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HMSA Akamai Advantage Dual Care (PPO D-SNP)

Hawaii Medicare-Medicaid Dual Eligible D-SNP Plan (2024 Plan)

Monthly Premium

Your Cost
$0
by HMSA Akamai Advantage

Additional Coverage

HearingVision

Overall Government Star Rating

 4.0
out of 5 stars

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Plan Overview

Plan Name
HMSA Akamai Advantage Dual Care (PPO D-SNP)
Insurance Carrier
HMSA Akamai Advantage
Plan Type
Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)
Network Type
PPO

HMSA Akamai Advantage Dual Care (PPO D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in Hawaii and offered by the health insurance company HMSA Akamai Advantage. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.

Cost Summary

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$8,850
Primary doctor visit
$0 copay
Specialist visit
$0 copay
ER visit
$0 copay
Ambulance
$0 copay

HMSA Akamai Advantage Dual Care (PPO D-SNP) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $13,300 In and Out-of-network $8,850 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for HMSA Akamai Advantage Dual Care (PPO D-SNP) are defined below.

Additional Benefits and Coverage

Yes
Part D Prescription Drug Coverage
No
Dental
Yes
Vision
Yes
Hearing

HMSA Akamai Advantage Dual Care (PPO D-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. HMSA Akamai Advantage Dual Care (PPO D-SNP) includes coverage for hearing, vision.

Medicare Advantage health plans can offer even more additional benefits. HMSA Akamai Advantage Dual Care (PPO D-SNP) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Not covered
Annual physical exams
Not covered
Telehealth
Limited coverage

Comparing the Quality Score of HMSA Akamai Advantage Dual Care (PPO D-SNP) to Other Plans in Hawaii

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2024, HMSA Akamai Advantage Dual Care (PPO D-SNP) received an overall government quality rating of 4.0 stars out of 5 stars.

HMSA Akamai Advantage Dual Care (PPO D-SNP) performed better than Hawaii’s State average overall quality score of 3.4 stars.

This Plan’s 5-star Gov’t Quality Score
Hawaii State Average Score
Overall Government 5 Star Quality Rating
 4.0
 3.4
Summary rating of health plan quality
 4
 3.3
Staying healthy: screenings, tests, & vaccines
 5
 3.0
Managing chronic (long term) conditions
 3
 2.9
Member experience with health plan
 4
 3.1
Member complaints & changes in the health plan's performance
 5
 3.5
Health plan customer service
 4
 3.8
Summary rating of drug plan quality
 3.5
 3.6
Drug plan customer service
 3
 3.3
Member complaints & changes in the drug plan's performance
 4
 3.8
Member experience with the drug plan
 3
 3.4
Drug safety & accuracy of drug pricing
 4
 3.5

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

HMSA Akamai Advantage Dual Care (PPO D-SNP) received 4 stars for its health plan quality score which is better than the Hawaii State average health plan quality score of 3.3 stars.

HMSA Akamai Advantage Dual Care (PPO D-SNP) received 3.5 stars for its drug plan quality score which is worse than the Hawaii State average drug plan quality score of 3.6 stars.

Plan Benefits and Coverage Details

Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$13,300 In and Out-of-network
$8,850 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
No
Doctor Lookup Link
http://www.hmsa.com/advantage
Plan Link
http://www.hmsa.com/advantage

Medical Benefits

Doctor Services

Primary doctor visit
In-network: $0 copay
Out-of-network: 30% coinsurance per visit
Specialist visit
In-network: $0 copay
Out-of-network: 30% coinsurance per visit

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $0 copay
Out-of-network: 30% coinsurance
Lab services
In-network: $0 copay
Out-of-network: 30% coinsurance
Diagnostic radiology services (like MRI)
In-network: $0 copay
Out-of-network: 30% coinsurance
Outpatient x-rays
In-network: $0 copay
Out-of-network: 30% coinsurance
Emergency care
$0 copay
Urgent care
$0 copay

Hospital Services

Inpatient hospital coverage
In-network: $0 copay
Out-of-network: In 2024 the amounts for each benefit period are:
$1,632 deductible for days 1 through 60
$408 copay per day for days 61 through 90
Outpatient hospital coverage
In-network: $0 copay
Out-of-network: 0-30% coinsurance per visit

Skilled nursing facility

Skilled nursing facility
In-network: $0 copay
Out-of-network: In 2024 the amounts for each benefit period are:
$0 copay for days 1 through 20
$204 copay per day for days 21 through 100

Preventive services

Preventive services
In-network: $0 copay
Out-of-network: $0 copay

Ambulance

Ground ambulance
In-network: $0 copay
Out-of-network: 30% coinsurance

Therapy services

Occupational therapy visit
In-network: $0 copay
Out-of-network: 30% coinsurance
Physical therapy & speech & language therapy visit
In-network: $0 copay
Out-of-network: 30% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $0 copay
Out-of-network: 30% coinsurance
Outpatient individual therapy with a psychiatrist
In-network: $0 copay
Out-of-network: 30% coinsurance
Outpatient group therapy visit
In-network: $0 copay
Out-of-network: 30% coinsurance
Outpatient individual therapy visit
In-network: $0 copay
Out-of-network: 30% coinsurance

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: $0 copay
Out-of-network: 30% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: $0 copay
Out-of-network: 30% coinsurance per item
Diabetes supplies
In-network: $0 copay
Out-of-network: 30% coinsurance per item

Prescription Drug Benefits

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$0 copay

Brand-name drugs :
$0 copay

Generic
Preferred Brand
Non-Preferred Drug
Specialty Tier

Part B Drugs

Chemotherapy drugs
In-network: $0 copay
Out-of-network: 30% coinsurance
Other Part B drugs
In-network: $0 copay
Out-of-network: 30% coinsurance

Extra Benefits

Hearing

Hearing exam
In-network: $0 copay
Out-of-network: 30% coinsurance
Fitting/evaluation
Not covered
Hearing aids - Inner ear
Not covered
Hearing aids - Outer ear
Not covered
Hearing aids - Over the ear
Not covered

Preventive Dental

Oral exam
Not covered
Cleaning
Not covered
Fluoride treatment
Not covered
Dental x-rays
Not covered

Comprehensive dental

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

Vision

Routine eye exam
In-network: $0 copay
Out-of-network: 30% coinsurance
Contact lenses
In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: $0 copay
Eyeglass frames (only)
Not covered
Eyeglass lenses (only)
Not covered
Upgrades
Not covered

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