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Aetna Medicare Premier (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier (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 Premier (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Premier (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Bowling Green and Southwest Kentucky Area. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Premier (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 Premier (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 Premier (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 $4900.00 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 Premier (HMO-POS)
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Drug Coverage
The Aetna Medicare Premier (HMO-POS) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance for your prescriptions. For preferred generic drugs, you will pay a $5 copay at preferred pharmacies and $12 at standard pharmacies. For standard generic drugs, you will pay 25% coinsurance, 35% coinsurance for preferred brand drugs, and 33% coinsurance for non-preferred drugs. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Premier (HMO-POS) plan offers comprehensive coverage with varying costs for different services. Inpatient hospital stays have a copay, while outpatient services have a copay that ranges from $0 to $300. Emergency services, primary care, and many preventive services have no copay, but some specialist visits and therapies do have copays. The plan also covers vision and dental services with no copays for most services. Hearing exams and hearing aids have no copay for one visit per year, and the plan offers coverage for medical equipment, home health, and dialysis services with varying copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital services are covered by the Aetna Medicare Premier (HMO-POS) plan. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $285 copay for days 1-7, and no copay for days 8-90.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services and outpatient blood services, are covered. Outpatient hospital services have a copay between $0 and $300, observation services have a $285 copay, and Ambulatory Surgical Center (ASC) Services have no copay, while outpatient substance abuse services and outpatient blood services have a $40 copay.
Partial Hospitalization See details
Aetna Medicare Premier (HMO-POS) covers partial hospitalization with a $40 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $260 copay for both ground and air ambulance services, and no copay for transportation services to a plan-approved health-related location. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered under the Aetna Medicare Premier (HMO-POS) plan. Emergency Services have a $125 copay and no coinsurance, Urgently Needed Services have a $45 copay and no coinsurance, Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $260 copay, with no coinsurance for any of these services.
Primary Care See details
Primary care physician services are covered with no copay, while chiropractic services have a $20 copay. Occupational therapy, physical therapy, and speech-language pathology services each have a $40 copay, and physician specialist services have a $35 copay. Mental health and psychiatric services have a $40 copay, while telehealth services have a 20% coinsurance and a copay between $0 and $45.
Preventive Services See details
Preventive services include Medicare-covered zero-dollar services, an annual physical exam with no copay, and additional preventive services with varying copays depending on the service. Kidney disease education services have a 20% coinsurance, while Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing Services include hearing exams with a $45 copay, routine hearing exams with no copay for one visit per year, and fitting/evaluation for hearing aids with no copay for one visit per year, but prescription hearing aids - inner ear, outer ear, and over-the-ear are not covered. The plan also covers prescription hearing aids (all types) with no copay for two visits per year.
Vision Services See details
The Aetna Medicare Premier (HMO-POS) plan covers vision services, including eye exams with a copay ranging from $0 to $45, and eyewear with a $0 copay and a combined maximum benefit of $235 every year. Routine eye exams are covered with no copay for one visit every year, and other eye exam services, as well as contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered with no copay.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, other diagnostic services, cleanings, fluoride treatments, other preventive services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no copay. Orthodontic Services are covered under Diagnostic and Preventive Dental, with a maximum benefit of $1,100 per year, and services such as maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Premier (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Premier (HMO-POS) plan, including Durable Medical Equipment (DME) with a 0-20% coinsurance and Prosthetics/Medical Supplies with a 0-20% coinsurance. Diabetic Supplies have a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Premier (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $100, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Premier (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 not covered by the Aetna Medicare Premier (HMO-POS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Premier (HMO-POS), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes over-the-counter items with no copay, a maximum benefit coverage amount of $120 every three months, and a meal benefit with no copay. Acupuncture, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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