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 Southwest 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 $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 features a $200 prescription drug deductible. Beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 2 generic drugs when using a preferred pharmacy or preferred mail order service. For standard pharmacies and standard mail order, Tier 1 copays start at $2 and Tier 2 copays start at $12 for a one-month supply. Brand-name and specialty medications under this plan are subject to 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 carry a 30% coinsurance. Coinsurance rates remain the same whether you use preferred or standard pharmacies, though specialty drugs are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Select (HMO) plan offers robust everyday coverage, featuring no copays for primary care doctor visits, annual physicals, and most preventive screenings. Members also benefit from generous supplemental benefits, including up to a $2,000 annual dental allowance and a $300 yearly eyewear allowance with no copays. Additionally, routine hearing exams and prescription hearing aids are covered with no copay, providing up to $1,000 per ear annually. For specialized and emergency care, specialist visits and physical therapy sessions are highly affordable with copays ranging from only $0 to $20. Emergency room visits require a $150 copay, which is completely waived if you are admitted to the hospital within 24 hours. If you require an inpatient hospital stay, there is a $195 daily copay for the first seven days, after which you will pay no copay for the remainder of your stay.
Inpatient Hospital See details
Aetna Medicare Select (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $195 daily copay for days 1 through 7 and no copay for days 8 through 90 per stay. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Select (HMO) covers outpatient services with no coinsurance, including no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $185, observation services have a $195 copay per stay, and outpatient substance abuse sessions carry a copay of $15 for group or $20 for individual visits.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Select (HMO) with a copay of either $55.00 or $180.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered under Aetna Medicare Select (HMO), as transportation to plan-approved or other health-related locations is not covered. Covered ground ambulance services require a $250 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay, with prior authorization required for both.
Emergency Services See details
Aetna Medicare Select (HMO) covers emergency services with a $150 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services are covered with a $20 copay and no coinsurance, while worldwide emergency and urgent services are covered up to a $250,000 maximum with no coinsurance and copays of $150 for emergency or urgent care and $250 for emergency transportation.
Primary Care See details
Aetna Medicare Select (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services have copays ranging from $0 to $20 and no coinsurance. Telehealth services are also covered with a $0 to $20 copay and 20% coinsurance, but chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Select (HMO) provides partially covered preventive services, featuring an annual physical exam, health education, and select screenings with no copay and no coinsurance, though kidney disease education requires a 20% coinsurance and no copay. Services not covered under this benefit include in-home safety assessments, PERS, medical nutrition therapy, 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, home safety modifications, post-discharge medication reconciliation, and re-admission prevention.
Hearing Services See details
Hearing services covered by Aetna Medicare Select (HMO) include Medicare-covered exams for a $20 copay and no coinsurance, plus annual routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered with no copay or coinsurance up to a $1,000 maximum per ear annually, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Aetna Medicare Select (HMO) offers partially covered vision services with no deductible, no copay, and no coinsurance for covered care, including annual routine eye exams and a $300 yearly allowance for eyewear. While contact lenses and complete eyeglasses are covered, 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 with no copay and no coinsurance for most preventive and comprehensive services, while Medicare-covered dental services require a $20 copay and no coinsurance. Fluoride treatments, other preventive services, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Select (HMO) with no copay and no coinsurance, though prior authorization and step therapy are required. Under this plan, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy and other Part B drugs feature no copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Select (HMO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered under the Aetna Medicare Select (HMO) plan with no copays for durable medical equipment (DME), prosthetics, medical supplies, and diabetic shoes. Depending on the item, coinsurance ranges from 0% to 20% for DME and diabetic supplies, while prosthetic devices require a 20% coinsurance and medical supplies have no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Select (HMO) with prior authorization and referrals required. Diagnostic tests have a $0 to $50 copay and no coinsurance, lab services have no copay and no coinsurance, and outpatient X-rays have no copay but require coinsurance. Diagnostic radiological services have copays starting at $0, while therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by Aetna Medicare Select (HMO) 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 and no coinsurance, though a referral is required. Although some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Aetna Medicare Select (HMO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
Aetna Medicare Select (HMO) partially covers other services with no copay and no coinsurance, including meal benefits for chronic illnesses, annual wellness exams, screening mammographies, additional gFOBT and FIT screenings, and a quarterly $30 over-the-counter reimbursement. Acupuncture is not covered under this benefit.
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