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Extra Help LIS Premium Summary Chart 2025

Low-Income Subsidy tables for 2025

Monthly premium

Premium SubsidyCompleteComplete PlusStandardStandard PlusDual Care
100%$0$79.60$0$103$0

HMSA Akamai Advantage (PPO) LIS premium summary

HMSA Akamai Advantage (PPO D-SNP) LIS premium summary

Out-of-pocket drug costs

Subsidy LevelsDeductibleCopayment*
Level 1$0$4.90/$12.15
Level 2$0$1.60/$4.80
Level 3$0$0/$0

* Copayment amounts for generic/preferred multi-source and other drugs, respectively. For example, the first amount shown ($4.90) is the copayment for a generic/preferred multi-source drug filled for a member in the LIS Category 1.

HMSA Disclaimer

  • HMSA Akamai Advantage® is a PPO plan with a Medicare contract. Enrollment in HMSA Akamai Advantage depends on contract renewal.