A non-government entity
Aetna Medicare Choice (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Choice (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 Choice (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Choice (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in North, Central, West, SW, Treasure Coast, South FL. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Choice (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 Choice (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 Choice (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 combined Maximum Out-Of-Pocket cost of $10100.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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:
Sign up for Aetna Medicare Choice (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Choice (HMO-POS) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions. For preferred generic drugs, you have no copay at preferred pharmacies and mail order. For standard generic drugs, you pay 24% coinsurance. Preferred brand drugs and non-preferred drugs have 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Choice (HMO-POS) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays depending on the service. Emergency, primary care, preventive, hearing, vision, and dental services are covered, often with no copay or a low copay. The plan also includes coverage for home health, skilled nursing facilities, and medical equipment, and has a maximum annual dental benefit of $3,000 and an over-the-counter item benefit of $105 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $250 copay for days 1-4, and no copay for days 5-90; for Inpatient Hospital Psychiatric, you will also pay a $250 copay for days 1-4, and no copay for days 5-90.
Outpatient Services See details
The Aetna Medicare Choice (HMO-POS) plan covers outpatient services including outpatient hospital services with a copay between $0 and $200, observation services with a $250 copay, and ambulatory surgical center (ASC) services with no copay. Outpatient substance abuse services have a copay of $35 for individual sessions and $30 for group sessions, while outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Choice (HMO-POS) plan, requiring prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Aetna Medicare Choice (HMO-POS) plan. Ground ambulance services have a $210 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, including Urgently Needed Services and Worldwide Emergency Services, are covered under the Aetna Medicare Choice (HMO-POS) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $30 copay, and Worldwide Emergency Services have a $125 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $210 copay for Worldwide Emergency Transportation.
Primary Care See details
The Aetna Medicare Choice (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy with a $35 copay, and physician specialist services with a $25 copay. Mental health specialty services, including individual and group sessions, have copays ranging from $30 to $35. Other covered benefits include other health care professionals with copays ranging from $0 to $25, psychiatric services with copays from $30 to $35, physical therapy and speech-language pathology services with a $35 copay, and additional telehealth benefits with a 20% coinsurance and copays from $0 to $35. The plan also covers opioid treatment program services with copays of $35.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services, including health education and wigs for hair loss related to chemotherapy, are covered with no copay. Kidney disease education services have a 20% coinsurance, and other preventive services, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits, are covered with no copay.
Hearing Services See details
Hearing exams are covered with a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered, with a maximum plan benefit of $1250 per year, while OTC hearing aids, and prescription hearing aids for the inner, outer, and over the ear are not covered.
Vision Services See details
The Aetna Medicare Choice (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$25 and eyewear with a $0 copay. Eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
The Aetna Medicare Choice (HMO-POS) plan covers dental services, including Medicare Dental Services with a $25 copay. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. This plan has a maximum benefit of $3,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but prior authorization is required. The plan covers Medicare Part B Insulin Drugs with a $35 copay, and covers both Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Choice (HMO-POS) plan, but require prior authorization. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment with 0% to 20% coinsurance and no copay, Prosthetics/Medical Supplies with coinsurance, and Diabetic Equipment with coinsurance and copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures, lab services, and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $200, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $200, while Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Choice (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Choice (HMO-POS) plan. Although the plan covers some Cardiac and Pulmonary Rehabilitation Services, they are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Choice (HMO-POS) with prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Choice (HMO-POS) plan covers over-the-counter (OTC) items with no copay, with a maximum benefit of $105 every three months. Acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. Other 1 has no copay, and covers annual wellness exams and screening mammography. Other 2 has no copay, and covers gFOBT and FIT.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved