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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 Ashland 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 $4500.00 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. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, the copay is $5.00 at preferred pharmacies and mail order, or $12.00 at standard pharmacies. After your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Aetna Medicare Premier (HMO-POS) plan offers comprehensive coverage with varying costs depending on the service. For inpatient hospital stays, you'll pay a $250 copay for the first five days, and then no copay. Outpatient services have copays ranging from $0 to $275, while primary care visits have no copay, and specialist visits have a $30 copay. This plan includes additional benefits such as hearing, vision, and dental services. Hearing exams have a $45 copay, while routine exams and hearing aids have no copay, up to an annual limit. Vision services include eye exams with a $0-$45 copay, and eyewear with no copay, with a combined maximum benefit of $295 per year. Dental services are covered with no copay up to $2,200 per year.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $250 copay for days 1-5, and no copay for days 6-90, while for Inpatient Hospital Psychiatric, you pay a $250 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient services are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $275, observation services have a $250 copay, ambulatory surgical center services have no copay, individual and group outpatient substance abuse sessions have a $40 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier (HMO-POS) plan, but requires prior authorization. The plan has a $40 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Premier (HMO-POS) plan. Ground and air ambulance services each have a $250 copay, and transportation services to plan-approved health-related locations are covered with no 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 under the Aetna Medicare Premier (HMO-POS) plan. Emergency Services has a $110 copay, Urgently Needed Services has a $40 copay, and Worldwide Emergency Services has a $110 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $250 copay for Worldwide Emergency Transportation.
Primary Care See details
The Aetna Medicare Premier (HMO-POS) plan covers primary care physician services with no copay. Chiropractic services and routine chiropractic care have a $20 copay, while occupational therapy services, individual and group sessions for both mental health and psychiatric services, have a $40 copay. Physician specialist services have a $30 copay, physical therapy and speech-language pathology services have a $40 copay, and podiatry services have a $45 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $40.
Preventive Services See details
The Aetna Medicare Premier (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are also covered, including health education and wigs for hair loss related to chemotherapy, both with no copay, and kidney disease education services with 20% coinsurance. Other services like in-home safety assessments, personal emergency response systems, and others are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $45 copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $2000 per year, with no copay for all types of prescription hearing aids except for inner ear, outer ear, and over-the-ear hearing aids which are not covered, and 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-$45, and eyewear with no copay. Routine eye exams are limited to one per year with no copay, while other eye exam services have no copay. Eyewear benefits include contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, all with no copay, with a combined maximum benefit of $295 per year.
Dental Services See details
Dental services, including oral exams, dental x-rays, and other services, are covered with no copay, up to a maximum of $2,200 per year. However, the plan does not cover maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with a $35 copay for Medicare Part B Insulin Drugs. The plan also covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Premier (HMO-POS) plan, and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the Aetna Medicare Premier (HMO-POS) plan. Durable Medical Equipment has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a coinsurance, and Medical Supplies have a coinsurance between 0% and 20%. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Premier (HMO-POS) plan. All diagnostic services are covered with a maximum copay of $100, while lab services have no copay. Diagnostic radiological services have a maximum copay of $150, therapeutic radiological services have a 20% coinsurance, and outpatient X-ray services have a $10 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, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under 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 under the Aetna Medicare Premier (HMO-POS) plan, with a $0 copay for days 1-20 and a $214 copay for days 21-100; additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered. Prior authorization is required.
Other Services See details
The Aetna Medicare Premier (HMO-POS) plan's "Other Services" benefit covers over-the-counter items with no copay, and a meal benefit 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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