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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 2025, 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 Jackson and Josephine Counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
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) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $5 copay at preferred pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. Please note that the plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Aetna Medicare Elite (HMO-POS) plan offers a range of benefits with varying cost-sharing. You'll find no copays for primary care visits, preventive services, and routine vision and hearing exams, with copays for specialist visits, outpatient services, and other treatments. The plan also includes coverage for dental, hearing aids, and eyewear, with specific limits on coverage. Hospital stays have copays, while ambulance services have a copay or coinsurance. The plan also covers home health and cardiac rehabilitation services with no copay, but certain services require prior authorization or have coinsurance. Additionally, the plan covers a quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric inpatient hospital stays. For acute stays, you will pay a $425 copay for days 1-5, and no copay for days 6-90; additional days are covered with no copay. For psychiatric stays, you will pay a $425 copay for days 1-5, and no copay for days 6-90; additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services are covered by the Aetna Medicare Elite (HMO-POS) plan, including outpatient hospital services with a copay between $0 and $375, observation services with a $425 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $40 copay for individual and group sessions, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Elite (HMO-POS) plan. Ground ambulance services have a $265 copay, while 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 Elite (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $40 copay, and Worldwide Emergency Transportation has a $265 copay. There is no coinsurance for any of these services.
Primary Care See details
The Aetna Medicare Elite (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $10 copay, and occupational therapy services with a $30 copay. The plan covers physician specialist services with a copay between $0 and $30, and physical therapy and speech-language pathology services with a $30 copay. Mental health and psychiatric services, and opioid treatment program services each have a $40 copay for individual and group sessions. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $40. Podiatry services are not covered.
Preventive Services See details
Preventive services, including annual physical exams, are covered with no copay. Additional preventive services, such as Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, are covered with a $0 copay. Kidney Disease Education Services are covered with 20% coinsurance.
Hearing Services See details
Hearing services with the Aetna Medicare Elite (HMO-POS) plan include hearing exams with no copay, and prescription hearing aids with a maximum benefit of $2,000 per year, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, and OTC hearing aids are not covered. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay, once per year.
Vision Services See details
The Aetna Medicare Elite (HMO-POS) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and the plan covers one routine eye exam every year. Eyewear has a combined maximum plan benefit of $200.00 every year.
Dental Services See details
The Aetna Medicare Elite (HMO-POS) plan covers dental services, with a $30 copay for Medicare dental services, and a maximum benefit of $1500 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 have no copay, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Elite (HMO-POS) plan, including Medicare Part B Insulin Drugs with a $35 copay. Other Medicare Part B drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Elite (HMO-POS) plan, but require prior authorization. You will pay a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Elite (HMO-POS) plan, including Durable Medical Equipment with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Equipment is covered, with the cost sharing varying based on the specific supplies or services.
Diagnostic and Radiological Services See details
The Aetna Medicare Elite (HMO-POS) plan covers Diagnostic and Radiological Services, including Diagnostic Procedures/Tests with no copay, and Lab Services with no copay. Radiological Services are also covered, with a copay of at most $225 for Diagnostic Radiological Services, and a coinsurance of at least 20% for Therapeutic Radiological Services.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Elite (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Elite (HMO-POS) plan, but the services have no copay. However, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Elite (HMO-POS) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $30 every three months. Acupuncture, Meal Benefit, 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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