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Aetna Medicare Elite (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Elite (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 Elite (HMO-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Elite (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Greater Portland Metro Area. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Aetna Medicare Elite (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 Elite (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 Elite (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 $300.00 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 $5900.00 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 Elite (HMO-POS) prescription drug plan features an annual drug deductible of $300. For Tier 1 preferred generic drugs, members benefit from no copay when using a preferred pharmacy or preferred mail order service, while standard options require a $2 copay for a one-month supply. Tier 2 generic drugs are also highly affordable, with copays starting at $10 for a one-month supply at preferred pharmacies and preferred mail order. For brand-name and specialty medications, the plan utilizes coinsurance instead of flat copays during the initial coverage phase. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 26% coinsurance across all pharmacy and mail order options. Tier 5 specialty drugs are covered with a 29% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Aetna Medicare Elite (HMO-POS) plan offers robust medical coverage featuring no copays for primary care visits and specialist copays ranging from no copay to $50. Inpatient hospital stays require a $450 daily copay for the first five days and no copay for days six through 90, while outpatient hospital services require a copay ranging from no copay to $375. Emergency care is available with a $130 copay, which is waived if you are admitted, and urgent care services carry a $45 copay. For routine health needs, the plan provides preventive care, routine eye exams, and annual hearing evaluations with no copays or coinsurance. Vision benefits include a $100 annual eyewear allowance, and hearing aid coverage provides up to $1,000 per ear annually with no copay. Preventive dental services also feature no copay, while comprehensive dental care is covered with a 20% to 50% coinsurance up to a $750 annual limit.
Inpatient Hospital See details
Aetna Medicare Elite (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $450 daily copay for days 1 to 5 and no copay for days 6 to 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Elite (HMO-POS) covers outpatient services with no coinsurance, including no copays for Ambulatory Surgical Center (ASC) and outpatient blood services. Outpatient hospital services require a $0 to $375 copay, observation services carry a $450 copay per stay, and outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Aetna Medicare Elite (HMO-POS) plan with a copayment of $140.00 or $145.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Elite (HMO-POS) covers ground ambulance services with a $295 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Prior authorization is required for all ambulance services, and transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Elite (HMO-POS) with a $130 copay (waived if admitted within 24 hours) and no coinsurance, while urgently needed services require a $45 copay and no coinsurance. Worldwide emergency and urgent care are also covered with no coinsurance and copays ranging from $130 to $295, up to a $250,000 maximum plan benefit limit.
Primary Care See details
Aetna Medicare Elite (HMO-POS) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $50 copay and no coinsurance. Physical, occupational, mental health, psychiatric, and opioid treatment therapies are covered with copays ranging from $30 to $40 and no coinsurance, while telehealth services require a $0 to $50 copay and 20% coinsurance. Podiatry is not covered, and while some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Elite (HMO-POS), offering no copay and no coinsurance for annual physical exams, health education, and most screenings. While kidney disease education has no copay but requires a 20% coinsurance, several services such as personal emergency response systems, weight management, and in-home support are not covered.
Hearing Services See details
Aetna Medicare Elite (HMO-POS) hearing services are partially covered, featuring Medicare-covered exams, one routine hearing exam, and one fitting evaluation per year with no copay and no coinsurance. Prescription hearing aids are covered up to $1,000 per ear annually with no copay or coinsurance, though OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Aetna Medicare Elite (HMO-POS) covers vision services with no copay, no coinsurance, and no deductible. The plan provides one annual routine eye exam, unlimited follow-up diabetic eye exams, and a $100 yearly allowance for eyewear, including contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Elite (HMO-POS), offering preventive care with no copay and no coinsurance, and comprehensive services with no copay and 20% to 50% coinsurance up to a $750 annual limit. Medicare-covered dental requires a $50 copay and no coinsurance, but fluoride, other diagnostic or preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Elite (HMO-POS) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs feature no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Aetna Medicare Elite (HMO-POS) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Elite (HMO-POS), offering durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies range from no coinsurance to 20% coinsurance, while diabetic therapeutic shoes and inserts are covered with no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Elite (HMO-POS) with prior authorization required. Diagnostic procedures and tests have no coinsurance and a $0 to $20 copay, while lab, diagnostic radiological, and outpatient X-ray services feature no copay. Therapeutic radiological services require a copay and a minimum 20% coinsurance, and outpatient X-rays are subject to coinsurance.
Home Health Services See details
Aetna Medicare Elite (HMO-POS) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Elite (HMO-POS) plan, as no coverage is provided for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Elite (HMO-POS) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required and a prior three-day hospital stay is not necessary, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Elite (HMO-POS) provides partial coverage for other services, offering annual wellness exams, screening mammographies, and additional gFOBT and FIT tests with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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