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Aetna Medicare Silver (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Silver (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Silver (HMO) in 2025, please refer to our full plan details page.
Aetna Medicare Silver (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 Silver (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 Silver (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 Silver (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 $7500.00 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 Silver (HMO) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the following costs for drugs. For preferred generic drugs, you will have no copay at preferred pharmacies and mail order, and a $12 copay at standard pharmacies. For standard generic drugs, you will pay 24% coinsurance regardless of the pharmacy. For preferred brand and non-preferred drugs, you will pay 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 Silver (HMO) plan offers comprehensive coverage, including inpatient hospital stays with a $350 copay for the first few days, and no copay thereafter. Outpatient services, primary care visits, preventive services, and home health services are covered with no copay, while other services like hearing, vision, and dental have varying copays or coinsurance. This plan provides additional benefits such as coverage for emergency services, ambulance services, and skilled nursing facilities. The plan also includes coverage for hearing aids, vision care, and dental services. There is also coverage for over-the-counter items up to $75 every three months, and meal benefits with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Aetna Medicare Silver (HMO) plan, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $350 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you pay a $350 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $350, observation services with a $350 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $45 copay for both individual and group sessions, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Aetna Medicare Silver (HMO) covers partial hospitalization with no copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Silver (HMO) plan. Ground Ambulance Services have a $300 copay, while Air Ambulance Services have a 20% coinsurance, and Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Silver (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Worldwide Emergency Transportation has a $300 copay, and Urgently Needed Services has a $45 copay; all services have no coinsurance.
Primary Care See details
The Aetna Medicare Silver (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a copay between $0 and $30, mental health specialty services with a $40 copay, podiatry services with a $30 copay, other health care professional services with a copay between $0 and $30, psychiatric services with a $40 copay, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a 20% coinsurance and a copay between $0 and $45, and opioid treatment program services with a $40 copay. Routine Chiropractic Care is not covered.
Preventive Services See details
The Aetna Medicare Silver (HMO) plan covers preventive services, including an annual physical exam with no copay. Additionally, the plan covers kidney disease education services with 20% coinsurance. Other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit are covered with no copay.
Hearing Services See details
Hearing services with the Aetna Medicare Silver (HMO) plan include hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $500 per year, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Silver (HMO) plan covers vision services, including eye exams with a copay of $0-$30, and eyewear with no copay. Contact lenses, eyeglasses, eyeglass lenses, eyeglass frames and upgrades are covered with no copay.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $30 copay and other dental services with a $1,000 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, 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 are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with prior authorization, and require a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Silver (HMO) plan, with Durable Medical Equipment (DME) subject to a 0%-20% coinsurance, and no copay. 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, and lab services with no copay. Diagnostic Radiological Services have a copay of at most $295, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Silver (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. The copay for covered services is listed in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Silver (HMO) plan, but require 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 Silver (HMO) plan covers Over-the-Counter (OTC) Items with no copay, up to a maximum of $75 every three months. The plan also covers meal benefits with no copay, and other services like annual wellness exams and screening mammography 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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