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 North FL, Treasure Coast 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 a $200.00 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 $3300.00 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 features a drug deductible of $200. You will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when filling prescriptions through a preferred pharmacy or preferred mail-order service. For standard pharmacies and standard mail orders, Tier 1 copays start at $2 and Tier 2 copays start at $12 for a one-month supply. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 30% coinsurance across all pharmacy and mail-order options. Note that Tier 5 specialty medications are only available for a one-month supply.
Additional Benefits
The Aetna Medicare Select (HMO) plan offers comprehensive medical coverage with affordable out-of-pocket costs, including no copay or coinsurance for primary care doctor visits and preventive services. For inpatient hospital stays, members pay a daily copay of $200 for the first six days and no copay for the remaining days up to day 90. Outpatient services, emergency care, and specialist visits generally feature low copays and no coinsurance, making essential healthcare highly accessible. This plan also includes valuable supplemental benefits like dental, vision, and hearing coverage with no deductibles. Members receive no-copay routine exams, up to a $2,000 annual limit for dental care, a $200 yearly vision allowance, and up to $1,000 per ear for prescription hearing aids. Additionally, the plan provides a $45 quarterly allowance for over-the-counter items and home health services with no copay.
Inpatient Hospital See details
Inpatient hospital care is covered by Aetna Medicare Select (HMO) with no coinsurance and a copay of $200 per day for days 1 through 6, followed by no copay for days 7 through 90. This benefit is partially covered as it includes unlimited additional acute care days with no copay, but excludes additional psychiatric days, upgrades, and non-Medicare-covered stays.
Outpatient Services See details
Aetna Medicare Select (HMO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay. Outpatient hospital services have a copay of $0 to $175, observation services cost a $200 copay per stay, and outpatient substance abuse sessions require a $15 to $20 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Select (HMO) with no coinsurance, though prior authorization is required and copays of $55.00 or $180.00 will apply depending on the service.
Ambulance and Transportation Services See details
Aetna Medicare Select (HMO) covers ground ambulance services with a $250 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, 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 by Aetna Medicare Select (HMO) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $15 copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 maximum with no coinsurance and copays ranging from $150 to $250.
Primary Care See details
Aetna Medicare Select (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits, mental health, and therapy services generally feature a $0 to $20 copay and no coinsurance. Chiropractic services are partially covered with a $20 copay and no coinsurance, though routine and other chiropractic services are not covered. Telehealth benefits are also available with a $0 to $20 copay and 20% coinsurance.
Preventive Services See details
Preventive services under Aetna Medicare Select (HMO) are partially covered, offering no copay and no coinsurance for annual physicals, health education, and select screenings, while kidney disease education requires a 20% coinsurance and no copay. Several additional supplemental benefits are not covered, including weight management programs, in-home safety assessments, nutritional/dietary benefits, and personal emergency response systems.
Hearing Services See details
Hearing services are covered under Aetna Medicare Select (HMO) with no deductible, featuring a $20 copay and no coinsurance for Medicare-covered exams, and annual routine exams and fittings with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,000 per ear annually, but OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Aetna Medicare Select (HMO) with no copay and no coinsurance for annual routine eye exams, diabetic exams, and select eyewear. Contact lenses and up to two pairs of eyeglasses (lenses and frames) are covered up to a $200 annual limit with no copay or coinsurance, while individual eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental services are partially covered by Aetna Medicare Select (HMO), offering up to a $2,000 annual maximum benefit with no copay and no coinsurance for most covered preventive and comprehensive services, while Medicare-covered dental has a $20 copay and no coinsurance. Fluoride treatments, other preventive dental services, maxillofacial prosthetics, implants, and orthodontics are not covered, and prior authorization is required for several services.
Home Infusion bundled Services See details
Aetna Medicare Select (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a coinsurance between 0% and 20%.
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
Medical equipment is covered by Aetna Medicare Select (HMO), offering durable medical equipment with no copay and 0% to 20% coinsurance, and prosthetic devices with no copay and 20% coinsurance. Medical supplies are available with no copay or coinsurance, while diabetic shoes and inserts require a $10 copay and diabetic supplies carry 0% to 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Select (HMO) covers diagnostic services with no coinsurance, offering no copay for lab tests and a $0 to $75 copay for diagnostic procedures. Covered radiological services require prior authorization and referrals, featuring no copay for outpatient X-rays (subject to coinsurance), copays starting at $0 for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered under Aetna Medicare Select (HMO) with no copay and no coinsurance, although prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Aetna Medicare Select (HMO) with no copay and no coinsurance, although a referral is required. While some services are covered, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Select (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and the plan does not cover additional days beyond the standard Medicare-covered limit.
Other Services See details
Other Services are partially covered under Aetna Medicare Select (HMO), as acupuncture is not covered. Covered benefits—including a chronic illness meal benefit, wellness exams, additional colon cancer screenings, and up to $45 every three months for over-the-counter items—are available with no copay and no coinsurance.
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