Understanding the Potential HMSA Medicare Advantage Plans for 2025

When it comes to healthcare, some of the HMSA Medicare Advantage Plans may offer a variety of benefits:

• Potential coverage for certain medical expenses

• Value-added services such as supplemental vision, dental, and hearing benefits

These plans may be designed to be as flexible as your needs and budget require, possibly enhancing your live healthcare experience, whether you’re ready to retire or not.

Moreover, the focus of some of these plans may not merely be on offering services but could also be on delivering high-quality services. With a rating of 4 out of 5 stars, HMSA Medicare Advantage Plans may be recognized for their quality and performance. It’s no wonder that many may be turning to HMSA for their healthcare needs.

HMSA Akamai Advantage Dual Care PPO SNP

The HMSA Akamai Advantage Dual Care PPO SNP exemplifies comprehensive healthcare coverage. This Medicare Advantage Prescription Drug plan is designed specifically for individuals who are eligible for both Medicare and full Medicaid benefits through QUEST Integration.

Key features of this plan include:

• No monthly premium (although you’re required to continue paying the Medicare Part B premium unless it’s covered by Medicaid or another third party)

• Prescription drug coverage

• Access to a network of doctors and hospitals

• Additional benefits such as dental, vision, and hearing coverage

If you’re eligible for both Medicare and full Medicaid benefits, the HMSA Akamai Advantage Dual Care PPO SNP may be a great option for you.

This plan offers extensive coverage for healthcare services, including:

• Inpatient hospital care

• Skilled nursing facility care

• Primary and specialty care provider office visits

• Preventive services

And the cherry on top? You get health coordinators who are there to assist you, providing additional support for navigating the healthcare system.

HMSA Akamai Advantage Complete Plus (PPO)

The HMSA Akamai Advantage Complete Plus (PPO) plan prioritizes providing you with choices. With a broad network of healthcare providers, you have the freedom to choose from a wide array of doctors, pharmacies, and other healthcare services within the PPO network.

Having a broad provider network allows you to choose from more healthcare options and potentially receive more convenient and local care.

Should you require further information or details on enrollment, you can reach out to the HMSA team anytime. You can contact HMSA directly for assistance or reference Section 2.0 Enrollment Process for HMSA Medicare Advantage Plans in this blog post.

Enrollment Process for HMSA Medicare Advantage Plans

Enrolling in your desired HMSA Medicare Advantage Plan could be straightforward. Just call one of our licensed agents at 1-844-709-9937 (TTY user 711) Mon-Fri 8am-9pm Est. They can provide comprehensive information, personalized guidance, and ongoing assistance to navigate the enrollment process for private insurance companies, making it easier for beneficiaries to make informed decisions about their healthcare.

After CMS has received and approved your application, your plan will begin on the first day of the following month.

But what if you can’t sign the application? No worries! A legal representative may sign on your behalf, and they must provide their:

• Name

• Mailing address

• Telephone number

• Relationship to you

Eligibility Criteria

Before you enroll, you need to make sure you meet the eligibility criteria. To be eligible for enrollment in HMSA Akamai Advantage, you must be a citizen or lawful resident of the United States, reside in the plan’s service area, and be enrolled in both Medicare Part A and Part B.

Enrollment Periods

The annual enrollment period for Medicare Advantage plans is from October 15 to Dec 7. If you enroll during this period, your coverage for HMSA Medicare Advantage plans will start on January 1, 2025.

If you’re new to Medicare or qualify for a special enrollment period, you must apply for HMSA Medicare Advantage plans before October 15.

HMSA accepts Medicare Advantage plan applications during the annual Open Enrollment Period or any time throughout the year for eligible individuals under a Special Enrollment Period (SEP). So, you have multiple opportunities to join the HMSA community and start enjoying your healthcare benefits.

Navigating Your Potential HMSA Medicare Advantage Plan Benefits

Learning how to navigate your potential plan benefits effectively may be key to maximizing your HMSA Medicare Advantage plan. Some of the plans may offer a range of benefits that could be tailored to your healthcare needs and might include preventive services, hospital care, and prescription drugs.

You may be able to manage these potential benefits through ‘My Account’ on HMSA.com by registering for an online account.

Another useful tool that may be at your disposal could be the provider directory on HMSA.com. Using this, you could easily find and choose from in-network healthcare providers that could ensure your care is covered by the plan. And if you’re a globetrotter, there’s good news.

The Traveler/Visitor program could potentially ensure that your healthcare coverage may be able to follow you when traveling outside of Hawaii, possibly safeguarding you from unexpected health issues while away from home.

My Account: Online Access to Plan Information

‘My Account’ may put the management of your healthcare plan at your fingertips. Once you register for My Account, you may be able to access personal health plan information, claims, and coverage details anytime, anywhere. This means you could keep track of your healthcare plan at your convenience, possibly managing your potential plan benefits a breeze.

Moreover, you may be able to manage your prescription drugs using the Caremark mobile app or through My Account on the HMSA website. So, whether it’s checking your coverage or managing your prescriptions, it’s all under your control with ‘My Account’.

Provider Directory and Network

Identifying the appropriate healthcare provider could play a vital role in managing your health. With the Provider Directory, you may easily locate in-network healthcare providers. You can access this directory through HMSA’s online portal or customer service outlets.

The directory will likely allow you to search by various criteria, which may include medical specialty and geographic location. This means you will likely find the right healthcare provider that aligns with your specific healthcare requirements. So, whether you need a specialist in neurology or a local family doctor, the Provider Directory could be your go-to resource.

Traveler/Visitor Program

While traveling is thrilling, unforeseen health issues could cause inconvenience. Not to worry, with the Visitor/Traveler Program, you may be assured that your health care coverage could potentially travel with you.

Whether you’re traveling within the United States or venturing abroad, you will likely be able to find preferred or participating providers to receive medical care during your visit.

For international travel, you may be able to continue to access your health plan benefits and might have the option to locate a participating BlueCard Worldwide Provider. So, whether you’re exploring the Grand Canyon or the Great Wall of China, your health coverage could be with you every step of the way.

Managing Prescription Drugs with HMSA Medicare Advantage Plans

Efficiently managing your prescription drugs is a significant part of your healthcare journey. Certain HMSA Medicare Advantage plans will likely include different tiers for prescription drug coverage, with potential co-payments that may vary based on whether medications may be obtained through retail or mail-order pharmacies during the initial coverage stage.

After surpassing the initial coverage limit, you enter the catastrophic coverage stage, which could potentially provide additional coverage for prescription drugs.

Coverage determinations by HMSA will likely be crucial decisions about whether a Part D drug may be provided or paid for, and these determinations may also involve making exceptions to the usual formulary list. So, it’s not just about getting your medications, it’s about making sure you could get the most appropriate and cost-effective medications.

Formulary and Drug Search Tools

With the possibility of having a comprehensive formulary that lists all drugs covered by the plan, you might easily find your prescribed medications. But did you know you could also find potential cost-saving alternatives?

Generic drugs may contain the same active ingredients as brand-name drugs, offering potential cost savings while providing the same therapeutic benefits.

Some of these generic alternatives may be introduced after the patent for the brand-name drug expires, usually after 20 years. So, by choosing available generic alternatives, you may be able to take advantage of the potential cost savings while receiving the same therapeutic benefits as the brand-name medications. It’s all about getting the best value for your money.

Mail-order Prescription Service

Getting your medications may now be as simple as checking your mail. With the CVS Caremark mail-order prescription service, you could have some of your medications delivered directly to your home. This service may be specifically designed for the delivery of maintenance medications that may be used for the treatment of chronic conditions.

So, if you’re managing a chronic condition, this service might be a convenient option for you. All you may need to do is order your medications and you could have them delivered straight to your doorstep.

Prior Authorization and Step Therapy

Sometimes, obtaining certain prescription drugs may require prior authorization. This process may ensure that you receive the most appropriate and cost-effective medications. There may also be the Step Therapy measure where you might need to try one or more preferred drug alternatives to determine effectiveness before being approved for a non-preferred drug.

But don’t worry, if you’re already undergoing treatment, Step Therapy protocols could potentially maintain continuity of care by not requiring a switch to preferred drug alternatives. So, these possible provisions for prior authorization and step therapy may be able to ensure appropriate medication use, keeping your health as the top priority.

Potential Financial Assistance for HMSA Medicare Advantage Plan Members

While healthcare costs may be worrisome, HMSA Medicare Advantage plan members may be able to avail of financial assistance programs such as Extra Help and the Low-Income Subsidy. Members who qualify for Extra Help may receive assistance with monthly premiums, annual deductibles, and prescription drug copayments.

These potential financial assistance programs may be able to ensure that your healthcare needs don’t have to take a toll on your finances. All you need to do is submit your applications for financial assistance to the Social Security Administration either online or at a local office.

Low-Income Subsidy Program

The Low-Income Subsidy, also known as the Extra Help program, will likely be a federal program that could potentially provide support to eligible Medicare beneficiaries with some of their medication expenses. This program could potentially reduce some out-of-pocket costs by paying for prescription drugs and possibly lowering monthly plan premiums for those who qualify.

Eligibility for the Low-Income Subsidy may be determined by income and assets, with considerations for higher income and resource limits that may be specific to residents of Hawaii.

Once Medicare notifies HMSA that you’re eligible for the Low-Income Subsidy, the subsidy is applied to your plan, potentially reducing some of your prescription drug copayments and monthly premiums.

Extra Help

The Extra Help program may be able to assist eligible individuals with potential Medicare Part D prescription drug plan costs, which could include premiums, deductibles, and co-payments.

Eligibility for Extra Help will likely require that you have Medicare, have limited resources and income from sources such as wages and benefits, and reside in one of the 50 states or the District of Columbia, possibly excluding the value of a primary residence if lived in.

To avail of Extra Help, you could apply via the Social Security Administration website, by phone, or by visiting a local Social Security office. So, don’t let potential financial constraints hinder your healthcare journey. Take advantage of the Extra Help program and you could potentially ease some of your healthcare costs.

Grievances, Appeals, and Coverage Determinations

Should you have any complaints or concerns about your medical care or service, you may have the option to file a grievance. Grievances could be filed either orally or in writing, and HMSA will likely be required to address the grievance as quickly as your health condition necessitates.

Additionally, if you disagree with an initial decision that may regard your potential medical benefits made by HMSA, you may have the right to file an appeal. Both you and your providers may be entitled to file an appeal if you do not agree with a coverage determination decision made by HMSA.

So, you will likely have the freedom to voice your potential concerns and may have the assurance that your grievances will be addressed promptly.

Potential Medical Benefits: Organization Determinations and Appeals

As a provider, you could have the opportunity to request a review of a claim decision from HMSA’s Provider Correspondence within 60 days of the original decision and might engage in a discussion with an HMSA medical director if the issue requires a medical or clinical review.

HMSA’s appeal process will likely include a standard procedure that may be completed within 30 days and an expedited process for urgent situations completed within 72 hours.

After reviewing an appeal, HMSA could potentially notify you of the decision within 60 days, and if the appeal is successful, payments may be made within 30 days of the decision notice. If an appeal decision is unfavorable, you could have the option to request arbitration within 60 calendar days, which could be final and binding.

Prescription Drugs: Coverage Determinations and Appeals

Coverage determination will likely refer to HMSA’s preliminary decision on whether a Part D prescription drug may be covered if an exception request could be made permissible, or if it is possible to reduce a drug tier.

You, your prescriber, or an authorized representative may be able to request this. When requesting a coverage determination, the form must include:

• Your personal information

• The drug name

• Type of request

• Indication for a fast decision if needed

• Signed by the requester with the prescribing physician’s name and contact details.

Prescribers must be able to provide supporting information, which could include the medical diagnosis and rationale for the requested prescription drug when filing for coverage determination. If coverage determination for a prescription drug is denied, an appeal or redetermination may be filed within 60 days, and HMSA could potentially provide both standard and expedited processes that could address the appeal.

You may be able to appoint a representative or might be able to have your prescriber or pharmacist initiate or assist with the coverage determination and appeals process on your behalf.

Summary

From understanding the different plans and their potential benefits, navigating the enrollment process, managing your potential plan benefits and prescription drugs, possibly availing of financial assistance programs, and addressing grievances and appeals – we’ve covered most of what the HMSA Medicare Advantage Plans for 2025 may have to offer.

Remember, some of these plans may be designed with your healthcare needs in mind, possibly providing comprehensive coverage, value-added services, and financial assistance programs that could ensure that you get the most out of your healthcare journey.

The road to a healthier you will likely begin with choosing the right plan. With certain HMSA Medicare Advantage Plans, you may have the freedom to choose a plan that could fit your healthcare needs and budget. So, take the leap, enroll in the HMSA Medicare Advantage Plan, and embark on a healthcare journey that may be unique to you.