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Visit a Center| wcagcolheader | HMSA Akamai Advantage Standard (PPO) | HMSA Akamai Advantage Standard Plus (PPO) |
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Monthly premium Extra Help, or Low Income Subsidy, can help pay for prescription drugs and monthly premiums. Find out more. |
$20 | $151 |
| 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 | |
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Provider directory |
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| 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 | $40 |
| Annual wellness visit | $0 | $0 |
| Ambulance, includes ground and air ambulance | $350 | $300 |
| Emergency care | $115 | $115 |
| Urgent care | $40 | $40 |
| Worldwide coverage for emergency and urgent care services | 10% | 10% |
| Diagnostic services, labs and imaging* | $0, 20%, or 25% depending on the service | $0, $100, 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 | ||
| You Pay | You Pay | |
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Diagnostic and preventive dental services:
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$0 | $0 |
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Comprehensive dental services:
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$0 | $0 |
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Comprehensive dental services:
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Not Covered | $0 |
| Dental Provider Directory | Dental Provider Directory English [PDF] | Chinese [PDF] | Ilocano [PDF] | Korean [PDF] | Vietnamese [PDF] |
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| 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 | Vision Provider 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) |
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| 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. |
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| 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. |
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| 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.
