Are you eligible for both Medicare and Medicaid (QUEST Integration)? Dual Care offers you a choice of doctors and a care coordinator who’ll help you get the care and support you need.
We can help
Not sure if you qualify for HMSA Akamai Advantage Dual Care? Make an appointment with a representative to find out. Call 8 a.m. to 8 p.m., seven days a week.
- Oahu: 808-948-6235
- Neighbor Islands: 1-800-693-4672 toll-free
- TTY: 711
Here’s a short description of the 2016 plan benefits and amount you’d pay. There may be some exceptions, so check the Summary of Benefits or Evidence of Coverage for details. Cost may be different, depending on how much you receive in Extra Help for prescription drugs. Please contact us if you have questions.
|Plan||HMSA Akamai Advantage Dual Care
(The amount you pay each month.)
In-network out-of-pocket maximum
(The most you pay each year for Medicare-covered services from in-network providers.)
|Inpatient hospital care||$0/day, up to 90 days|
|Skilled nursing facility||$0/day, up to 100 days|
|Primary care provider office visit||$0|
|Specialty care provider office visit||$0|
|Annual wellness visit||$0|
|Durable medical equipment||$0|
|Part B drugs||$0|
|Annual deductible||If you don’t qualify for Low-Income Subsidy (LIS), you pay the Medicare Part D cost share outlined in the Summary of Benefits and Evidence of Coverage. If you qualify for LIS, you pay $0.|
|30-day supply from retail pharmacy|
|Generic||$0, $1.20, $2.95, or 15%|
|All other drugs||$0, $3.60, $7.40, or 15%|
|HMSA’s Online Care||$0|
|Resources and Plan Materials|
|Evidence of Coverage||Download|
|Member Resources||Learn more|
- This plan information is effective January 1, 2016.
- Limitations, copayments, and restrictions may apply.
- This benefit information is a brief summary, not a complete description of benefits. For more information, contact the plan.
- Beneficiaries may not enroll in HMSA Akamai Advantage Dual Care through the CMS Medicare Online Enrollment Center at this time; please contact HMSA for enrollment assistance.
- Medicare evaluates plans based on 5-Star Rating system. Star Ratings are calculated each year and may change from one year to the next.
- HMSA Akamai Advantage is a PPO plan with a Medicare contract. Enrollment in HMSA Akamai Advantage depends on contract renewal.
- Out-of-network/non-contracted providers are under no obligation to treat HMSA Akamai Advantage members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
- To be enrolled in HMSA Akamai Advantage Dual Care, you must be eligible for your state’s Medicaid program and belong to a qualifying Medicaid category.
- Premium, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
- You must continue to pay your part B premiums unless your Part B premium is paid for you by Medicaid or another third party.
* Because you get assistance from Medicaid, you pay nothing for your premium or covered services as long as you follow the plans’ rules for getting your care.
1 - Physician visit copayment may apply.