A non-government entity
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 Riverside and San Bernardino Counties. 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:
Sign up for Aetna Medicare Prime (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 (HMO-POS) plan features an annual prescription drug deductible of $615.00. During the initial coverage phase, Tier 1 preferred generic drugs have no copay when filled at preferred pharmacies or through preferred mail order, while standard pharmacies and mail options require a $12.00 copay. For other tiers, you will pay a 24% coinsurance for Tier 2 standard generics and a 25% coinsurance for both Tier 3 preferred brands and Tier 4 non-preferred drugs. These cost-sharing rates apply during the initial coverage phase until total drug costs reach $2,100.00. After your yearly out-of-pocket drug costs reach this $2,100.00 threshold, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs. Beneficiaries who qualify for the low-income subsidy may also see their Part D premium reduced to $0.00.
Additional Benefits
The Aetna Medicare Prime (HMO-POS) plan offers comprehensive coverage with no copay and no coinsurance for many essential services, including inpatient hospital stays, outpatient services, and primary care visits. Members also benefit from no copays or coinsurance for routine preventive care, home health services, and the first 20 days of a skilled nursing facility stay. For emergency care, there is a $150 copay and no coinsurance, while urgent care visits require no copay. This plan features strong ancillary benefits, including no copay and no coinsurance for routine dental, vision, and hearing exams, alongside a $250 annual eyewear allowance and a $1,250 annual per-ear hearing aid allowance. Comprehensive dental services and durable medical equipment are available with no copays and coinsurance ranging up to 50%. Additionally, members receive a $65 quarterly allowance for select over-the-counter items with no copay.
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. However, non-Medicare-covered stays, upgrades for acute care, and additional days for psychiatric care are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Prime (HMO-POS) with no copays and no coinsurance for outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most of these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Aetna Medicare Prime (HMO-POS) covers partial hospitalization services with copays ranging from no copay to $180 and no coinsurance. Prior authorization is required to access these benefits.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by Aetna Medicare Prime (HMO-POS), as transportation services to plan-approved or any health-related locations are not covered. For covered ambulance services, ground transportation requires a $275 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay.
Emergency Services See details
Aetna Medicare Prime (HMO-POS) covers emergency services with a $150 copay and urgently needed services with no copay, with no coinsurance required for either. Worldwide emergency and urgent care are also covered with a $150 copay ($275 for worldwide emergency transportation) and no coinsurance, up to a $250,000 maximum benefit.
Primary Care See details
Primary Care benefits are partially covered by Aetna Medicare Prime (HMO-POS), with podiatry services excluded from coverage. Most covered services, including primary care physician visits, specialist services, and physical therapy, require no copay and no coinsurance, though additional telehealth benefits carry a 20% coinsurance and no copay.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Prime (HMO-POS), featuring no copay and no coinsurance for annual physical exams, health education, and glaucoma screenings. Kidney disease education services require a 20% coinsurance and no copay, while several sub-services like weight management, therapeutic massage, alternative therapies, and in-home safety assessments are not covered.
Hearing Services See details
Hearing Services are partially covered by Aetna Medicare Prime (HMO-POS), featuring routine hearing exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $1,250 per ear annually with no copay or coinsurance, though OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription models, are not covered.
Vision Services See details
Aetna Medicare Prime (HMO-POS) covers vision services with no copay and no coinsurance for eye exams and eyewear. This includes one routine eye exam per year and a combined annual eyewear allowance of up to $250 for contacts, lenses, frames, and upgrades.
Dental Services See details
Aetna Medicare Prime (HMO-POS) offers partially covered dental services with no copay and no coinsurance for Medicare-covered dental care, oral exams, cleanings, and x-rays. Other covered services, such as restorative care, endodontics, periodontics, prosthodontics, and oral surgery, require no copay and a 20% to 50% coinsurance, while fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Prime (HMO-POS) covers home infusion bundled services, which require prior authorization and step therapy. Under this benefit, Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and a 0% to 20% coinsurance.
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 covered services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Prime (HMO-POS) with coinsurance ranging from 0% to 20% and no copays for durable medical equipment, prosthetics, and diabetic supplies. Prior authorization is required for durable medical equipment, prosthetics, and diabetic equipment.
Diagnostic and Radiological Services See details
Aetna Medicare Prime (HMO-POS) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Members pay no copay for lab services, diagnostic tests, and outpatient X-rays, while diagnostic and therapeutic radiological services require a copay of up to $60.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Prime (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Prime (HMO-POS) covers Cardiac Rehabilitation Services with a copay and no coinsurance, though a doctor referral is required. While some services are covered, in practice Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered under Aetna Medicare Prime (HMO-POS), requiring prior authorization, while additional days beyond those covered by Medicare are not covered. There is no copay and no coinsurance for days 1 to 20, followed by a $50 daily copay and no coinsurance for days 21 to 100.
Other Services See details
Other Services are partially covered by Aetna Medicare Prime (HMO-POS), offering no copay and no coinsurance for acupuncture, select over-the-counter items up to $65 quarterly, and annual wellness exams. Meal benefits and dual eligible SNPs with highly integrated 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