2022 HMSA Akamai Advantage Standard (PPO)

HMSA Akamai Advantage Standard (PPO) H3832-007 is a 2022 Medicare Advantage Plan or Part-C by HMSA Akamai Advantage available to residents in Hawaii. This plan includes additional prescription drug (Part-D) coverage. The HMSA Akamai Advantage Standard (PPO) has a monthly premium of $40.00 and has an in-network maximum out-of-pocket limit of $6,700 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $6,700 out-of-pocket. This can be a extremely nice safety net.

HMSA Akamai Advantage Standard (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

HMSA Akamai Advantage works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for HMSA Akamai Advantage Standard (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from HMSA Akamai Advantage and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from HMSA Akamai Advantage except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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2022 HMSA Akamai Advantage Medicare Advantage Plan Costs

HMSA Akamai Advantage Standard (PPO) Part-C Premium

HMSA Akamai Advantage charges a $15.50 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

H3832-007 Part-D Deductible and Premium

HMSA Akamai Advantage Standard (PPO) has a monthly drug premium of $24.50 and a $400.00 drug deductible. This HMSA Akamai Advantage plan offers a $24.50 Part-D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by HMSA Akamai Advantage above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $24.50 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

HMSA Akamai Advantage Gap Coverage

In 2022 once you and your plan provider have spent $4430 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This HMSA Akamai Advantage plan does not offer additional coverage through the gap.

Premium Assistance

The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The HMSA Akamai Advantage Standard (PPO) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $6.10 for 75% low income subsidy $12.20 for 50% and $18.40 for 25%.

H3832-007 Formulary or Drug Coverage

HMSA Akamai Advantage Standard (PPO) formulary is divided into Tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price. You can see complete 2022 HMSA Akamai Advantage Standard (PPO) H3832-007 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	NA	$5
Tier 2	NA	$20
Tier 3	NA	$47
Tier 4	NA	$100
Tier 5	NA	25%

*Initial Coverage Phase and 30 day supply

2021 HMSA Akamai Advantage Standard (PPO) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

No

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Comprehensive Dental

Diagnostic services	Not covered
Endodontics	Not covered
Extractions	Not covered
Non-routine services	Not covered
Periodontics	Not covered
Prosthodontics, other oral/maxillofacial surgery, other services	Not covered
Restorative services	Not covered

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Deductible

$150 annual deductible

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	30% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI)	25% coinsurance
Diagnostic tests and procedures	20% coinsurance
Diagnostic tests and procedures	30% coinsurance (Out-of-Network)
Lab services	20% coinsurance
Lab services	30% coinsurance (Out-of-Network)
Outpatient x-rays	20% coinsurance
Outpatient x-rays	30% coinsurance (Out-of-Network)

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Doctor Visits

Primary	$30 copay per visit
Primary	$40 copay per visit (Out-of-Network)
Specialist	$50 copay per visit
Specialist	$60 copay per visit (Out-of-Network)

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$50 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	30% coinsurance (Out-of-Network)
Foot exams and treatment	$50 copay
Routine foot care	Not covered

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Ground Ambulance

$250 copay (Out-of-Network)
$250 copay

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Hearing

Fitting/evaluation	Not covered
Hearing aids - inner ear	Not covered
Hearing aids - outer ear	Not covered
Hearing aids - over the ear	Not covered
Hearing exam	$50 copay
Hearing exam	30% coinsurance (Out-of-Network)

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Inpatient Hospital Coverage

$300 per day for days 1 through 6 $44 per day for days 7 through 60 $0 per day for days 61 through 90
$375 per day for days 1 through 14 $0 per day for days 15 through 90 (Out-of-Network)

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Medical Equipment/Supplies

Diabetes supplies	30% coinsurance per item (Out-of-Network)
Diabetes supplies	$0 copay
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	30% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs)	30% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item

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Medicare Part B Drugs

Chemotherapy	30% coinsurance (Out-of-Network)
Chemotherapy	20% coinsurance
Other Part B drugs	30% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance

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Mental Health Services

Inpatient hospital - psychiatric	$375 per day for days 1 through 14 $0 per day for days 15 through 90 (Out-of-Network)
Inpatient hospital - psychiatric	$100 per day for days 1 through 20 $0 per day for days 21 through 90
Outpatient group therapy visit	$40 copay
Outpatient group therapy visit	30% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$40 copay
Outpatient group therapy visit with a psychiatrist	30% coinsurance (Out-of-Network)
Outpatient individual therapy visit	$40 copay
Outpatient individual therapy visit	30% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit with a psychiatrist	30% coinsurance (Out-of-Network)

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MOOP

$10,000 In and Out-of-network $6,700 In-network

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Option

No

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

30% coinsurance per visit (Out-of-Network)
20% coinsurance per visit

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Preventive Care

$0 copay
$0 copay (Out-of-Network)

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Preventive Dental

Cleaning	Not covered
Dental x-ray(s)	Not covered
Fluoride treatment	Not covered
Oral exam	Not covered

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Rehabilitation Services

Occupational therapy visit	30% coinsurance (Out-of-Network)
Occupational therapy visit	$35 copay
Physical therapy and speech and language therapy visit	30% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	$35 copay

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Skilled Nursing Facility

$200 per day for days 1 through 50 $0 per day for days 51 through 100 (Out-of-Network)
$0 per day for days 1 through 20 $170 per day for days 21 through 60 $0 per day for days 61 through 100

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Transportation

Not covered

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Vision

Contact lenses	$0 copay (Out-of-Network)
Contact lenses	$0 copay
Eyeglass frames	Not covered
Eyeglass lenses	Not covered
Eyeglasses (frames and lenses)	$0 copay (Out-of-Network)
Eyeglasses (frames and lenses)	$0 copay
Other	Not covered
Routine eye exam	$30 copay
Routine eye exam	30% coinsurance (Out-of-Network)
Upgrades	Not covered

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for HMSA Akamai Advantage Standard (PPO) H3832

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in HMSA Akamai Advantage Standard (PPO) Plans Performance

Health Plan Customer Service Rating for HMSA Akamai Advantage Standard (PPO)

HMSA Akamai Advantage Standard (PPO) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ready to Enroll?

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Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for HMSA Akamai Advantage Standard (PPO)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.