Manage your plan online with HMSA’s My Account. My Account gives you convenient access to your health plan information.
Take control of your health care by getting answers to your questions from someone who knows. Our representatives can help you learn about your bill, make payments, check on a claim, explore well-being resources, or start a new plan.
Visit a Center| wcagcolheader | HMSA Akamai Advantage Complete (PPO) | HMSA Akamai Advantage Complete Plus (PPO) | |
|---|---|---|---|
|
Monthly premium Extra Help, or Low Income Subsidy, can help pay for prescription drugs and monthly premiums. Find out more. |
$20 | $160 | |
| In-network maximum out-of-pocket The most you pay each year for Medicare-covered medical services from in-network providers. |
$7,700 | $5,100 | |
| 2026 Star Rating | Coming soon
|
||
|
Provider Directory |
|
||
| Medical Benefits* | |||
| You Pay | You Pay | ||
| Annual medical deductible | $0 | $0 | |
| Inpatient hospital care* |
Days 1 to 5: Days 6 to 60: Days 61 to 90: |
Days 1 to 4: Days 5 to 90: Additional Days: |
|
| Skilled nursing facility* |
Days 1 to 20: Days 21 to 60: Days 61 to 100: |
Days 1 to 20: Days 21 to 40: Days 41 to 100: |
|
| Outpatient hospital and ambulatory surgical center services* | 20% | 20% | |
| Primary care provider office visit | $0 | $0 | |
| Specialty care provider office visit | $55 | $35 | |
| Annual wellness visit | $0 | $0 | |
| Ambulance, includes ground and air ambulance | $350 | $300 | |
| Emergency care | $115 | $115 | |
| Urgent care | $40 | $35 | |
| Worldwide coverage for emergency and urgent care services | 10% | 10% | |
| Diagnostic services, labs, and imaging* | $0 or 20% depending on the service | $0, $50, or 20% depending on the service | |
| Medicare Part B drugs* | Up to 20% | Up to 20% | |
| Medicare Part B insulin drugs* | $35 | $35 | |
| Medical equipment and supplies* | 20% | 20% | |
| Supplemental Dental Benefits | |||
|
Diagnostic and preventive dental services:
|
$0 | $0 | |
|
Comprehensive dental services:
|
$0 | $0 | |
|
Comprehensive dental services:
|
Not covered | $0 | |
| Dental Provider Directory | Dental Provider Directory English [PDF] | Chinese [PDF] | Ilocano [PDF] | Korean [PDF] | Vietnamese [PDF] |
||
| Supplemental Vision Benefits | |||
| You Pay | You Pay | ||
| Routine eye exam (once a calendar year) | $10 | $0 | |
| Contact lenses and eyeglasses (frames and lenses) | $0 Plan pays up to $300 every calendar year |
$0 Plan pays up to $300 every calendar year |
|
| Vision Provider Directory | Routine Vision Directory [PDF] | ||
| Supplemental Hearing Benefits | |||
| Supplemental Hearing Benefits | For more information, visit TruHearing or see our Frequently Asked Questions [PDF]. | ||
| Routine hearing exam (one every calendar year) | $0 | $0 | |
| Hearing aids (one aid per ear every calendar year) |
|
|
|
| Other Supplemental Benefits and Programs | |||
| Telehealth services Includes HMSA’s Online Care. |
$0 | $0 | |
| Health education Learn more |
$0 | $0 | |
| Health coaching Learn more |
$0 | $0 | |
| Drug Benefits | |||
| You Pay | You Pay | ||
|
Annual drug deductible Extra Help, or Low Income Subsidy, can help pay for prescription drugs and monthly premiums. Find out more. |
$300 Does not apply to tier 1 drugs, insulin and most Part D vaccines |
$200 Does not apply to tier 1 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 | $0 | |
|
Tier 2 - Generic
|
$11 | $11 | |
|
Tier 3 - Preferred Brand
|
20% | 20% | |
|
Tier 3 - Preferred Brand Insulin
|
Lesser of $35 and 20% | Lesser of $35 and 20% | |
|
Tier 4 - Non-Preferred Drug
|
30% | 30% | |
|
Tier 5 - Specialty
|
29% | 29% | |
|
Tier 5 - Specialty Insulin
|
Lesser of $35 and 25% | Lesser of $35 and 25% | |
| 100-day supply from mail-order pharmacy | |||
|
Tier 1 - Preferred Generic
|
$0 | $0 | |
|
Tier 2 - Generic
|
$11 | $11 | |
|
Tier 3 - Preferred Brand
|
20% | 20% | |
|
Tier 3 - Preferred Brand Insulin
|
Lesser of $105 and 20% | Lesser of $105 and 20% | |
|
Tier 4 - Non-Preferred Drug
|
30% | 30% | |
|
Tier 5 - Specialty
|
29% | 29% | |
|
Tier 5 - Specialty Insulin
|
Lesser of $105 and 25% | Lesser of $105 and 25% | |
| 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 [PDF] | Summary of Benefits [PDF] | |
| Annual Notice of Changes | Annual Notice of Changes [PDF] | Annual Notice of Changes [PDF] | |
| Evidence of Coverage | |||
| Member Resources | Learn more | Learn more | |
* For some services, your doctor or other network provider may request prior authorization. Please contact us for more information.
