HMSA Akamai Advantage Dual Care (PPO D-SNP)

H3832 - 011 - 0
4 out of 5 stars (4 / 5)

HMSA Akamai Advantage Dual Care (PPO D-SNP) is a Medicare Advantage (Part C) Special Needs Plan by HMSA Akamai Advantage.

This page features plan details for 2024 HMSA Akamai Advantage Dual Care (PPO D-SNP) H3832 – 011 – 0 available in Hawaii, Kalawao, Kauai, Maui and Honolulu counties.

IMPORTANT: This page has been updated with plan and premium data for 2024.

Locations

HMSA Akamai Advantage Dual Care (PPO D-SNP) is offered in the following locations.

Plan Overview

HMSA Akamai Advantage Dual Care (PPO D-SNP) offers the following coverage and cost-sharing.

Special Needs Plan Type:Dual-Eligible
Conditions Covered:
Insurer:HMSA Akamai Advantage
Health Plan Deductible:$0.00
MOOP:$13,300 In and Out-of-network
$8,850 In-network
Drugs Covered:Yes
Please Note:
  • This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.
  • Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.
  • This plan's deductible only applies to out-of-network services.

Ready to sign up for HMSA Akamai Advantage Dual Care (PPO D-SNP) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

Premium Breakdown

HMSA Akamai Advantage Dual Care (PPO D-SNP) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$174.70 $0.00 $0.00 $0.00 $174.70
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

HMSA Akamai Advantage Dual Care (PPO D-SNP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible:$545.00
Initial Coverage Limit:$5,030.00
Catastrophic Coverage Limit:$8,000.00
Drug Benefit Type:Basic
Additional Gap Coverage:No
Formulary Link: Formulary Link

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$0.00$0.00

NOTE:  The Inflation Reduction Act of 2022 has expanded full subsidy eligibility under the LIS program to individuals with incomes up to 150% of the Federal Poverty Level. People who qualify for Extra Help generally will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug.

Initial Coverage Phase

After you pay your $545.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00. Once you reach that amount, you will enter the next coverage phase.

Gap Coverage Phase

After your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00, you will pay no more than the amounts below for any drug tier until you reach $8,000.00.

Drug TypeCost Share
Generic drugs25%
Brand-name drugs25%

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs.

Additional Benefits

HMSA Akamai Advantage Dual Care (PPO D-SNP) also provides the following benefits.

Health plan deductible

$0

Other health plan deductibles?

In-network No

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$13,300 In and Out-of-network
$8,850 In-network

Optional supplemental benefits

No

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-network No

Outpatient hospital coverage

In-network $0 copay (Authorization is required.) (Referral is not required.)
out-of-network 0-30% coinsurance per visit (Authorization is required.) (Referral is not required.)

Doctor visits

In-network Primary$0 copay (Not applicable.) (Not applicable.)
out-of-network Primary30% coinsurance per visit (Not applicable.) (Not applicable.)
In-network Specialist$0 copay (Authorization is not required.) (Referral is not required.)
out-of-network Specialist30% coinsurance per visit (Authorization is not required.) (Referral is not required.)

Preventive care

In-network $0 copay (Authorization is required.) (Referral is not required.)
out-of-network $0 copay (Authorization is required.) (Referral is not required.)

Emergency care/Urgent care

Emergency$0 copay (Not applicable.) (Not applicable.)
Urgent care$0 copay (Not applicable.) (Not applicable.)

Diagnostic procedures/lab services/imaging

In-network Diagnostic tests and procedures$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Diagnostic tests and procedures30% coinsurance (Authorization is required.) (Referral is not required.)
In-network Lab services$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Lab services30% coinsurance (Authorization is required.) (Referral is not required.)
In-network Diagnostic radiology services (e.g., MRI)$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Diagnostic radiology services (e.g., MRI)30% coinsurance (Authorization is required.) (Referral is not required.)
In-network Outpatient x-rays$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient x-rays30% coinsurance (Authorization is required.) (Referral is not required.)

Hearing

In-network Hearing exam$0 copay (Authorization is not required.) (Referral is not required.)
out-of-network Hearing exam30% coinsurance (Authorization is not required.) (Referral is not required.)
Fitting/evaluationNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Hearing aids – inner earNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Hearing aids – outer earNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Hearing aids – over the earNot covered (There are no limits.) (Not applicable.) (Not applicable.)

Preventive dental

Oral examNot covered (There are no limits.) (Not applicable.) (Not applicable.)
CleaningNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Fluoride treatmentNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Dental x-ray(s)Not covered (There are no limits.) (Not applicable.) (Not applicable.)

Comprehensive dental

Non-routine servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Diagnostic servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Restorative servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
EndodonticsNot covered (There are no limits.) (Not applicable.) (Not applicable.)
PeriodonticsNot covered (There are no limits.) (Not applicable.) (Not applicable.)
ExtractionsNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)

Vision

In-network Routine eye exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Routine eye exam30% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
OtherNot covered (There are no limits.) (Not applicable.) (Not applicable.)
In-network Contact lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Contact lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Eyeglasses (frames and lenses)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Eyeglasses (frames and lenses)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Eyeglass framesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Eyeglass lensesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
UpgradesNot covered (Not applicable.) (Not applicable.)

Rehabilitation services

In-network Occupational therapy visit$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Occupational therapy visit30% coinsurance (Authorization is required.) (Referral is not required.)
In-network Physical therapy and speech and language therapy visit$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Physical therapy and speech and language therapy visit30% coinsurance (Authorization is required.) (Referral is not required.)

Ground ambulance

In-network $0 copay (Not applicable.) (Not applicable.)
out-of-network 30% coinsurance (Not applicable.) (Not applicable.)

Transportation

Not covered (Not applicable.) (Not applicable.)

Foot care (podiatry services)

In-network Foot exams and treatment$0 copay (Authorization is not required.) (Referral is not required.)
out-of-network Foot exams and treatment30% coinsurance (Authorization is not required.) (Referral is not required.)
Routine foot careNot covered (Not applicable.) (Not applicable.)

Medical equipment/supplies

In-network Durable medical equipment (e.g., wheelchairs, oxygen)$0 copay (Authorization is required.) (Not applicable.)
out-of-network Durable medical equipment (e.g., wheelchairs, oxygen)30% coinsurance per item (Authorization is required.) (Not applicable.)
In-network Prosthetics (e.g., braces, artificial limbs)$0 copay (Authorization is required.) (Not applicable.)
out-of-network Prosthetics (e.g., braces, artificial limbs)30% coinsurance per item (Authorization is required.) (Not applicable.)
In-network Diabetes supplies$0 copay (Authorization is not required.) (Not applicable.)
out-of-network Diabetes supplies30% coinsurance per item (Authorization is not required.) (Not applicable.)

Wellness programs (e.g., fitness, nursing hotline)

Covered (Authorization is not required.) (Referral is not required.)

Medicare Part B drugs

In-network Chemotherapy$0 copay (Authorization is required.) (Not applicable.)
out-of-network Chemotherapy30% coinsurance (Authorization is required.) (Not applicable.)
In-network Other Part B drugs$0 copay (Authorization is required.) (Not applicable.)
out-of-network Other Part B drugs30% coinsurance (Authorization is required.) (Not applicable.)
In-network Part B Insulin drugs$0 copay (Authorization is required.) (Not applicable.)
out-of-network Part B Insulin drugs30% coinsurance (Authorization is required.) (Not applicable.)

Inpatient hospital coverage

In-network $0 copay (Authorization is required.) (Referral is not required.)
out-of-network Coming soon (Authorization is required.) (Referral is not required.)

Mental health services

In-network Inpatient hospital – psychiatric$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Inpatient hospital – psychiatricComing soon (Authorization is required.) (Referral is not required.)
In-network Outpatient group therapy visit with a psychiatrist$0 copay (Authorization is not required.) (Referral is not required.)
out-of-network Outpatient group therapy visit with a psychiatrist30% coinsurance (Authorization is not required.) (Referral is not required.)
In-network Outpatient individual therapy visit with a psychiatrist$0 copay (Authorization is not required.) (Referral is not required.)
out-of-network Outpatient individual therapy visit with a psychiatrist30% coinsurance (Authorization is not required.) (Referral is not required.)
In-network Outpatient group therapy visit$0 copay (Authorization is not required.) (Referral is not required.)
out-of-network Outpatient group therapy visit30% coinsurance (Authorization is not required.) (Referral is not required.)
In-network Outpatient individual therapy visit$0 copay (Authorization is not required.) (Referral is not required.)
out-of-network Outpatient individual therapy visit30% coinsurance (Authorization is not required.) (Referral is not required.)

Skilled Nursing Facility

In-network $0 copay (Authorization is required.) (Referral is not required.)
out-of-network Coming soon (Authorization is required.) (Referral is not required.)

Ready to sign up for HMSA Akamai Advantage Dual Care (PPO D-SNP) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

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