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Aetna Medicare Prime (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare 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 Prime (HMO-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Prime (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2026 to people living in Los Angeles County. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Aetna Medicare 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 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 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 a $615.00 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 $299.00 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 Prime (HMO-POS) plan offers an Enhanced Alternative drug benefit with a $615.00 prescription drug deductible. After meeting this deductible, you will have no copay for Tier 1 preferred generic drugs at preferred pharmacies and preferred mail order, or a $12.00 copay at standard pharmacies and standard mail. For Tier 2 standard generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs, you will pay coinsurance ranging from 24% to 25% depending on the tier. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D prescription drugs. Furthermore, beneficiaries who qualify for the low-income subsidy can reduce their Part D premium to $0.00.
Additional Benefits
The Aetna Medicare Prime (HMO-POS) plan offers comprehensive medical coverage featuring no copay and no coinsurance for inpatient hospital stays, outpatient services, and primary care visits. Emergency care is available with a $150 copay, which is waived upon hospital admission, while ground ambulance services require a $275 copay. Additionally, diagnostic labs, routine X-rays, and home health services are fully covered with no copay or coinsurance. This plan also includes valuable supplemental benefits, such as routine vision and hearing exams with no copay, alongside annual allowances of up to $250 for eyewear and $1,250 per ear for prescription hearing aids. Preventive dental care features no copay, though comprehensive dental services require a 20% to 50% coinsurance up to a $2,000 yearly limit. Members also benefit from a $45 quarterly over-the-counter allowance and skilled nursing facility stays with no copay for the first 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by Aetna Medicare Prime (HMO-POS) with no copay and no coinsurance for Medicare-covered acute and psychiatric stays. Prior authorization is required, and non-Medicare-covered stays, acute care upgrades, and additional days for psychiatric stays are not covered.
Outpatient Services See details
Aetna Medicare Prime (HMO-POS) covers outpatient services with no copay and no coinsurance, including outpatient hospital visits, ambulatory surgical center services, outpatient substance abuse sessions, and outpatient blood services. Prior authorization is required for most of these services, and there is no deductible.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Aetna Medicare Prime (HMO-POS) with copays ranging from no copay to $180 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered under Aetna Medicare Prime (HMO-POS), as transportation services to plan-approved or any health-related locations are not covered. Covered ground ambulance services require a $275 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay, with prior authorization required for all ambulance services.
Emergency Services See details
Aetna Medicare Prime (HMO-POS) covers emergency services with a $150 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services have no copay and no coinsurance, while worldwide emergency and urgent services are covered up to $250,000 with copays ranging from $150 to $275 and no coinsurance.
Primary Care See details
Aetna Medicare Prime (HMO-POS) offers partially covered Primary Care benefits, as podiatry services are not covered. Most covered services, such as primary care physician and specialist visits, feature no copay and no coinsurance, while additional telehealth benefits require a 20% coinsurance and no copay.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Prime (HMO-POS), featuring no copays or coinsurance for annual exams, health education, and screenings, while kidney disease education requires a 20% coinsurance and no copay. Uncovered sub-services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered under Aetna Medicare Prime (HMO-POS), with routine exams and fitting evaluations offered at no copay and no coinsurance. Prescription hearing aids (all types) are covered with no copay and no coinsurance up to $1,250 per ear annually, while OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Prime (HMO-POS) covers vision services with no copay, no coinsurance, and no deductible for both eye exams and eyewear. This includes one routine eye exam per year and a combined maximum benefit of $250 annually for eyewear, including contacts, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Prime (HMO-POS), featuring no copay for Medicare dental services, oral exams, cleanings, and x-rays. Comprehensive care like restorative services, endodontics, periodontics, prosthodontics, and oral surgery requires a 20% to 50% coinsurance up to a $2,000 annual maximum, while fluoride, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Prime (HMO-POS) covers home infusion bundled services with prior authorization, requiring a $35 copay and no coinsurance for Medicare Part B insulin. Other covered Part B drugs, including chemotherapy and radiation drugs, have no copay and a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Prime (HMO-POS) with a 20% coinsurance and no copay. Prior authorization is required to receive these services.
Medical Equipment See details
Aetna Medicare Prime (HMO-POS) covers medical equipment, including durable medical equipment, prosthetics, and diabetic equipment, with prior authorization required. There are no copays for these covered benefits, and coinsurance ranges from no coinsurance up to 20% depending on the specific item.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under Aetna Medicare Prime (HMO-POS) with no coinsurance. Members pay no copay for lab services, diagnostic procedures, outpatient X-rays, and diagnostic radiological services, while therapeutic radiological services require a $60 copay.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Prime (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Prime (HMO-POS) plan, as none of the associated sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Prime (HMO-POS) covers Skilled Nursing Facility (SNF) services with prior authorization, featuring no copay for days 1 through 20 and a $50 daily copay for days 21 through 100, with no coinsurance. This benefit is partially covered because additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Aetna Medicare Prime (HMO-POS) with no copay or coinsurance for unlimited acupuncture, annual wellness exams, and a $45 quarterly over-the-counter allowance. Meal benefits and Dual Eligible SNPs with Highly Integrated Services are not covered under this plan.
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