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Aetna Medicare Advantra Signature (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Signature (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Advantra Signature (HMO) in 2026, please refer to our full plan details page.
Aetna Medicare Advantra Signature (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Southern West Virginia. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Advantra Signature (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 Advantra Signature (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 Advantra Signature (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 $615.00 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 $6900.00 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 Advantra Signature (HMO) plan features an annual prescription drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic medications when using preferred pharmacies or preferred mail-order services. If you choose standard pharmacies or standard mail-order options, Tier 1 drugs require a copay starting at $2, while Tier 2 drugs carry a copay starting at $12 for a one-month supply. For higher-tier medications, you will pay coinsurance regardless of whether you use a preferred or standard pharmacy. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 25% coinsurance. Specialty drugs are limited to a one-month supply under these cost-sharing terms.
Additional Benefits
The Aetna Medicare Advantra Signature (HMO) provides cost-effective medical coverage with no copay and no coinsurance for primary care visits, home health services, and most preventive care. Specialist visits are highly affordable with a copay ranging from no copay to $30, while inpatient hospital stays require a $325 daily copay for the first five days. Emergency services carry a $115 copay that is waived upon hospital admission, and urgent care visits require a $40 copay. For extra wellness benefits, the plan features no copay for routine dental, vision, and hearing exams, alongside a $200 annual eyewear allowance and up to $500 per ear for hearing aids. Comprehensive dental services are covered up to a $1,250 yearly limit with coinsurance ranging from 20% to 50% and no copay. Members also benefit from a $60 quarterly allowance for over-the-counter health products and no copay for skilled nursing care during the first 20 days of a stay.
Inpatient Hospital See details
Inpatient hospital coverage through the Aetna Medicare Advantra Signature (HMO) requires no coinsurance and features a daily copay of $325 for days 1-5 of acute stays and $350 for days 1-5 of psychiatric stays, with no copay for subsequent covered days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Advantra Signature (HMO) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $325 copay and observation services with a $325 copay per stay. Ambulatory surgical center and outpatient blood services feature no copay and no coinsurance, while outpatient substance abuse sessions require a $30 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Advantra Signature (HMO) with either no copay or a $110 copay, and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Aetna Medicare Advantra Signature (HMO) covers ground ambulance services with a $300 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Advantra Signature (HMO) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay, with no coinsurance for either service. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 maximum plan benefit with no coinsurance, carrying a $115 copay for emergency or urgent care and a $300 copay for emergency transportation.
Primary Care See details
Aetna Medicare Advantra Signature (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $30 copay and no coinsurance. Most other services, including therapy, mental health, and podiatry, require a $30 copay and no coinsurance, while telehealth has a $0 to $40 copay and 20% coinsurance. Some chiropractic services are covered, but routine and other chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Advantra Signature (HMO) preventive services are partially covered, offering annual physical exams, health education, and select screenings with no copay and no coinsurance, though kidney disease education requires a 20% coinsurance and no copay. Numerous supplemental options are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, and alternative therapies.
Hearing Services See details
Hearing Services are partially covered by Aetna Medicare Advantra Signature (HMO), offering Medicare-covered exams for a $30 copay and no coinsurance, alongside annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to $500 per year per ear with no copay or coinsurance, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Advantra Signature (HMO) covers vision services with no coinsurance and no deductible, offering annual routine eye exams and follow-up diabetic exams with no copay, and Medicare-covered exams with a $0 to $30 copay. Eyewear, including contact lenses and eyeglasses, is also covered with no copay up to a combined maximum benefit of $200 per year.
Dental Services See details
Aetna Medicare Advantra Signature (HMO) partially covers dental services, offering Medicare-covered dental with a $30 copay and no coinsurance, and preventive services like cleanings and exams with no copay and no coinsurance. Comprehensive dental care is covered up to a $1,250 annual maximum with no copay and 20% to 50% coinsurance, though fluoride, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Advantra Signature (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Aetna Medicare Advantra Signature (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Advantra Signature (HMO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay for all covered services. Depending on the specific item, coinsurance ranges from no coinsurance up to 20%, and prior authorization is required.
Diagnostic and Radiological Services See details
Aetna Medicare Advantra Signature (HMO) covers diagnostic and radiological services, with prior authorization required for these benefits. Diagnostic procedures and tests carry a $0 to $10 copay with no coinsurance, lab services and diagnostic radiology have no copay, while outpatient X-rays require a $35 copay and therapeutic radiology has a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Advantra Signature (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 Advantra Signature (HMO) with no copay and no coinsurance, though some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Aetna Medicare Advantra Signature (HMO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Advantra Signature (HMO) partially covers other services with no copay and no coinsurance, including chronic illness meal benefits, annual wellness exams, and up to $60 every three months for over-the-counter items. Acupuncture is not covered under these services.
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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.
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