Oahu Plans for 2024

Plans start at $0 a month.

HMSA can help you live your best life.

  • $0 dental cleanings, exams, X-rays, fillings, and more with no dollar limits or waiting period.
  • $300 annually toward eyeglasses and contact lenses. IMPROVED
  • Up to $95 allowance every quarter for over-the-counter health and wellness products. NEW
  • $0 copayments for primary care provider visits.
  • Care you need from providers you choose.
  • Friendly, local customer service.
  • Convenient telehealth, including HMSA’s Online Care®, at no cost.
  • Benefits for travel, fitness, prescription drugs, and more that go beyond Original Medicare.

HMSA is here with you.

 wcagcolheader HMSA Akamai Advantage Complete (PPO) HMSA Akamai Advantage Complete Plus (PPO)

Monthly premium
(The amount you pay each month.)
You must continue to pay your Medicare Part B premium.

Low Income Subsidy can help pay for prescription drugs and monthly premiums. Find out more.

$0 $120
In-network out-of-pocket maximum
(The most you pay each year for Medicare-covered services from in-network providers.)
$6,700 $3,850
2024 Star Rating 4 out of 5 stars

4 out of 5 Star Rating (H3832 [PDF]).

Provider directory
Medical Benefits*
  You Pay You Pay
Annual deductible $0 $0
Inpatient hospital care*

Days 1 to 6:
$370/day

Days 7 to 60:
$50/day

Days 61 to 90:
$0/day

Days 1 to 5:
$350/day

Days 6 to 90:
$0/day

Additional Days:
$0/day

Skilled nursing facility*

Days 1 to 20:
$0/day

Days 21 to 60:
$200/day

Days 61 to 100:
$0/day

Days 1 to 20:
$20/day

Days 21 to 40:
$190/day

Days 41 to 100:
$0/day

Outpatient hospital facility and ambulatory surgical center services* 20% 20%
Primary care provider office visit $0 $0
Specialty care provider office visit $50 $30
Annual wellness visit $0 $0
Ambulance service
Includes ground and air.
$250 $225
Emergency care $100 $100
Urgent care $50 $30
Worldwide coverage for emergency and urgent care services 10% 10%
Diagnostic tests and procedures, lab services, and outpatient X-rays* 20% 20%
Medicare Part B drugs* 20% 20%
Medicare Part B insulin drugs* $35 $35
Medical equipment and supplies* 20% 20%
Supplemental Dental Benefits
Preventive dental services, including two oral exams every year, two cleanings every year, one set of X-rays every year, and two fluoride treatments every year $0 $0
Comprehensive dental services, including four extractions every year and two fillings every year $0 $0
Comprehensive dental services, including one root canal every year and one crown following a root canal on the same tooth every year Not covered $0
Dental Provider Directory Dental Provider Directory [PDF]
Supplemental Vision Benefits
  You Pay You Pay
Routine eye exam $10/1 exam per calendar year $0/1 exam per calendar year
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
Other Supplemental Benefits

Over-the-Counter (OTC) Health Products

OTC health and wellness products available at select retail stores or through mail order delivery online at HMSAExtra Benefits.com or by calling 1-800-790-6019.

For more information, visit coolvcd918.net/ ExtraBenefits

$0

Plan pays $65 per quarter

$0

Plan pays $95 per quarter

Over-the-Counter (OTC) Health Products Catalog

Over-the-Counter (OTC) Health Products Catalog [PDF]

Fitness - Silver&Fit Healthy Aging and Exercise Program
A membership to a participating fitness center, one home fitness kit per year, Healthy Aging Coaching sessions and more.

Fitness Center Membership
$0/month for standard fitness center,
$30- $200/month for premium fitness center

Home Fitness Kit
$0
1 Home Fitness Kit per calendar year

Healthy Aging Coaching
$0

Digital Workout Videos
$0

Fitness Center Membership
$0/month for standard fitness center,
$30- $200/month for premium fitness center

Home Fitness Kit
$0
1 Home Fitness Kit per calendar year

Healthy Aging Coaching
$0

Digital Workout Videos
$0

Telehealth services
Includes HMSA’s Online Care.
$0 $0
Health education $0
Learn more
$0
Learn more
Health coaching $0
Learn more
$0
Learn more
Drug Benefits
  You Pay You Pay

Annual deductible

Low Income Subsidy can help pay for prescription drugs and monthly premiums. Find out more.

$380
Does not apply to tier 1 drugs, insulin and most Part D vaccines
$0
Initial coverage stage
Until total drug costs reach $5,030
30-day supply from retail pharmacies
Tier 1 - Preferred Generic
$4.50 $4
Tier 2 - Generic
$12 $11
Tier 3 - Preferred Brand
$47 $45
Tier 3 - Preferred Brand Inslulin
$35 $35
Tier 4 - Non-Preferred Drug
$100 $95
Tier 5 - Specialty
27% 33%
Tier 5 - Specialty Insulin
$35 $35
100-day supply from mail-order pharmacy
Tier 1 - Preferred Generic
$4.50 $4
Tier 2 - Generic
$12 $11
Tier 3 - Preferred Brand
$94 $90
Tier 3 - Preferred Brand Insulin
$70 $70
Tier 4 - Non-Preferred Drug
$200 $190
Tier 5 - Specialty
27% 33%
Tier 5 - Specialty Insulin
$105 $105
Coverage gap stage
Until your yearly out-of-pocket drug costs reach $8,000
25% of the cost of brand or generic drugs
Additional gap coverage for Tier 1 drugs
30-day supply from retail pharmacy Not covered $4
100-day supply from mail-order pharmacy Not covered $4
Catastrophic coverage stage
After your yearly out-of-pocket drug costs
reach $8,000
$0 for generic drugs (including brand drugs treated as generic) and all other drugs
Part D vaccines $0 for most Part D vaccines on all drug tiers.
Pharmacy Find a pharmacy
Prescription Drugs List (Formulary)
See if your prescription drugs are covered and search for lower-cost alternatives. Drug Search Tool.
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

HMSA Disclaimer

  • This plan information is effective January 1, 2024.
  • Medicare beneficiaries may also enroll in HMSA Akamai Advantage through the CMS Medicare Online Enrollment Center at www.medicare.gov.
  • Every year, Medicare evaluates plans based on a 5-star rating system.
  • Benefit amounts listed are based on using HMSA participating providers.
  • HMSA Akamai Advantage® is a PPO plan with a Medicare contract. Enrollment in HMSA Akamai Advantage depends on contract renewal.

* For some services, your doctor or other network provider may request prior authorization. Please contact us for more information.