We can help
Not sure if you qualify for HMSA Akamai Advantage Dual Care? Visit an HMSA Center or office near you, or call us 8 a.m. to 8 p.m., seven days a week.
Here's a short description of the 2018 plan benefits and amount you'd pay. There may be some exceptions, so check your Summary of Benefits or Evidence of Coverage for plan details. Costs may be different, depending on how much you receive in Extra Help for prescription drugs. Please contact us if you have questions.
To be enrolled in a Dual Eligible Special Needs Plan, you must be eligible for your state's Medicaid program.
|HMSA Akamai Advantage Dual Care|
(The amount you pay each month.)
You must continue to pay your Part B premium (if Medicaid or another source doesn’t already pay for it).
In-network out-of-pocket maximum
(The most you pay each year for Medicare-covered services from in-network providers.)
|2018 Star Rating|
|Inpatient hospital care||$0 up to 90 days|
|Skilled nursing facility||$0 up to 100 days|
|Primary care provider office visit||$0|
|Specialty care provider office visit||$0|
|Annual wellness visit||$0|
|Medical equipment and supplies||$0|
|Chemotherapy and other Part B drugs||$0|
|Annual deductible||If you qualify for a low-income subsidy, you pay $0. If you don't qualify for a low-income subsidy, you pay a $405 deductible for your drugs.|
|30-day supply from retail pharmacy|
|Generic||$0, $1.25, $3.35|
|All other drugs||$0, $3.70, $8.35|
|Plan pays up to $1,500/year|
|Oral exams||$0 for 2 exams/calendar year|
|Cleanings||$0 for 2 cleanings/calendar year|
|X-rays||$0 for 1 set of X-rays/calendar year|
|Filling||$0 for 1 filling per tooth surface/calendar year|
|Root canal||$0 for 1 root canal per tooth/calendar year|
|HMSA’s Online Care||$0|
|Resources and Plan Materials|
|Evidence of Coverage||Download|
|Member Resources||Learn more|
- This plan information is effective January 1, 2018.
- Limitations, copayments, and restrictions may apply.
- This benefit information is a brief summary, not a complete description of benefits. Contact the plan for more information.
- 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 a 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. To see if we’ll help pay for an out-of-network service, you or your provider can ask us for a pre-service organization determination before you receive the service. Please call Customer Relations or see your Evidence of Coverage for more information, including the share of your costs for out-of-network services.
- To enroll in this plan, you must be eligible for Medicare and full Medicaid benefits.
- Premium, copayments, coinsurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for details.
- You must continue to pay your part B premiums unless Medicaid or another third party pays your Part B premium.
* Because you get Medicaid assistance, you pay nothing for your premium or covered services as long as you follow the plans' rules for getting care.