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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 Lexington 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:
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Drug Coverage
The Aetna Medicare Premier (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $5 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Aetna Medicare Premier (HMO-POS) plan offers comprehensive coverage with a variety of benefits. This plan includes coverage for inpatient and outpatient services, with copays varying depending on the service. There is no copay for many services, including primary care, preventive services, hearing exams, vision eyewear, dental services, and home health services. The plan also provides coverage for emergency services, ambulance services, and transportation to health-related locations. Additionally, it offers benefits for home infusion, dialysis, medical equipment, and diagnostic services. Many services have no copay, but some services, such as inpatient hospital stays, have copays.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, but require prior authorization. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you pay a $290 copay for days 1-7, and no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services for Aetna Medicare Premier (HMO-POS) includes coverage for all outpatient hospital services with a copay ranging from $0 to $325, observation services with a $290 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services and outpatient blood services are also covered, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier (HMO-POS) plan, with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including ground and air ambulance, are covered by the Aetna Medicare Premier (HMO-POS) plan. There is a $290 copay for both ground and air ambulance services, and transportation services to plan-approved health-related locations have a $0 copay for up to 12 one-way trips per year. 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. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Transportation has a $290 copay; all have no coinsurance.
Primary Care See details
The Aetna Medicare Premier (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, physician specialist services with a $35 copay, mental health specialty services with a $40 copay for individual and group sessions, podiatry services with a $40 copay, other health care professional services with a $0-$35 copay, psychiatric services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a 20% coinsurance and a $0-$45 copay, and opioid treatment program services with a $40 copay.
Preventive Services See details
Preventive Services include annual physical exams with no copay, and other preventive services with a copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing services include hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with no copay, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Premier (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$40 and eyewear with no copay. Routine eye exams are covered with no copay, and other eye exam services are also covered with no copay. Eyewear benefits include contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, all with no copay, and a combined maximum of $235 per year.
Dental Services See details
Dental services are covered, with no copay for Medicare Dental Services, 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. This plan has a maximum of $1,100 per year for other dental services. 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, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
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, including Durable Medical Equipment (DME), is covered with a coinsurance between 0% and 20%, and Prosthetic Devices and Medical Supplies are covered with a coinsurance of 20% and 0-20% respectively. Diabetic Equipment, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are covered, with Diabetic Therapeutic Shoes/Inserts having no copay, and Diabetic Supplies having a coinsurance between 0% and 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, lab services, all radiological services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. Diagnostic Procedures/Tests have a copay ranging from $0 to $100, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $200, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Premier (HMO-POS) plan, but the specific services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are not covered. There is a copay for some Cardiac and Pulmonary Rehabilitation Services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered under the Aetna Medicare Premier (HMO-POS) plan, requiring 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 and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Premier (HMO-POS) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay, and covers other services including annual wellness exams, screening mammography, gFOBT, and FIT with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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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