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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 WI Southeast. The overall rating for this plan is not yet available for 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 $590.00 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 $4900.00 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 $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. The plan offers no copay for preferred generic drugs at a preferred pharmacy or through the mail. For standard generic drugs, you will pay 24% coinsurance, regardless of the pharmacy. Preferred and non-preferred brand drugs have a 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Premier (HMO-POS) plan offers a range of benefits, including inpatient and outpatient hospital services with varying copays. It also covers primary care with no copay, and specialist visits with a copay between $0 and $25. Emergency services have a $125 copay, while hearing exams have a $25 copay. This plan includes coverage for vision services like eye exams and eyewear with no copay, and dental services with no copay for exams and cleanings. Additionally, the plan covers home health services and skilled nursing facility stays with no or low copays for the first 100 days. The plan also offers an over-the-counter (OTC) benefit of $30 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. For Inpatient Hospital-Acute, you will pay a $300 copay for days 1-7, and no copay for days 8-90, while Inpatient Hospital Psychiatric has a $1871 copay.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services, with a copay between $0 and $300, and observation services with a $300 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and individual and group sessions for outpatient substance abuse each have a $75 copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Premier (HMO-POS) plan, with a $75 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Premier (HMO-POS). Ground ambulance services have a $285 copay, while air ambulance services have a 20% coinsurance; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency services are covered under the Aetna Medicare Premier (HMO-POS) plan. Emergency services have a $125 copay, urgently needed services have a $40 copay, and worldwide emergency coverage and worldwide urgent coverage have a $125 copay, while worldwide emergency transportation has a $285 copay.
Primary Care See details
The Aetna Medicare Premier (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy with a $40 copay. It also covers physician specialist services with a copay between $0 and $25, and physical therapy and speech-language pathology services with a $40 copay. Mental health and psychiatric services have a $40 copay for individual and group sessions, while additional telehealth benefits have a 20% coinsurance and a copay between $0 and $75.
Preventive Services See details
Preventive services include Medicare-covered services, annual physical exams with no copay, and additional preventive services with varying copays. Kidney disease education services have a 20% coinsurance, while other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit have no copay. Other services like in-home safety assessments, personal emergency response systems, medical nutrition therapy, and others are not covered.
Hearing Services See details
Hearing exams are covered with a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a maximum plan benefit coverage of $500 per year, though inner ear, outer ear, and over the ear prescription hearing aids are not covered. 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-$25, and routine eye exams with no copay. The plan also covers eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades with no copay, up to a combined maximum of $195 per year.
Dental Services See details
Dental services include a $25 copay for Medicare dental services and no copay for oral exams, dental x-rays, and prophylaxis (cleaning). Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have a coinsurance between 20% and 50%. Orthodontic services are covered up to a maximum of $2500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Premier (HMO-POS) plan. The plan covers Medicare Part B insulin drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Premier (HMO-POS) plan. The plan requires prior authorization and has a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment with a coinsurance of 0-20%, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 0-20% coinsurance. Diabetic Supplies have a coinsurance of 0-20%, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $100, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $250, while Therapeutic Radiological Services have at least 20% coinsurance. Outpatient X-Ray Services have a $20 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. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Premier (HMO-POS) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and 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, 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 for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Premier (HMO-POS) plan covers over-the-counter (OTC) items with no copay, and a maximum benefit coverage amount of $30 every three months. Other services like acupuncture, meal benefits, and several others are not covered.
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