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Aetna Medicare Classic Prime (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Classic Prime (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 Classic Prime (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Classic Prime (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in San Diego County. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Aetna Medicare Classic Prime (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 Classic Prime (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 Classic Prime (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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $799.00 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:
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Drug Coverage
The Aetna Medicare Classic Prime (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you'll pay a $5 copay for preferred generic drugs at a preferred pharmacy. After your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. The plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Aetna Medicare Classic Prime (HMO-POS) plan offers comprehensive coverage, including inpatient and outpatient hospital services with varying copays. You'll have no copay for primary care, vision, dental, and home health services, along with hearing exams and hearing aids. The plan also covers emergency services, ambulance services, and offers an allowance for eyewear and OTC items. This plan provides additional benefits such as coverage for preventive services, home infusion, and dialysis services. Other covered services include ambulance services, diagnostic and radiological services, and skilled nursing facility stays. The plan has a $1,500 annual maximum for dental services, and a $1250 per ear maximum for hearing aids.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, there is a $100 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, there is a $100 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered, and all other sub-services are not covered.
Outpatient Services See details
Outpatient services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have a copay between $0 and $100, while observation services, ambulatory surgical center services, and outpatient blood services have no copay; individual and group sessions for outpatient substance abuse have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with prior authorization and no copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Classic Prime (HMO-POS). Ground ambulance services have a $245 copay, while air ambulance services have 20% coinsurance; transportation services to a plan-approved health-related location are covered with no copay for up to 12 one-way trips per year, but 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 under the Aetna Medicare Classic Prime (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Worldwide Emergency Transportation has a $245 copay, and Urgently Needed Services has no copay.
Primary Care See details
Aetna Medicare Classic Prime (HMO-POS) offers primary care services with no copay, chiropractic services with no copay, occupational therapy with a copay, physician specialist services with no copay, mental health specialty services with a copay, other health care professional services with a copay, psychiatric services with a copay, physical therapy and speech-language pathology services with no copay, additional telehealth benefits with a 20% coinsurance and no copay, and opioid treatment program services with a copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services with varying copays. Kidney Disease Education Services have a 20% coinsurance. Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered with no copay. Prescription hearing aids are covered, with a maximum plan benefit of $1250 per ear every year, and no copay for Prescription Hearing Aids (all types). OTC hearing aids, and prescription hearing aids for the inner, outer, and over the ear are not covered.
Vision Services See details
Vision services are covered by the Aetna Medicare Classic Prime (HMO-POS) plan, including eye exams and eyewear. Eye exams and eyewear have no copay, and the plan offers a combined maximum of $300 per year for eyewear.
Dental Services See details
Dental services include 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 with no copay, while maxillofacial prosthetics, implant services, and orthodontics are not covered. This plan has a $1,500 annual maximum for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Classic Prime (HMO-POS) plan. 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 Classic Prime (HMO-POS) plan. There is a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay and a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies - Non-Medicare benefit, which has no copay and an unspecified coinsurance. Diabetic Equipment is covered, with a coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts, and a copay for Medicare-covered Diabetes Supplies. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and lab services with no copay. Therapeutic Radiological Services have a copay of $60, while other diagnostic radiological services and outpatient X-rays have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Classic Prime (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 under the Aetna Medicare Classic Prime (HMO-POS) plan, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. A doctor referral is required, but the copay information is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Classic Prime (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, and a $100 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the "Other Services" benefit, acupuncture and over-the-counter (OTC) items are covered. Acupuncture has no copay, while OTC items have no copay and a maximum benefit coverage amount of $75 every three months.
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