A non-government entity
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 Greater Cincinnati Dayton OH 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 a $250.00 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 $5500.00 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)
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 Premier (HMO-POS) plan has a $250 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $10 copay at preferred pharmacies. The plan offers an enhanced alternative drug benefit. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs. If you qualify for the low-income subsidy (LIS), you will have no copay.
Additional Benefits
The Aetna Medicare Premier (HMO-POS) plan offers a wide range of benefits with varying cost-sharing. It covers inpatient hospital stays with a copay, as well as outpatient services and emergency services with copays, with no copays for services such as outpatient blood services. The plan also includes coverage for primary care, preventive services, hearing, vision, dental, and home health services, often with no copay or low copays for many services, and offers additional benefits like transportation, and meal benefits with no copay. This plan provides coverage for several services with no copay, including preventive services, routine hearing exams, and various dental services. Other services like specialist visits, mental health, and physical therapy have copays ranging from $20 to $45. There is also coverage for ambulance and transportation services, with copays for ambulance and no copay for transportation to plan-approved health-related locations.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care. For acute care, you will pay a $380 copay for days 1-6, and no copay for days 7-90; additional days for inpatient hospital-acute are covered with no copay. For psychiatric care, you will pay a $380 copay for days 1-6, and no copay for days 7-90; additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
The Aetna Medicare Premier (HMO-POS) plan covers outpatient services including outpatient hospital services with a copay of $0-$320, observation services with a $380 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a $40 copay per individual or group session. Outpatient blood services have no copay.
Partial Hospitalization See details
Aetna Medicare Premier (HMO-POS) covers partial hospitalization with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Aetna Medicare Premier (HMO-POS) plan. Ground and air ambulance services have a copay of $290, while transportation services to plan-approved health-related locations have no copay for up to 12 one-way trips per year using rideshare services, bus/subway, or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Premier (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $45 copay, and Worldwide Emergency Transportation has a $290 copay; all services have no coinsurance.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services are covered with a $20 copay for routine care. Occupational Therapy Services are covered with a $40 copay, and Physician Specialist Services are covered with a $40 copay. Mental Health Specialty Services have a $40 copay for both individual and group sessions. Podiatry Services and Other Health Care Professional services are covered with a copay between $0 and $45. Psychiatric Services, Individual Sessions for Psychiatric Services, and Group Sessions for Psychiatric Services are covered with a $40 copay. Physical Therapy and Speech-Language Pathology Services are covered with a $40 copay. Additional Telehealth Benefits are covered with a 20% coinsurance and a copay between $0 and $45. Opioid Treatment Program Services are covered with a $40 copay.
Preventive Services See details
The Aetna Medicare Premier (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additionally, the plan covers kidney disease education services with 20% coinsurance, and other preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay. The plan also covers wigs for hair loss related to chemotherapy, health education, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, fitness benefits, and remote access technologies, all with no copay.
Hearing Services See details
Hearing exams are covered with a $35 copay. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay, once per year. Prescription hearing aids are covered up to a $1,000 maximum benefit per year, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$35, while routine eye exams have no copay and are limited to one per year, and other eye exam services have no copay. Eyewear has no copay, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum of $200 per year.
Dental Services See details
The Aetna Medicare Premier (HMO-POS) plan covers Medicare Dental Services with no copay, as well as oral exams, dental x-rays, and prophylaxis (cleaning) with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered, and prosthodontics, fixed, prosthodontics, removable, endodontics, periodontics, and oral and maxillofacial surgery have coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, are covered by the Aetna Medicare Premier (HMO-POS) plan. The plan has a $35 copay for Medicare Part B Insulin Drugs; other services have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Premier (HMO-POS) plan, requiring prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetics/Medical Supplies with a coinsurance, and Diabetic Equipment with a coinsurance between 0% and 20% and a copay for some services. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $250, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $200, and Outpatient X-Ray Services have a $15 copay. Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered under 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. While the plan covers Cardiac Rehabilitation Services generally, it does not cover any of the sub-services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. 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 meal benefits with no copay. The plan also covers Other 1 and Other 2 services with no copay. However, acupuncture, over-the-counter items, 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.
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