A non-government entity
Aetna Medicare Select (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Select (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Select (HMO) in 2026, please refer to our full plan details page.
Aetna Medicare Select (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in South FL. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Select (HMO) 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 Select (HMO).
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 Select (HMO), 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3400.00 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 Select (HMO) plan offers prescription drug coverage with a $0 drug deductible, allowing your benefits to start immediately. Members pay no copay for Tier 1 preferred generics and Tier 2 generics when using preferred retail pharmacies or preferred mail-order services. If you use standard pharmacies or standard mail order, copays range from $2 to $6 for Tier 1 and $12 to $36 for Tier 2 depending on the supply length. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 21% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 33% coinsurance across all pharmacy networks. Specialty tier medications are limited to a one-month supply under this plan.
Additional Benefits
The Aetna Medicare Select (HMO) plan delivers comprehensive healthcare coverage featuring no copay for primary care visits and low copays of up to $5 for specialists. Inpatient hospital stays require a $100 daily copay for days one through six and no copay for days seven through 90, while emergency room visits carry a $150 copay. Most outpatient services, diagnostic lab tests, and home health services are covered with no copay and no coinsurance. Supplemental benefits include routine vision and hearing exams with no copay, alongside a $300 annual eyewear allowance and up to $1,000 per ear annually for prescription hearing aids. Dental care is covered up to a $2,000 annual limit, featuring no copay for preventive services and a low $5 copay for Medicare-covered dental care. Additionally, members receive a $100 quarterly allowance for over-the-counter items and have access to fitness benefits with no copay.
Inpatient Hospital See details
Aetna Medicare Select (HMO) covers inpatient hospital services with no coinsurance, requiring a $100 daily copay for days 1 to 6 and no copay for days 7 to 90, subject to prior authorization. Acute stays include unlimited additional days with no copay, but the plan does not cover upgrades, non-Medicare-covered stays, or additional days for psychiatric hospitalizations.
Outpatient Services See details
Outpatient services are covered under Aetna Medicare Select (HMO) with no coinsurance, including no copays for ambulatory surgical center and blood services. Patients will pay a copay of $0 to $100 for outpatient hospital services, $100 per stay for observation services, and $5 to $10 for outpatient substance abuse sessions, with prior authorization required for most services.
Partial Hospitalization See details
Aetna Medicare Select (HMO) covers partial hospitalization services with no coinsurance, though prior authorization is required. Depending on the specific service received, you will pay a copay of either $15.00 or $180.00.
Ambulance and Transportation Services See details
Aetna Medicare Select (HMO) covers ambulance services with prior authorization, which cost a $225 copay and no coinsurance for ground transport, and 20% coinsurance with no copay for air transport. Transportation services are not covered.
Emergency Services See details
Emergency services under Aetna Medicare Select (HMO) are covered with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $10 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 limit with no coinsurance and copays ranging from $150 to $225.
Primary Care See details
Aetna Medicare Select (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits range from a $0 to $5 copay with no coinsurance. Additional covered benefits like physical therapy, occupational therapy, podiatry, and mental health services feature low copays ranging from $5 to $10 and no coinsurance.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Select (HMO) with no copay and no coinsurance for annual physicals and fitness benefits, though kidney education has a 20% coinsurance and no copay. Non-covered services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services are covered by Aetna Medicare Select (HMO), featuring Medicare-covered exams for a $5 copay and no coinsurance, alongside annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,000 per ear annually, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services are covered by Aetna Medicare Select (HMO) with no deductible, no copay, and no coinsurance for eye exams and eyewear, which includes a $300 annual eyewear allowance. This benefit is partially covered because eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Aetna Medicare Select (HMO) partially covers dental services up to a $2,000 annual limit, featuring a $5 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered preventive and comprehensive services. Fluoride treatments, other preventive services, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Aetna Medicare Select (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Select (HMO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Select (HMO) covers medical equipment with no copays for durable medical equipment (DME), prosthetics, and diabetic shoes, though prior authorization is required. Coinsurance ranges from 0% to 20% for DME and diabetic supplies, and is 20% for prosthetic devices, while medical supplies have no coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Select (HMO) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $25 copay for diagnostic procedures. Radiological services are also covered with prior authorization and referrals required, offering no copay for X-rays, copays starting at $0 for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Aetna Medicare Select (HMO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Select (HMO) with no copay, no coinsurance, and a required referral. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation sub-services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Select (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond standard Medicare coverage are not covered.
Other Services See details
Aetna Medicare Select (HMO) partially covers other services with no copay and no coinsurance, including chronic illness meal benefits, annual wellness exams, and up to $100 every three months for over-the-counter items. Acupuncture is not covered under this plan.
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