2025 HMSA Medicare Advantage Application Instructions

Thanks for choosing HMSA Medicare Advantage.

HMSA Medicare Advantage plans (except HMSA Akamai Advantage Dual Care)

  • HMSA Akamai Advantage Complete
  • HMSA Akamai Advantage Complete Plus
  • HMSA Akamai Advantage Standard
  • HMSA Akamai Advantage Standard Plus
View Form [PDF]

Who can enroll?

You can enroll in HMSA Akamai Advantage if you:

  • Are a U.S. citizen or lawfully present in the U.S.
  • Live in the plan's service area.*
  • Have Medicare Part A (hospital insurance).
  • Have Medicare Part B (medical insurance).

If you live on Oahu, the available plans are HMSA Akamai Advantage Complete and Complete Plus. If you live on a Neighbor Island, the available plans are HMSA Akamai Advantage Standard and Standard Plus.

Open Enrollment Dates

This year’s annual enrollment period for Medicare Advantage will be Oct. 15 to Dec. 7, 2024. If you enroll during this time, your plan will start on Jan. 1, 2025. If you’re new to Medicare or qualify for a special enrollment period, you may be able to submit your application outside of these dates.

If you’re enrolling outside of the Medicare annual enrollment period, complete this Attestation of Eligibility [PDF] to choose a valid election period and include the form with your application.


What you’ll need

  • Your Medicare number (the number on your red, white, and blue Medicare card).
  • Your HMSA subscriber ID number, if you have one.
  • Your primary care provider’s name. If you don’t have a PCP, let us know and we can help you find one.
  • The date you’d like your health plan to start.
  • If you (the applicant) are unable to sign, your legal representative may sign for you. Your representative must fill in their name, mailing address, telephone number, and their relationship to you (the applicant).

Before you send

Complete all sections of the form accurately and write legibly so we can process your application without any delays.

Please don’t send payment with your application.


Where to send

Please mail your completed form to:

HMSA Medicare Advantage Sales
P.O. Box 3500
Honolulu, HI  96811-9983

You can also fax the completed application to 808-948-6343.


Set up automatic payments

Never worry about remembering to pay your health plan premiums. Once you receive your HMSA membership card, you can set up automatic payments through My Account. There’s no cost, and most major banks and some credit unions participate.