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Aetna Medicare Enhanced (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Enhanced (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 Enhanced (HMO-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Enhanced (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2026 to people living in Santa Clara County. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Aetna Medicare Enhanced (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 Enhanced (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 Enhanced (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $65.00. 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 $300.00 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 $3900.00 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 Enhanced (HMO-POS) prescription drug plan features an enhanced alternative benefit design with an annual drug deductible of $300. Under the initial coverage phase, Tier 1 preferred generic drugs require a $10 copay at preferred pharmacies and preferred mail-order, or a $12 copay at standard pharmacies and standard mail-order. If you qualify for the low-income subsidy, your drug costs under this plan may be reduced to a flat $10. For higher-tier medications, you will pay coinsurance rather than a copay, including 25% for standard generics, 26% for preferred brands, and 29% for non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs.
Additional Benefits
Aetna Medicare Enhanced (HMO-POS) offers robust medical coverage with no copay and no coinsurance for primary care, specialist visits, and routine preventive services. Inpatient hospital care requires a daily copay of $400 for days 1 to 7 with no copay thereafter, while emergency room visits carry a $150 copay. Outpatient hospital services feature no coinsurance and a copay ranging from no copay up to $475. Routine vision, hearing, and preventive dental services are fully covered with no copay and no coinsurance. The plan also provides up to $1,250 per ear annually for prescription hearing aids and $100 annually for eyewear with no copay. While home health and diagnostic labs require no copay or coinsurance, other services like dialysis and durable medical equipment involve up to a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Aetna Medicare Enhanced (HMO-POS) with no coinsurance, featuring a $400 daily copay for days 1 to 7 (no copay for days 8 to 90) for acute stays and a $370 daily copay for days 1 to 7 (no copay for days 8 to 90) for psychiatric stays. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Enhanced (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $475 copay for outpatient hospital services and a $400 copay per stay for observation services. Outpatient substance abuse sessions require a $10 copay, while ambulatory surgical center and blood services are available with no copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Aetna Medicare Enhanced (HMO-POS) with prior authorization, requiring no coinsurance and copays ranging from no copay to $180.
Ambulance and Transportation Services See details
Aetna Medicare Enhanced (HMO-POS) provides partial coverage for ambulance and transportation services, as transportation services to plan-approved or any health-related locations are not covered. Covered ground ambulance services require a $300 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay, with prior authorization required.
Emergency Services See details
Aetna Medicare Enhanced (HMO-POS) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $65 copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 limit with copays ranging from $150 to $300 and no coinsurance.
Primary Care See details
Aetna Medicare Enhanced (HMO-POS) partially covers primary care benefits, as podiatry services are not covered. Most covered services, including primary care, specialist, and therapy visits, feature no copay and no coinsurance, while mental health, psychiatric, and opioid treatment services require a $10 copay, and telehealth benefits carry a $0 to $65 copay and 20% coinsurance.
Preventive Services See details
Aetna Medicare Enhanced (HMO-POS) partially covers preventive services, offering no copay and no coinsurance for annual exams, fitness benefits, and screenings, while kidney disease education requires a 20% coinsurance and no copay. Uncovered sub-services include in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, disease management, telemonitoring, home modifications, and counseling.
Hearing Services See details
Aetna Medicare Enhanced (HMO-POS) partially covers hearing services, providing one routine hearing exam and fitting evaluation per year with no copay and no coinsurance. Prescription hearing aids (all types) are covered up to $1,250 per ear every year with no copay and no coinsurance, while OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are covered by Aetna Medicare Enhanced (HMO-POS) with no copay and no coinsurance, including one routine eye exam per year and follow-up diabetic eye exams. Eyewear, such as contact lenses and eyeglasses, is also covered with no copay and no coinsurance up to a combined maximum benefit of $100 every year.
Dental Services See details
Dental services are partially covered by Aetna Medicare Enhanced (HMO-POS), excluding fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics. Covered preventive services, including oral exams, cleanings, and x-rays, feature no copay and no coinsurance, while covered comprehensive services require a 20% to 50% coinsurance and no copay.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Enhanced (HMO-POS) with prior authorization, featuring a $35 copay and no coinsurance for Medicare Part B insulin. Other covered Part B chemotherapy, radiation, and miscellaneous drugs require no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Enhanced (HMO-POS) with a 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical Equipment is covered by Aetna Medicare Enhanced (HMO-POS) with prior authorization, featuring no copays across all covered services. Depending on the specific item, you will pay between no coinsurance and 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic equipment.
Diagnostic and Radiological Services See details
Aetna Medicare Enhanced (HMO-POS) covers diagnostic and radiological services with no copay and no coinsurance for lab services, diagnostic tests, outpatient X-rays, and diagnostic radiological services. Therapeutic radiological services are covered with a 20% coinsurance and no copay, though prior authorization and doctor referrals may be required.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Enhanced (HMO-POS) with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Enhanced (HMO-POS) plan, as all related sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Enhanced (HMO-POS) partially covers Skilled Nursing Facility (SNF) services, which require prior authorization and have no coinsurance. Under this plan, you will pay a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond Medicare-covered limits are not covered.
Other Services See details
Other Services are partially covered under the Aetna Medicare Enhanced (HMO-POS) plan, featuring acupuncture, annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings with no copay and no coinsurance. Over-the-counter (OTC) items, meal benefits, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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