2016 - Oahu Plans

Request HMSA Akamai Advantage Info Kit

If you'd like an HMSA Akamai Advantage information kit, please fill out the form below. Information kits take about five business days to get to you.

* Required field









Form validation failed
Send failed, please try again

Thanks
We're glad you're interested in learning more about the many benefits HMSA Akamai Advantage has to offer you. If you don't get an information kit in seven days or would like to get your questions answered now, please call us.


Hours Available
You can call from 8 a.m to 8 p.m., seven days a week

Request HMSA Akamai Advantage Provider Directory

If you’d like an HMSA Akamai Advantage Provider Directory, please fill out the form below. We will mail it to you within three business days.

* Required field








Form validation failed
Send failed, please try again

Thanks
We’ll mail your HMSA Akamai Advantage Provider Directory within three business days. If you have other questions you would like to get answered now, please call us.


Hours Available
You can call from 8 a.m to 8 p.m., seven days a week

These plans will help create a strong, sustainable health care system for Hawaii’s seniors. You’ll get comprehensive medical, prescription drugs, and vision benefits.

Plan Complete
Plan
Complete Plus
Plan
Monthly premium
(The amount you pay each month.)
$70 $126
In-network out-of-pocket maximum
(The most you pay each year for Medicare-covered services from in-network providers.)
$6,700 $3,400
Medical Benefits*
  You Pay You Pay
Annual deductible $150 per year for some in-network and out-of-network services $0
Inpatient hospital care Days 1 to 6 - $280/day
Days 7 to 43 - $68/day
Days 44 to 90- $0/day
Days 1 to 7 - $270/day
Days 8 to 90 - $0/day
Additional days - $0/day
Skilled nursing facility Days 1 to 20 - $0/day
Days 21 to 62 - $160/day
Days 63 to 100 - $0/day
Days 1 to 20 - $40/day
Days 21 to 38 - $150/day
Days 39 to 100 - $ 0/day
Primary care provider office visit $35 $15
Specialty care provider office visit $50 $30
Annual wellness visit $0 $0
Outpatient services/surgery1 $150 deductible, then 20% 20%
Ambulance service $200 $200
Emergency room $75 $75
Urgent care $50 $30
Worldwide coverage for emergency physician
and outpatient services
10% 10%
Durable medical equipment 20% 20%
Diagnosis X-rays 20% 20%
Kidney dialysis 20% 20%
Part B drugs 20% 20%
Drug Benefits
  You Pay You Pay
Annual deductible $360
Does not apply to Tier 1
$0
 
Initial coverage stage
Until total drug costs reach $3,310
30-day supply from retail pharmacies
Tier 1 - Preferred Generic $4.50 $4
Tier 2 - Generic $12 $11
Tier 3 - Preferred Brand $47 $45
Tier 4 - Non-Preferred Brand $100 $95
Tier 5 - Specialty Drugs 25% 33%
90-day supply from mail-order pharmacy
Tier 1 - Preferred Generic $4.50 $4
Tier 2 - Generic $24 $22
Tier 3 - Preferred Brand $94 $90
Tier 4 - Non-Preferred Brand $200 $190
Tier 5 - Specialty Drugs 25% 33%
Coverage gap
Until your yearly out-of-pocket drug costs
reach $4,850
45% of the drug cost for brand drugs.
58% of the drug cost for generic drugs.
Additional gap coverage for some Tier 1 drugs
30-day supply from retail pharmacy Not available $4
90-day supply from mail-order pharmacy Not available $4
Catastrophic coverage
After your yearly out-of-pocket drug costs
reach $4,850
The greater of 5% or $2.95 for generic drugs (including brand drugs treated as generic) and $7.40 for other drugs.
Vision Benefits
  You Pay You Pay
Routine eye exam $50/1 exam per year $30/1 exam per year
Eyewear (supplemental) $0 for frames, lenses
or contacts. Every 2 years,
plan pays up to $70
$0 for frames, lenses
or contacts. Every 2 years,
plan pays up to $75
Wellness Benefits
SilverSneakers Available Not Available
Health Education and Health Coaching Available Available
Resources and Plan Materials
Evidence of Coverage Download Download
Member Resources Learn more Learn more

HMSA Disclaimer

  • This plan information is effective January 1, 2016. Benefits, formulary, provider network, premium, and/or copayments/coinsurance may change on January 1 of each year.
  • 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.
  • Medicare beneficiaries may also enroll in HMSA Akamai Advantage through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • 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.

* All plan benefits above are based on in-network services.
With the exception of emergency or urgent care, it may cost more to get care from out-of-network providers.
1 - Physician visit copayment may apply.

You’re eligible to enroll in HMSA Akamai Advantage if you:

  • Are entitled to Medicare Part A and enrolled in Medicare Part B.
  • Continue to pay your Part B premium.
  • Are a U.S. citizen or lawfully present in the United States.
  • Are a permanent resident of Honolulu County.

People with ESRD are not eligible for enrollment in this plan. Some exceptions may be applicable, please speak with a sales agent to determine eligibility.

Done