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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 Cincinnati Dayton OH 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 $56.00. 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 $4150.00 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 prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay when using preferred pharmacies or preferred mail-order services. If standard pharmacies or standard mail-order services are used, generic drug copays range from $2 to $12 for a one-month supply. For higher-tier medications, cost-sharing transitions to coinsurance across all pharmacy and mail-order options. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance. Specialty tier medications are limited to a one-month supply under this plan.
Additional Benefits
The Aetna Medicare Enhanced (HMO-POS) plan provides robust coverage for essential medical services, often featuring low out-of-pocket costs and no coinsurance. Beneficiaries enjoy primary care visits, home health services, and annual physicals with no copay, while specialist visits require a $40 copay. For hospital stays, inpatient care incurs a $350 copay for the first six days followed by no copay, and emergency room visits carry a $150 copay which is waived if admitted. This plan also includes valuable everyday health benefits, offering preventative dental care, routine eye exams, and routine hearing tests with no copay. Prescription hearing aids are covered up to $1,250 per ear annually and eyewear is covered up to $175 per year with no copays. Additionally, members receive up to $100 in over-the-counter items every three months at no cost, while durable medical equipment is covered with no copay and a 0% to 20% coinsurance.
Inpatient Hospital See details
Aetna Medicare Enhanced (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $350 copayment for days 1 through 6 and no copayment for days 7 through 90. Prior authorization is required, and the benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Enhanced (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $350 copay for outpatient hospital services and a $350 copay per stay for observation services. Outpatient substance abuse sessions require a $35 copay and no coinsurance, while ambulatory surgical center and outpatient blood services are fully covered with no copay and no coinsurance.
Partial Hospitalization See details
Aetna Medicare Enhanced (HMO-POS) covers partial hospitalization with a copay of $40.00 or $180.00 and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Aetna Medicare Enhanced (HMO-POS), requiring a $290 copay for ground ambulance services and a 20% coinsurance for air ambulance services, with prior authorization required. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Emergency services under Aetna Medicare Enhanced (HMO-POS) are covered with a $150 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgent care has a $65 copay with no coinsurance, and worldwide emergency, urgent, and transportation services are covered up to $250,000 with no coinsurance and copays ranging from $150 to $290.
Primary Care See details
Aetna Medicare Enhanced (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Chiropractic services are partially covered, offering routine care for a $15 copay and no coinsurance, but other chiropractic services are not covered. Therapy and mental health services are also covered with copays ranging from $25 to $35 and no coinsurance.
Preventive Services See details
Aetna Medicare Enhanced (HMO-POS) offers partial coverage for preventive services, with no copay and no coinsurance for annual physicals, health education, smoking cessation, fitness benefits, remote access, wigs (up to $400), and various screenings, while kidney disease education has no copay and a 20% coinsurance. Sub-services not covered under this plan include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home/bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Enhanced (HMO-POS), with Medicare-covered exams requiring a $40 copay and no coinsurance, while annual routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are covered up to $1,250 per ear annually with no copay or coinsurance, but OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Enhanced (HMO-POS) covers vision services with no coinsurance or deductibles, offering eye exams with a $0 to $40 copay and routine annual exams with no copay. Eyewear is also covered with no copay up to a combined maximum plan benefit of $175 per year for contacts, lenses, and frames.
Dental Services See details
Aetna Medicare Enhanced (HMO-POS) partially covers dental services, featuring Medicare-covered dental with a $40 copay and no coinsurance, alongside preventive care like cleanings and exams with no copay and no coinsurance. Comprehensive dental care is available with no copay and 20% to 50% coinsurance, though fluoride, implants, orthodontics, other diagnostic services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Enhanced (HMO-POS) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Enhanced (HMO-POS) with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
Aetna Medicare Enhanced (HMO-POS) covers medical equipment, including durable medical equipment (DME), medical supplies, and diabetic supplies, with no copay and 0% to 20% coinsurance. Prosthetic devices are covered with no copay and 20% coinsurance, while diabetic therapeutic shoes and inserts have no copay, with prior authorization required for most services.
Diagnostic and Radiological Services See details
Aetna Medicare Enhanced (HMO-POS) covers diagnostic and radiological services with prior authorization, offering diagnostic services with no coinsurance, no copay for lab work, and a $0 to $150 copay for procedures. Radiological services feature copays starting at $0 for diagnostic radiology, no copay for outpatient X-rays with applicable coinsurance, and a minimum 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home health services are covered under the Aetna Medicare Enhanced (HMO-POS) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Aetna Medicare Enhanced (HMO-POS) with no coinsurance, though only some services are covered in practice. Standard Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for PAD services are not covered and require a $15 copay.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are partially covered by Aetna Medicare Enhanced (HMO-POS), as additional days beyond the standard Medicare limit are not covered. Covered stays require prior authorization with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100.
Other Services See details
Other Services are partially covered under the Aetna Medicare Enhanced (HMO-POS) plan, offering no copay and no coinsurance for covered benefits such as wellness exams, chronic illness meals, and up to $100 in over-the-counter items every three months. However, acupuncture is not covered under this plan.
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