Oahu Plans for 2019

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.

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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.

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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

When it comes to your health plan, one size doesn’t fit all. And with an HMSA Akamai Advantage (PPO) or Essential Advantage (HMO) plan, you have the power to choose a plan that fits your health, budget, and lifestyle needs.

Choosing a plan is a personal decision. Each plan comes with different levels of medical benefits and costs.

Ask yourself these things:

  • How much health care do I need?
  • How many medications do I need?
  • How much financial protection do I want?
  • How much can I afford?

  HMO Plan   PPO Plans  
  Essential Advantage Complete Complete Plus

Monthly premium
(The amount you pay each month.)
You must continue to pay your Medicare Part B premium.

Low Income Subsidy can help pay for prescription medications and monthly premiums. Find out more.

$20 $56 $146
In-network out-of-pocket maximum
(The most you pay each year for Medicare-covered services from in-network providers.)
$5,000 $6,700 $3,400
2019 Star Rating

Plan too new to be measured.

4.5 out of 5 Star Rating (H3832).

Provider directory
Request hard copy
Medical Benefits*
  You Pay You Pay You Pay
Annual deductible $150 per year for some in-network services $150 per year for some in-network and out-of-network services $0
Inpatient hospital care*

Days 1 to 6:
$300/day

Days 7 to 60:
$44/day

Days 61 to 90:
$0/day

Days 1 to 6:
$300/day

Days 7 to 60:
$44/day

Days 61 to 90:
$0/day

Days 1 to 7:
$280/day

Days 8 to 90:
$0/day

Additional Days:
$0/day

Skilled nursing facility*

Days 1 to 20:
$0/day

Days 21 to 60:
$170/day

Days 61 to 100:
$0/day

Days 1 to 20:
$0/day

Days 21 to 60:
$170/day

Days 61 to 100:
$0/day

Days 1 to 20:
$20/day

Days 21 to 40:
$160/day

Days 41 to 100:
$0/day

Primary care provider office visit $15 $30 $10
Specialty care provider office visit $50 $50 $30
Annual wellness visit $0 $0 $0
Outpatient hospital facility and ambulatory surgical center services* $150 deductible, then 20% $150 deductible, then 20% 20%
Ambulance service $250 $250 $225
Emergency care $90 $90 $90
Urgent care $50 $50 $30
Worldwide coverage for emergency physician and outpatient services 10% 10% 10%
Medical equipment and supplies* 20% 20% 20%
Diagnostic tests and procedures, lab services, and outpatient X-rays* 20% 20% 20%
Chemotherapy and other Part B drugs* 20% 20% 20%
Drug Benefits
  You Pay You Pay You Pay

Annual deductible

Low Income Subsidy can help pay for prescription medications and monthly premiums. Find out more.

$380
(Does not apply to Tier 1)
$380
(Does not apply to Tier 1)
$0
 
Initial coverage stage
Until total drug costs reach $3,820
30-day supply from retail pharmacies
Tier 1 - Preferred Generic
$4.50 $4.50 $4
Tier 2 - Generic
$12 $12 $11
Tier 3 - Preferred Brand
$47 $47 $45
Tier 4 - Non-Preferred Drug
$100 $100 $95
Tier 5 - Specialty
25% 25% 33%
90-day supply from mail-order pharmacy
Tier 1 - Preferred Generic
$4.50 $4.50 $4
Tier 2 - Generic
$12 $12 $11
Tier 3 - Preferred Brand
$94 $94 $90
Tier 4 - Non-Preferred Drug
$200 $200 $190
Tier 5 - Specialty
25% 25% 33%
Coverage gap
Until your yearly out-of-pocket drug costs reach $5,100
25% of the drug cost for brand drugs.
37% of the drug cost for generic drugs.
Additional gap coverage for Tier 1 drugs
30-day supply from retail pharmacy Not covered Not covered $4
90-day supply from mail-order pharmacy Not covered Not covered $4
Catastrophic coverage
After your yearly out-of-pocket drug costs
reach $5,100
The greater of 5% or $3.40 for generic drugs (including brand drugs treated as generic) and $8.50 for all other drugs.
Pharmacy Find a pharmacy
Prescription Drugs List (Formulary)
Request hard copy
Download
Vision Benefits
  You Pay You Pay You Pay
Routine eye exam $15/1 exam per calendar year $30/1 exam per calendar year $10/1 exam per calendar year
Eyewear (supplemental) $0 for frames, lenses or contacts. Plan pays up to $100 every 24 months. $0 for frames, lenses or contacts. Plan pays up to $100 every 24 months. $0 for frames, lenses or contacts. Plan pays up to $100 every 24 months.
Wellness Benefits
Silver&Fit Program $0 $0 $0
Health Education and Health Coaching Available Available Available
Resources and Plan Materials
Summary of Benefits Download Download Download
Annual Notice of Changes and Evidence of Coverage Download
Request hard copy
Download
Request hard copy
Download
Request hard copy
Member Resources Learn more Learn more Learn more

Essential Advantage Plan (HMO)

Monthly premium
(The amount you pay each month.)

Low Income Subsidy can help pay for prescription medications and monthly premiums. Find out more.

$20
In-network out-of-pocket maximum
(The most you pay each year for Medicare-covered services from in-network providers.)
$5,000
2019 plan rating Plan too new to be measured.
Provider directory
Request hard copy
Medical Benefits*
  You Pay
Annual deductible $150 per year for some in-network services
Inpatient hospital care*

Days 1 to 6:
$300/day

Days 7 to 60:
$44/day

Days 61 to 90:
$0/day

Skilled nursing facility*

Days 1 to 20:
$0/day

Days 21 to 60:
$170/day

Days 61 to 100:
$0/day

Primary care provider office visit $15
Specialty care provider office visit $50
Annual wellness visit $0
Outpatient hospital facility and ambulatory surgical center services* 20%
Ambulance service $225
Emergency care $90
Urgent care $50
Worldwide coverage for emergency physician and outpatient services 10%
Medical equipment and supplies* 20%
Diagnostic tests and procedures, lab services, and outpatient X-rays* 20%
Chemotherapy and other Part B drugs* 20%
Drug Benefits
  You Pay

Annual deductible

Low Income Subsidy can help pay for prescription medications and monthly premiums. Find out more.

$380
(Does not apply to Tier 1)
Initial coverage stage
Until total drug costs reach $3,820
30-day supply from retail pharmacies
    Tier 1 - Preferred Generic $4.50
    Tier 2 - Generic $12
    Tier 3 - Preferred Brand $47
    Tier 4 - Non-Preferred Drug $100
    Tier 5 - Specialty 25%
90-day supply from mail-order pharmacy
    Tier 1 - Preferred Generic $4.50
    Tier 2 - Generic $12
    Tier 3 - Preferred Brand $94
    Tier 4 - Non-Preferred Drug $200
    Tier 5 - Specialty 25%
Coverage gap
Until your yearly out-of-pocket drug costs reach $5,100
25% of the drug cost for brand drugs.
37% of the drug cost for generic drugs.
Additional gap coverage for Tier 1 drugs
30-day supply from retail pharmacy Not covered
90-day supply from mail-order pharmacy Not covered
Catastrophic coverage
After your yearly out-of-pocket drug costs
reach $5,100
The greater of 5% or $3.40 for generic drugs (including brand drugs treated as generic) and $8.50 for all other drugs.
Pharmacy Find a pharmacy
Prescription Drugs List (Formulary)
Request hard copy
Download
Vision Benefits
  You Pay
Routine eye exam $15/1 exam per calendar year
Eyewear (supplemental) $0 for frames, lenses or contacts. Plan pays up to $100 every 24 months.
Wellness Benefits
Silver&Fit Program Available
Health Education and Health Coaching Available
Resources and Plan Materials
Annual Notice of Changes Download
Member Resources Learn more

Complete Plan (PPO)

Monthly premium
(The amount you pay each month.)

Low Income Subsidy can help pay for prescription medications and monthly premiums. Find out more.

$56
In-network out-of-pocket maximum
(The most you pay each year for Medicare-covered services from in-network providers.)
$6,700
2019 plan rating

4.5 out of 5 Star Rating (H3832).

Provider directory
Request hard copy
Medical Benefits*
  You Pay
Annual deductible $150 per year for some in-network and out-of-network services
Inpatient hospital care*

Days 1 to 6:
$300/day

Days 7 to 60:
$44/day

Days 61 to 90:
$0/day

Skilled nursing facility*

Days 1 to 20:
$0/day

Days 21 to 60:
$170/day

Days 61 to 100:
$0/day

Primary care provider office visit $30
Specialty care provider office visit $50
Annual wellness visit $0
Outpatient hospital facility and ambulatory surgical center services* $150 deductible, then 20%
Ambulance service $250
Emergency care $90
Urgent care $50
Worldwide coverage for emergency physician and outpatient services 10%
Medical equipment and supplies* 20%
Diagnostic tests and procedures, lab services, and outpatient X-rays* 20%
Chemotherapy and other Part B drugs* 20%
Drug Benefits
  You Pay

Annual deductible

Low Income Subsidy can help pay for prescription medications and monthly premiums. Find out more.

$380
(Does not apply to Tier 1)
Initial coverage stage
Until total drug costs reach $3,820
30-day supply from retail pharmacies
Tier 1 - Preferred Generic
$4.50
Tier 2 - Generic
$12
Tier 3 - Preferred Brand
$47
Tier 4 - Non-Preferred Drug
$100
Tier 5 - Specialty
25%
90-day supply from mail-order pharmacy
Tier 1 - Preferred Generic
$4.50
Tier 2 - Generic
$12
Tier 3 - Preferred Brand
$94
Tier 4 - Non-Preferred Drug
$200
Tier 5 - Specialty
25%
Coverage gap
Until your yearly out-of-pocket drug costs reach $5,100
25% of the drug cost for brand drugs.
37% of the drug cost for generic drugs.
Additional gap coverage for Tier 1 drugs
30-day supply from retail pharmacy Not covered
90-day supply from mail-order pharmacy Not covered
Catastrophic coverage
After your yearly out-of-pocket drug costs
reach $5,100
The greater of 5% or $3.40 for generic drugs (including brand drugs treated as generic) and $8.50 for all other drugs.
Pharmacy Find a pharmacy
Prescription Drugs List (Formulary)
Request hard copy
Download
Vision Benefits
  You Pay
Routine eye exam $30/1 exam per calendar year
Eyewear (supplemental) $0 for frames, lenses or contacts. Plan pays up to $100 every 24 months.
Wellness Benefits
Silver&Fit Program Available
Health Education and Health Coaching Available
Resources and Plan Materials
Annual Notice of Changes Download
Member Resources Learn more

Complete Plus Plan (PPO)

Monthly premium
(The amount you pay each month.)
$146

In-network out-of-pocket maximum
(The most you pay each year for Medicare-covered services from in-network providers.)

Low Income Subsidy can help pay for prescription medications and monthly premiums. Find out more.

$3,400
2019 Star Rating

4.5 out of 5 Star Rating (H3832).

Provider directory
Request hard copy
Medical Benefits*
  You Pay
Annual deductible $0
Inpatient hospital care*

Days 1 to 7:
$280/day

Days 8 to 90:
$0/day

Additional days:
$0/day

Skilled nursing facility*

Days 1 to 20:
$20/day

Days 21 to 40:
$160/day

Days 41 to 100:
$0/day

Primary care provider office visit $10
Specialty care provider office visit $30
Annual wellness visit $0
Outpatient hospital facility and ambulatory surgical center services* 20%
Ambulance service $225
Emergency care $90
Urgent care $30
Worldwide coverage for emergency physician and outpatient services 10%
Medical equipment and supplies* 20%
Diagnostic tests and procedures, lab services, and outpatient X-rays* 20%
Chemotherapy and other Part B drugs* 20%
Drug Benefits
  You Pay

Annual deductible

Low Income Subsidy can help pay for prescription medications and monthly premiums. Find out more.

$0
Initial coverage stage
Until total drug costs reach $3,820
30-day supply from retail pharmacies
Tier 1 - Preferred Generic $4
    Tier 2 - Generic $11
    Tier 3 - Preferred Brand $45
    Tier 4 - Non-Preferred Drug $95
    Tier 5 - Specialty 33%
90-day supply from mail-order pharmacy
    Tier 1 - Preferred Generic $4
    Tier 2 - Generic $11
    Tier 3 - Preferred Brand $90
    Tier 4 - Non-Preferred Drug $190
    Tier 5 - Specialty 33%
Coverage gap
Until your yearly out-of-pocket drug costs reach $5,100
25% of the drug cost for brand drugs.
37% of the drug cost for generic drugs.
Additional gap coverage for Tier 1 drugs
30-day supply from retail pharmacy $4
90-day supply from mail-order pharmacy $4
Catastrophic coverage
After your yearly out-of-pocket drug costs
reach $5,100
The greater of 5% or $3.40 for generic drugs (including brand drugs treated as generic) and $8.50 for all other drugs.
Pharmacy Find a pharmacy
Prescription Drugs List (Formulary)
Request hard copy
Download
Vision Benefits
  You Pay
Routine eye exam $10/1 exam per calendar year
Eyewear (supplemental) $0 for frames, lenses or contacts. Plan pays up to $100 every 24 months.
Wellness Benefits
Silver&Fit Program Available
Health Education and Health Coaching Available
Resources and Plan Materials
Annual Notice of Changes Download
Member Resources Learn more

HMSA Disclaimer

  • This plan information is effective January 1, 2019.
  • This information is not a complete description of benefits. Contact the plan for more information.
  • Medicare beneficiaries may also enroll in HMSA Akamai Advantage and Essential Advantage through the CMS Medicare Online Enrollment Center at www.medicare.gov.
  • Every year, Medicare evaluates plans based on a 5-star rating system.
  • HMSA Akamai Advantage is a PPO plan and Essential Advantage is an HMO plan with a Medicare contract. Enrollment in HMSA Akamai Advantage and Essential 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.

* For some services, your doctor or other network provider must request prior authorization. Please contact us for more information. All plan benefits above are based on in-network services.

If you have Essential Advantage, your PCP needs to arrange all your health care services in the Essential Advantage network except for emergency and urgent care. If you see providers outside the Essential Advantage network, you’ll be responsible for the full cost.

You’re eligible to enroll in HMSA Medicare 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.

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