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Aetna Medicare Enhanced (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Enhanced (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 Enhanced (HMO-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Enhanced (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Greater Central Ohio Area. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Enhanced (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 Enhanced (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 Enhanced (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $52.00. 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 $5900.00 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 Enhanced (HMO-POS) plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members pay no copay when using preferred pharmacies or preferred mail-order services. Standard pharmacies and standard mail-order options require small copays, starting at $2.00 for Tier 1 and $12.00 for Tier 2 for a one-month supply. Brand-name and specialty medications under this plan are subject to coinsurance rather than flat copays. Members pay 24% coinsurance for Tier 3 preferred brand drugs, and 25% coinsurance for Tier 4 non-preferred drugs and Tier 5 specialty drugs. These coinsurance rates apply equally across both preferred and standard pharmacies, as well as mail-order delivery.
Additional Benefits
The Aetna Medicare Enhanced (HMO-POS) plan offers robust medical coverage with no copays or coinsurance for primary care visits, preventive screenings, and home health services. For inpatient hospital stays, members pay a $325 daily copay for the first seven days and no copay for days eight through 90, while outpatient hospital services feature copays ranging from no copay up to $325. Emergency room visits require a $130 copay, which is waived if admitted, and urgent care has a $50 copay. This plan also includes key supplemental benefits, featuring no copays for routine annual eye exams, preventive dental care, and routine hearing exams. Members receive up to $1,250 per ear annually for prescription hearing aids and a $200 annual allowance for eyewear, both with no copays. Other valuable perks include a $50 quarterly over-the-counter item allowance and skilled nursing facility care with no copay for the first 20 days.
Inpatient Hospital See details
Aetna Medicare Enhanced (HMO-POS) partially covers inpatient hospital services with no coinsurance and a $325 daily copay for days 1 through 7, followed by no copay for days 8 through 90. Prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Enhanced (HMO-POS) with no coinsurance, including no copays for ambulatory surgical center and blood services. Outpatient hospital copays range from $0 to $325, observation services require a $325 copay per stay, and individual or group substance abuse sessions have a $40 copay.
Partial Hospitalization See details
Aetna Medicare Enhanced (HMO-POS) covers partial hospitalization services with no coinsurance, though a copay of either $55.00 or $145.00 is required depending on the service. Prior authorization is also required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Enhanced (HMO-POS), featuring ground ambulance services for a $290 copay with no coinsurance and air ambulance services for a 20% coinsurance with no copay, both requiring prior authorization. However, transportation services to plan-approved or any other health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Enhanced (HMO-POS) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency and urgent services are covered up to a $250,000 maximum with no coinsurance and copays of $130 for care and $290 for emergency transportation.
Primary Care See details
Primary Care benefits under Aetna Medicare Enhanced (HMO-POS) feature no copay and no coinsurance for primary care visits, while specialist and psychiatric services require a $40 copay and no coinsurance. Chiropractic services are partially covered, costing a $15 copay and no coinsurance for routine care, while physical and occupational therapies require a $35 copay and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Enhanced (HMO-POS), offering an annual physical exam, health education, and select screenings with no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Several supplemental benefits are not covered, including in-home safety assessments, personal emergency response systems, weight management programs, and medical nutrition therapy.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Enhanced (HMO-POS), offering Medicare-covered exams for a $40 copay and no coinsurance, as well as annual routine 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, but OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Enhanced (HMO-POS) with no deductibles or coinsurance, featuring a $0 to $40 copay for eye exams and no copay for eyewear. Routine eye exams are covered annually with no copay, and a combined maximum benefit of $200 per year is provided for contacts, eyeglasses, frames, and upgrades.
Dental Services See details
Aetna Medicare Enhanced (HMO-POS) provides partially covered dental services, featuring preventive care like exams and cleanings with no copay and no coinsurance, and Medicare-covered dental for a $40 copay and no coinsurance. Comprehensive services are covered with no copay and 20% to 50% coinsurance up to a $1,000 annual limit, but other diagnostic services, fluoride, other preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Enhanced (HMO-POS) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Aetna Medicare Enhanced (HMO-POS) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
Aetna Medicare Enhanced (HMO-POS) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copays and coinsurance ranging from no coinsurance up to 20%. Prior authorization is required for these covered items, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Enhanced (HMO-POS) with prior authorization, featuring no coinsurance and a $0 to $100 copay for diagnostic tests, and no copay or coinsurance for lab services. Radiological services require a $10 copay and coinsurance for x-rays, a minimum 20% coinsurance for therapeutic radiology, and a copay starting at $0 with no coinsurance for diagnostic radiology.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Enhanced (HMO-POS) with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Aetna Medicare Enhanced (HMO-POS) features no coinsurance for cardiac rehabilitation, meaning some services are covered. However, Cardiac Rehabilitation (with a $20 copay), Intensive Cardiac Rehabilitation ($20 copay), Pulmonary Rehabilitation ($15 copay), and SET for PAD services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Enhanced (HMO-POS) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Enhanced (HMO-POS) with no copay and no coinsurance, though acupuncture is not covered. Covered benefits include a $50 quarterly over-the-counter item allowance, chronic illness meal benefits, annual wellness exams, and additional colorectal cancer screenings.
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