum coinsurance
20
Dialysis Services
Dialysis Services benefits are covered.
Cost Sharing:
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Medical Equipment
Medical Equipment benefits are covered.
Durable Medical Equipment (DME)
Durable Medical Equipment (DME) benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Are there preferred vendors/manufacturers for Durable Medical Equipment (DME)?
No
Prosthetics/Medical Supplies - Non-Medicare benefit
Prosthetics/Medical Supplies - Non-Medicare benefit benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Which Prosthetics/Medical Supplies have a Coinsurance
Medicare-covered Prosthetic Devices, Medicare-covered Medical Supplies
Prosthetic Devices
Prosthetic Devices benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Medical Supplies
Medical Supplies benefits are covered.
Cost Sharing:
Diabetic Equipment
Diabetic Equipment benefits are covered.
Cost Sharing:
More Details:
Which Diabetic Supplies and Services have a Coinsurance
Medicare-covered Diabetic Supplies, Medicare-covered Diabetic Therapeutic Shoes or Inserts
Do you limit Diabetic supplies and services to those from specified manufacturers
Yes
Diabetic Supplies
Diabetic Supplies benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Diabetic Therapeutic Shoes/Inserts
Diabetic Therapeutic Shoes/Inserts benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Diagnostic and Radiological Services
Diagnostic and Radiological Services benefits are covered.
All Diagnostic services
All Diagnostic services benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Which Outpatient Diagnostic Procedures/Tests/Lab Services have a Coinsurance
Medicare-covered Diagnostic Procedures/Tests, Medicare-covered Lab Services
Is there a copayment?
No
Diagnostic Procedures/Tests
Diagnostic Procedures/Tests benefits are covered.
Cost Sharing:
More Details:
Minimum coinsurance
20
Lab Services
Lab Services benefits are covered.
Cost Sharing:
More Details:
Minimum coinsurance
20
All Radiological Services
All Radiological Services benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Which Outpatient Diagnostic/Therapeutic Radiological Services have a Coinsurance
Medicare-covered Diagnostic Radiological Services, Medicare-covered Therapeutic Radiological Services, Medicare-covered X-Ray Services
Is there a copayment?
No
Diagnostic Radiological Services
Diagnostic Radiological Services benefits are covered.
Cost Sharing:
More Details:
Minimum coinsurance
20
Therapeutic Radiological Services
Therapeutic Radiological Services benefits are covered.
Cost Sharing:
More Details:
Minimum coinsurance
20
Outpatient X-Ray Services
Outpatient X-Ray Services benefits are covered.
Cost Sharing:
More Details:
Minimum coinsurance
20
Home Health Services
Home Health Services benefits are covered. Prior Authorization is required.
Cost Sharing:
Cardiac Rehabilitation Services
Cardiac Rehabilitation Services benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Which Cardiac and Pulmonary Rehabilitation Services have a Coinsurance
Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, Additional Cardiac Rehabilitation Services
Cardiac Rehabilitation Services
Not covered.
Intensive Cardiac Rehabilitation Services
Not covered.
Pulmonary Rehabilitation Services
Not covered.
SET for PAD Services
Not covered.
Skilled Nursing Facility (SNF)
Skilled Nursing Facility (SNF) benefits are covered. Prior Authorization is required.
Cost Sharing:
More Details:
Does the plan provide Skilled Nursing Facility Services as a supplemental benefit under Part C?
Yes
Do you allow less than 3 day inpatient hospital stay prior to SNF admission?
Yes
Days
Zero
Do you charge the Medicare-defined cost share for tier 1?
Yes
Periodicity
Original Medicare
Additional Days beyond Medicare-covered for Skilled Nursing Facility (SNF)
Not covered.
Other Services
Other Services benefits are covered.
Acupuncture
Not covered.
Over-the-Counter (OTC) Items
Over-the-Counter (OTC) Items benefits are covered.
More Details:
Does the plan provide Over-The-Counter (OTC) Items as a supplemental benefit under Part C?
Yes
Is there a maximum plan benefit coverage amount?
Yes
Maximum plan benefit coverage amount
125.00
Periodicity
Every month
Does your Maximum Plan Benefit Coverage amount carry forward to the next period if it is unused?
No
Plan offers Nicotine Replacement Therapy (NRT) as a Part C OTC benefit?
Yes
The Nicotine Replacement Therapy (NRT) being offered does not duplicate any Part D OTC or formulary drugs.
The Nicotine Replacement Therapy (NRT) being offered does not duplicate any Part D OTC or formulary drugs.
Plan offers Naloxone coverage as a Part C OTC benefit?
Yes
Does this cover all of the drugs on the CMS OTC list which may be found in Chapter 4 of the Medicare Managed Care Manual
No
Indicate mode of delivery for the OTC Items
Claims Processing, Reimbursement, Other
Meal Benefit
Not covered.
Dual Eligible SNPs with Highly Integrated Services
Not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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
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