Medicare and HMSA QUEST (Medicaid) – Better Together
HMSA Akamai Advantage® Dual Care (PPO D-SNP) coordinates your Medicare and HMSA QUEST (Medicaid) benefits at no additional cost.
- A $125 monthly allowance for over-the-counter (OTC) health products, food, and home utilities.1
- $0 dental cleanings, exams, X-rays, fillings, dentures, and more.
- $0 eye exam and $300 annually toward eyeglasses and contact lenses.
- $0 generic prescription drugs.
- Silver&Fit® fitness center membership and home fitness program.
With this plan, you’ll also get a health coordinator who can help you with your health care.
| wcagcolheader | HMSA Akamai Advantage Dual Care (PPO D-SNP) |
|---|---|
|
Monthly premium You must continue to pay your Part B premium if Medicaid or another source doesn’t already pay for it. Extra Help, or Low Income Subsidy, can help pay for prescription drugs and monthly premiums. Find out more. |
$0 |
| In-network maximum out-of-pocket The most you pay each year for Medicare-covered medical services from in-network providers. |
$9,250 |
| 2026 Star Rating |
Plan too new to be measured (H8481). |
|
Provider directory |
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| Medical Benefits2 | |
| You Pay | |
| Annual medical deductible | $0 |
| Inpatient hospital care3 | $0 up to 90 days |
| Skilled nursing facility3 | $0 up to 180 days |
| Primary care provider office visit | $0 |
| Specialty care provider office visit | $0 |
| Annual wellness visit | $0 |
| Outpatient hospital and ambulatory surgical center services3 | $0 |
| Ambulance, includes ground and air ambulance | $0 |
| Emergency care | $0 |
| Urgent care | $0 |
| Diagnostic services, labs, and imaging3 | $0 |
| Medicare Part B drugs3 | $0 |
| Medicare Part B insulin drugs3 | $0 |
| Medical equipment and supplies3 | $0 |
| Supplemental Vision Benefits | |
| You Pay | |
| Routine eye exam (once a calendar year) | $0 |
| Contact lenses and eyeglasses (frames and lenses) | $0 Plan pays up to $300 every calendar year. |
| Vision Provider Directory | English [PDF] | Chinese [PDF] | Ilocano [PDF] | Korean [PDF] | Vietnamese [PDF] |
| Supplemental Dental Benefits | |
|
Diagnostic and preventive dental services:
|
$0 |
|
Comprehensive dental services:
|
$0 |
| Dental Provider Directory | Dental Provider Directory English [PDF] | Chinese [PDF] | Ilocano [PDF] | Korean [PDF] | Vietnamese [PDF] |
| Other Supplemental Benefits and Programs | |
|
Over-the-counter (OTC) Health Products, Food, and Home Utilities Allowance1 You’ll receive an HMSA Extra Benefits debit card with an allowance for over-the-counter health products. If you’re eligible, you'll also be able to use the allowance for healthy food and home utilities. You can purchase covered products at select retail stores or through mail order delivery at HMSAExtraBenefits.com or by calling 1-800-790-6019. For more information, visit hmsa.com/ExtraBenefits. |
$0 Plan pays $125 a month |
| Over-the-counter (OTC) Health Products and Healthy Food Catalog | Over-the-counter (OTC) Health Products and Healthy Food Catalog [PDF] |
| Fitness — Silver&Fit Healthy Aging and Exercise Program A membership to a participating fitness center, one Home Fitness Kit per year, Well-Being Coaching, and more. |
Fitness Center Membership $0/month for standard fitness center, $30-$580/month for premium fitness center Home Fitness Kit $0 One Home Fitness Kit per calendar year Well-Being Coaching $0 |
| Telehealth services Includes HMSA’s Online Care |
$0 |
| Health education Learn more |
$0 |
| Drug Benefits | |
| You Pay | |
| Annual drug deductible Extra Help, or Low Income Subsidy, can help pay for prescription drugs and monthly premiums. Find out more. |
$615 Does not apply to Tier 1 and Tier 2 drugs, insulin, and most Part D vaccines. |
| Initial coverage stage Until you’ve paid $2,100 out of pocket for Part D drugs. |
|
| 30-day supply from retail pharmacies | |
| Tier 1 - Preferred Generic | $0 |
| Tier 2 - Generic | $0 |
| Tier 3 - Preferred Brand Tier 4 - Non-preferred Drug Tier 5 - Specialty |
For generic drugs: $0, $1.60, or $5.10. For all other drugs: $0, $4.90, or $12.65. Copayments for drugs may vary based on the level of Extra Help you get. |
| 100-day supply from mail-order pharmacy | |
| Tier 1 - Preferred Generic | $0 |
| Tier 2 - Generic | $0 |
| Tier 3 - Preferred Brand Tier 4 - Non-preferred Drug Tier 5 - Specialty |
For generic drugs: $0, $1.60, or $5.10. For all other drugs: $0, $4.90, or $12.65. Copayments for drugs may vary based on the level of Extra Help you get. |
| Catastrophic coverage stage After you’ve paid $2,100 out-of-pocket for Part D drugs. |
$0 |
| Most Part D vaccines | $0 |
| Pharmacy | Find a pharmacy |
| Prescription Drugs List (Formulary) See if your prescription drugs are covered and search for lower-cost alternatives. |
|
| Resources and Plan Materials | |
| Summary of Benefits | Summary of Benefits English [PDF] | Chinese [PDF] | Ilocano [PDF] | Korean [PDF] | Vietnamese [PDF] |
| Annual Notice of Changes | Annual Notice of Changes English [PDF] | Chinese [PDF] | Ilocano [PDF] | Korean [PDF] | Vietnamese [PDF] |
| Evidence of Coverage |
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| Member Resources | Learn more |
1 The Food and Home Utilities allowance is a special supplemental benefit available only to chronically ill members with eligible chronic conditions, including diabetes, high blood pressure (hypertension), high cholesterol (hyperlipidemia), cardiovascular and other heart disorders, and stroke. Other conditions may be eligible. For the full list of eligible chronic conditions, see hmsa.com/ExtraBenefits-DualCare. All applicable eligibility requirements must be met before the benefit is provided. Not all members qualify. This benefit is only available on HMSA Akamai Advantage Dual Care (PPO D-SNP).
2 Because you get Medicaid assistance, you pay nothing for HMSA Akamai Advantage Dual Care (PPO D-SNP) premium or Medicare-covered medical services as long as you follow the plans’ rules for getting care.
3 For some services, your doctor or other network provider may request prior authorization. Please contact us for more information.