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Aetna Medicare Signature (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Signature (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 Signature (HMO-POS) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Aetna Medicare Signature (HMO-POS) is a HMO-POS plan offered by Coventry Health Care of Illinois, Inc. available for the 2026 plan year to people living in WI Southeast. CMS star rating not available for 2026.
It's important to know that Aetna Medicare Signature (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 Signature (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 Signature (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
Health deductible: information not available.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5900.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $5900.00 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 Signature (HMO-POS) plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, members pay no copay when using a preferred pharmacy or preferred mail-order service for up to a three-month supply. If standard pharmacies or standard mail-order services are used, Tier 1 copays start at $2 and Tier 2 copays start at $12 for a one-month supply. For higher-tier medications, cost-sharing transitions from flat copays to coinsurance percentages. 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 across all pharmacy and mail-order options. These percentage-based costs apply regardless of whether you choose standard or preferred fulfillment methods.
Additional Benefits
The Aetna Medicare Signature (HMO-POS) plan offers comprehensive medical coverage with affordable out-of-pocket costs, including no copay for primary care visits and annual routine physicals. Specialist visits feature a cost ranging from no copay to a $35 copay, while emergency room visits require a $130 copay that is waived if you are admitted. For hospital stays, members pay no coinsurance and a $345 daily copay for the first seven days of inpatient acute care, with no copay for unlimited additional days. This plan also includes valuable supplemental benefits, such as home health services with no copay and no coinsurance. Routine hearing and vision exams feature no copay, alongside dental coverage that offers no copay for preventive care and 20% to 50% coinsurance for comprehensive services up to a $2,000 annual limit. Additionally, prescription hearing aids and eyewear are covered with no copay up to specified annual allowance limits.
Inpatient Hospital See details
Aetna Medicare Signature (HMO-POS) covers inpatient acute hospital stays with no coinsurance and a $345 daily copay for days 1 to 7, with no copay for unlimited additional days. Inpatient psychiatric stays are also covered with no coinsurance and a $325 daily copay for days 1 to 7, with no copay for days 8 to 90, though prior authorization is required and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Signature (HMO-POS) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital and observation services have copays ranging from $0 to $345, while outpatient substance abuse sessions require a $40 copay with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Signature (HMO-POS) with a copay of either $75.00 or $145.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Signature (HMO-POS) covers ground ambulance services with a $300 copay and air ambulance services with a 20% coinsurance, with prior authorization required for both. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered under the Aetna Medicare Signature (HMO-POS) plan with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgent care is covered with a $40 copay and no coinsurance, while worldwide emergency services are covered up to $250,000 with no coinsurance and copays of $130 for emergency or urgent care and $300 for emergency transportation.
Primary Care See details
Primary care benefits under the Aetna Medicare Signature (HMO-POS) plan feature no copay and no coinsurance for primary care visits, and a $0 to $35 copay with no coinsurance for specialists. Physical, occupational, speech, mental health, psychiatric, and opioid treatment services require a $40 copay and no coinsurance, while telehealth services carry a $0 to $40 copay and 20% coinsurance; chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Signature (HMO-POS), offering no copay and no coinsurance for annual physicals, wellness screenings, and select supplemental benefits, while kidney disease education is covered with no copay and a 20% coinsurance. Several supplemental preventive services are not covered, including in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, re-admission 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, counseling, and home safety modifications.
Hearing Services See details
Aetna Medicare Signature (HMO-POS) covers hearing services with no coinsurance and no deductible, offering Medicare-covered exams for a $35 copay alongside annual routine exams and fittings for no copay. Prescription hearing aids are partially covered with no copay up to $500 per ear annually, while OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are covered under Aetna Medicare Signature (HMO-POS) with no deductibles and no coinsurance, offering routine annual eye exams and follow-up diabetic eye exams with no copay, while Medicare-covered exams require a copay of up to $35. Covered eyewear, including contacts, eyeglasses, frames, and upgrades, also features no copay and no coinsurance up to a combined maximum benefit of $100 per year.
Dental Services See details
Aetna Medicare Signature (HMO-POS) partially covers dental services, offering Medicare-covered dental for a $35 copay and no coinsurance, and preventive services like cleanings and exams with no copay and no coinsurance. Covered comprehensive services such as restorative, endodontics, periodontics, prosthodontics, and oral surgery require no copay and 20% to 50% coinsurance up to a $2,000 annual limit, while fluoride, other diagnostic or preventive dental services, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Signature (HMO-POS) with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Signature (HMO-POS) with no copay and a 20% coinsurance, although prior authorization is required for these services.
Medical Equipment See details
Medical equipment is covered under the Aetna Medicare Signature (HMO-POS) plan with no copays, though prior authorization is required and coinsurance ranges from no coinsurance up to 20% depending on the item. This benefit includes durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with diabetic therapeutic shoes and inserts available for no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Signature (HMO-POS) with prior authorization required. Diagnostic services require no coinsurance, offering lab services with no copay and diagnostic tests with a $0 to $100 copay, while radiological services range from outpatient X-rays with a $20 copay to therapeutic radiology with 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Signature (HMO-POS) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered with no coinsurance under Aetna Medicare Signature (HMO-POS), though only some services are covered in practice. Specifically, cardiac rehabilitation ($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
Aetna Medicare Signature (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Signature (HMO-POS) partially covers other services, offering an annual wellness exam, screening mammography, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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* 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.
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