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 no drug deductible. Your prescription medication coverage will start immediately.
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 $0 drug deductible, meaning your prescription coverage begins immediately without any out-of-pocket deductible costs. You will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when filling your prescriptions through a preferred pharmacy or preferred mail order service. For standard pharmacies and standard mail order, copays start at $2 for Tier 1 drugs and $12 for Tier 2 drugs for a one-month supply. For higher-tier medications, you will pay a coinsurance rather than a flat copay, which includes 21% coinsurance for Tier 3 preferred brand drugs. Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 33% coinsurance across all pharmacy and mail order options, with specialty drugs limited to a one-month supply.
Additional Benefits
The Aetna Medicare Select (HMO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copays for primary care visits and low copays ranging from $0 to $25 for specialists. For inpatient hospital stays, members pay a $190 daily copay for the first six days and no copay for days 7 through 90, with no coinsurance. Emergency room visits carry a $150 copay, which is waived if admitted, while ground ambulance services require a $250 copay. Ancillary benefits include routine vision and hearing exams with no copays, alongside a $1,000 annual hearing aid allowance per ear. Dental care is covered up to a $2,500 annual maximum, offering no copay for covered preventive and comprehensive services and a $25 copay for Medicare-covered dental work. Additionally, members benefit from home health care with no copay and a $20 quarterly reimbursement for over-the-counter items.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Aetna Medicare Select (HMO) with no coinsurance, requiring a $190 daily copay for days 1 through 6 and no copay for days 7 through 90. Prior authorization is required, and non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Select (HMO) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and blood services. Outpatient hospital services require prior authorization with a $0 to $185 copay (and a $190 copay per stay for observation services), while outpatient substance abuse services require prior authorization with a $15 to $20 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Select (HMO) with copays ranging from $55.00 to $180.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Select (HMO), with ground ambulance services requiring a $250 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Prior authorization is required for ambulance services, and while some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Aetna Medicare Select (HMO) covers emergency services with a $150 copay (waived if admitted within 24 hours) and no coinsurance, and urgently needed services with a $25 copay and no coinsurance. Worldwide emergency services are covered up to a $250,000 maximum with no coinsurance, carrying a $150 copay for emergency or urgent care and a $250 copay for emergency transportation.
Primary Care See details
Aetna Medicare Select (HMO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $25 copay and no coinsurance. Most other primary care benefits, including physical therapy, mental health, and podiatry, feature copays ranging from $15 to $25 with no coinsurance, though chiropractic services are not covered. Telehealth services are also available with a $0 to $25 copay and 20% coinsurance.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Select (HMO), offering most covered services like annual exams and screenings with no copay and no coinsurance, while kidney disease education requires a 20% coinsurance and no copay. Sub-services such as in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Hearing services are covered by Aetna Medicare Select (HMO), featuring Medicare-covered exams for a $25 copay and no coinsurance, and annual routine exams and fittings with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,000 maximum per ear annually, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Select (HMO) covers vision services with no copay, no coinsurance, and no deductible, though the benefit is partially covered because individual eyeglass lenses and eyeglass frames are not covered. Covered services include one annual routine eye exam, unlimited follow-up diabetic eye exams, and select eyewear like contact lenses and eyeglasses up to a $100 annual maximum.
Dental Services See details
Dental services are partially covered under Aetna Medicare Select (HMO) with an annual maximum benefit of $2,500. Medicare-covered dental services require a $25 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance. Fluoride treatment, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Select (HMO) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Aetna Medicare Select (HMO) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Select (HMO) covers medical equipment, prosthetics, and diabetic supplies with no copays, and coinsurance ranging from no coinsurance up to 20% depending on the item. Prior authorization is required for most services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Select (HMO) covers diagnostic and radiological services, with prior authorization and referrals required for care. Diagnostic services feature no coinsurance, offering no copay for lab services and a $0 to $100 copay for procedures, while radiological services include no copay for X-rays, a $0 minimum copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
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 offered by Aetna Medicare Select (HMO) with no copay and no coinsurance, though a referral is required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Select (HMO) with no coinsurance, featuring no 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 for admission, and additional days beyond the standard 100 Medicare-covered days 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, and a $20 quarterly reimbursement for over-the-counter items. Acupuncture is not covered under this plan.
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