A non-government entity
Aetna Medicare Prime II (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Prime II (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Prime II (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Prime II (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Orange County. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Aetna Medicare Prime II (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Aetna Medicare Prime II (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Aetna Medicare Prime II (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $599.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for Aetna Medicare Prime II (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Prime II (HMO-POS) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. Once you meet your deductible, you will pay the following costs for your prescriptions. For preferred generic drugs, there is no copay at preferred pharmacies or mail order. For standard generic, preferred brand, and non-preferred drugs, you pay 24% or 25% coinsurance, depending on the tier and pharmacy. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Prime II (HMO-POS) plan offers a wide range of benefits with varying costs. Many services, like inpatient hospital stays, outpatient services, primary care visits, preventive services, vision and dental care, and home health services, have no copay. However, other services like ambulance, emergency services, and some outpatient services have copays or coinsurance requirements. The plan includes coverage for hearing aids, with an annual maximum, and also covers medical equipment and home infusion services. Additionally, there are no copays for many services, but some services have coinsurance, such as dialysis and some diagnostic services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. Inpatient Hospital-Acute has no copay for a Medicare-covered stay, and also includes additional days with no copay; Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services have no copay, while individual and group substance abuse sessions have a $10 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Prime II (HMO-POS) plan. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including all ambulance services, are covered, but require prior authorization. Ground ambulance services have a $275 copay, while air ambulance services have 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, with a limit of 12 one-way trips every year, and using rideshare services, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. For Emergency Services and Worldwide Emergency Coverage and Worldwide Urgent Coverage, you'll pay a $140 copay, and for Worldwide Emergency Transportation, you'll pay a $275 copay; all services have no coinsurance.
Primary Care See details
The Aetna Medicare Prime II (HMO-POS) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, and physical therapy and speech-language pathology services have no copay, while other services have a $10 copay. Additionally, additional telehealth benefits have a 20% coinsurance.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other services like Health Education, Wigs for Hair Loss Related to Chemotherapy, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, all with no copay. Kidney Disease Education Services have a 20% coinsurance. Some services, such as In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services include coverage for hearing exams with no copay, and fitting/evaluation for hearing aids with no copay, both once per year. Prescription Hearing Aids are covered up to a maximum of $1250 per year, but specific types of hearing aids are not covered. OTC Hearing Aids are not covered.
Vision Services See details
Vision services, including routine eye exams and eyewear, are covered. Eye exams and eyewear have no copay, and eyewear has a combined maximum plan benefit coverage amount of $275 per year.
Dental Services See details
Dental services are covered, with no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Maxillofacial prosthetics, implant services, and orthodontics are not covered, and there is a $1,000 annual maximum for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Prime II (HMO-POS) plan and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Aetna Medicare Prime II (HMO-POS) plan covers medical equipment including Durable Medical Equipment (DME) with no copay and a coinsurance between 0% and 20%, Prosthetic Devices with a 20% coinsurance, Medical Supplies with no coinsurance, and Diabetic Equipment. Diabetic Supplies have a coinsurance between 0% and 20%, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures, tests, and lab services, are covered under the Aetna Medicare Prime II (HMO-POS) plan. Diagnostic Procedures/Tests have no copay, while Lab Services also have no copay. Therapeutic Radiological Services have a $60 copay, while Diagnostic Radiological Services and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Prime II (HMO-POS) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Prime II (HMO-POS) plan, but no specific services are covered. A doctor's referral is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Prime II (HMO-POS) plan with prior authorization required. You will have no copay for days 1-20, and a $50 copay for days 21-100. Additional days beyond Medicare-covered, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other services, such as acupuncture and over-the-counter (OTC) items, are covered under the Aetna Medicare Prime II (HMO-POS) plan. Acupuncture has no copay, and OTC items have no copay with a maximum plan benefit coverage amount of $75 every three months. Meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and other services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved