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Aetna Medicare Advantra Elite (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Elite (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 Elite (HMO) in 2025, please refer to our full plan details page.
Aetna Medicare Advantra Elite (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Northern West Virginia. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Advantra Elite (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 Elite (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 Elite (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 $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 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 Elite (HMO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions. For Tier 1 drugs, you'll pay no copay at preferred pharmacies or with preferred mail order, and a $12 copay at standard pharmacies or with standard mail order. For other tiers, you will pay a coinsurance of 24% or 25%. After your total drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for your drugs.
Additional Benefits
The Aetna Medicare Advantra Elite (HMO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. You'll have no copay for primary care, and many preventive services. The plan also includes coverage for hearing, vision, and dental services, with specific copays and annual maximums. Additional benefits include ambulance, emergency, and skilled nursing facility services, with copays and coinsurance amounts. This plan also covers home health services, home infusion, and durable medical equipment, along with diagnostic and radiological services. Other services include over-the-counter items and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered by the Aetna Medicare Advantra Elite (HMO) plan. For inpatient hospital acute care, you will pay a $355 copay for days 1-7, and no copay for days 8-90; for inpatient hospital psychiatric care, you will pay a $350 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay of $0-$355, Observation Services have a $355 copay, Ambulatory Surgical Center Services have no copay, and Outpatient Blood Services have no copay, while Individual and Group Sessions for Outpatient Substance Abuse have a copay of $30.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Advantra Elite (HMO) plan, but requires prior authorization, and has a $10 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Advantra Elite (HMO) plan. Ground Ambulance Services have a copay of $325, and Air Ambulance Services have a 20% coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Advantra Elite (HMO) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay, with no coinsurance for either. Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $110 copay, and Worldwide Emergency Transportation has a $325 copay, with no coinsurance.
Primary Care See details
The Aetna Medicare Advantra Elite (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $35 copay. The plan also covers physician specialist services with a copay between $0 and $30, mental health and psychiatric services with a $30 copay, podiatry services with a $30 copay, and other health care professionals with a copay between $0 and $30. Physical therapy and speech-language pathology services have a $35 copay, additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45, and opioid treatment program services have a $30 copay.
Preventive Services See details
Preventive Services include annual physical exams with no copay, and additional preventive services that have varying copays. The plan also covers kidney disease education services with a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a $30 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $500 per year, and prescription hearing aids (all types) have no copay. Prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have a copay of $0-$30, and eyewear has a copay of $0, with a combined maximum plan benefit of $350 per year.
Dental Services See details
Dental services include a $30 copay for Medicare dental services, with a $2,000 annual maximum. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. For Medicare Part B Insulin Drugs, there is a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Advantra Elite (HMO) plan, with a coinsurance between 20% and 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with a coinsurance of 0% to 20%, though Durable Medical Equipment for use outside the home is not covered. Prosthetics, Medical Supplies, and Diabetic Equipment are also covered, with varying coinsurance amounts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $15, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $315, Therapeutic Radiological Services with a coinsurance of at least 20%, and Outpatient X-Ray Services with a $20 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Advantra Elite (HMO) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Advantra Elite (HMO) plan, but the plan does not cover the sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. There is a copay for some services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Advantra Elite (HMO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, Meal Benefit, annual wellness exam and screening mammography, and gFOBT/FIT. Over-the-Counter (OTC) Items have no copay, and the plan offers a maximum benefit of $75 every three months. The plan also covers a meal benefit with no copay. Acupuncture, 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.
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