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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 2026, 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 3.5 out of 5 stars in 2026.
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 $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 $9250.00 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:
Sign up for Aetna Medicare Advantra Elite (HMO)
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Drug Coverage
The Aetna Medicare Advantra Elite (HMO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using a preferred retail pharmacy or preferred mail-order service. If you choose a standard pharmacy or standard mail-order option, Tier 1 copays range from $2 to $6, and Tier 2 copays range from $12 to $36 depending on the supply length. For higher-tier medications, cost-sharing is based on a percentage of the drug cost rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance across all pharmacy types. Tier 3 and Tier 4 medications are available for one, two, or three-month supplies, whereas Tier 5 specialty drugs are restricted to a one-month supply.
Additional Benefits
The Aetna Medicare Advantra Elite (HMO) plan offers comprehensive medical coverage with no copay for primary care visits, annual physical exams, and home health services. For inpatient hospital stays, members pay a $325 daily copay for the first seven days and no copay thereafter, with no coinsurance. Emergency care is available with a $115 copay, while urgent care visits require a $40 copay. Routine dental, vision, and hearing exams are covered with no copay, though specialized services, dental care, and eyewear have specific allowance limits and copays. Major medical services such as dialysis, durable medical equipment, and Part B drugs generally carry a 20% coinsurance. Additionally, skilled nursing facility stays require no copay for the first 20 days, but routine transportation and cardiac rehabilitation are not covered.
Inpatient Hospital See details
Aetna Medicare Advantra Elite (HMO) covers inpatient acute hospital stays with no coinsurance, requiring a $325 daily copay for days 1 to 7 and no copay for additional days, though the benefit is partially covered as upgrades and non-Medicare-covered stays are excluded. Inpatient psychiatric care is also partially covered with no coinsurance, requiring a $350 daily copay for days 1 to 5 and no copay for days 6 to 90, while additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Advantra Elite (HMO) with no coinsurance, including ambulatory surgical center and blood services with no copay, and substance abuse sessions for a $30 copay. Outpatient hospital and observation services have no coinsurance and copays ranging from $0 to $325, with prior authorization required for most outpatient benefits.
Partial Hospitalization See details
Aetna Medicare Advantra Elite (HMO) covers partial hospitalization services with either no copay or a $110 copay, and no coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Aetna Medicare Advantra Elite (HMO), requiring prior authorization and featuring a $325 copay for ground ambulance services and a 20% coinsurance for air ambulance services. Routine transportation services, including trips to plan-approved or any health-related locations, are not covered under this plan.
Emergency Services See details
Aetna Medicare Advantra Elite (HMO) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed care is covered with a $40 copay and no coinsurance, and worldwide emergency services are covered up to a $250,000 maximum with no coinsurance and copays ranging from $115 to $325.
Primary Care See details
Aetna Medicare Advantra Elite (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits, therapy services, and mental health care generally carry a $0 to $30 copay and no coinsurance. Telehealth benefits are also available with a $0 to $40 copay and 20% coinsurance, though routine chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Advantra Elite (HMO) partially covers preventive services with no copay and no coinsurance for annual physical exams, fitness benefits, and select screenings, while kidney disease education has no copay and a 20% coinsurance. However, several services are not covered, including medical nutrition therapy, weight management programs, personal emergency response systems, in-home safety assessments, alternative therapies, and home-based palliative care.
Hearing Services See details
Aetna Medicare Advantra Elite (HMO) covers Medicare-covered hearing exams for a $30 copay and no coinsurance, and routine exams and fitting evaluations with no copay and no coinsurance. Hearing aid benefits are partially covered with no copay or coinsurance up to $500 per ear annually, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Advantra Elite (HMO) covers vision services with no deductibles and no coinsurance, featuring annual routine eye exams and eyewear with no copay. Medicare-covered eye exams carry a copay of $0 to $30, while eyewear benefits—including contacts, frames, and lenses—are covered up to a $100 yearly maximum.
Dental Services See details
Aetna Medicare Advantra Elite (HMO) provides partially covered dental services, featuring Medicare-covered dental with a $30 copay and no coinsurance, alongside other covered services with no copay and 0% to 50% coinsurance. However, other diagnostic dental services, 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 Advantra Elite (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by the Aetna Medicare Advantra Elite (HMO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Advantra Elite (HMO) with no copay, though prior authorization is required. Coinsurance ranges from no coinsurance up to 20% for durable medical equipment, medical supplies, and diabetic supplies, while prosthetic devices and diabetic shoes or inserts carry a flat 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Advantra Elite (HMO) covers diagnostic and radiological services with prior authorization, offering lab services and diagnostic radiology with no copay. Diagnostic tests have no coinsurance and a copay of up to $15, while outpatient x-rays require a $20 copay with coinsurance and therapeutic radiology has a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Advantra Elite (HMO) with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by Aetna Medicare Advantra Elite (HMO), with no copay or coinsurance, because cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Advantra Elite (HMO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days are not covered.
Other Services See details
Other Services are partially covered by Aetna Medicare Advantra Elite (HMO) with no copay and no coinsurance, though acupuncture is not covered. Covered benefits under this category include a $30 quarterly over-the-counter item allowance, meals for chronic illnesses, and annual wellness and screening exams.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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