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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 Jackson and Josephine Counties. 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. Additionally, this plan comes with a Part B Premium reduction of $5.00. You must continue to pay paying your reduced 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 features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using a preferred pharmacy or preferred mail-order service. If you choose a standard pharmacy or standard mail order, Tier 1 copays start at $2 and Tier 2 copays start at $12 for a one-month supply. For higher-tier medications, the plan transitions to coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 21% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 33% coinsurance across all pharmacy types. These coinsurance rates apply whether you use preferred or standard pharmacies, or mail-order options.
Additional Benefits
The Aetna Medicare Elite (HMO-POS) plan offers comprehensive medical coverage with no copay for primary care visits, annual physicals, and home health services. Specialist visits feature a copay ranging from no copay to $40, while inpatient hospital stays require a daily copay of $475 for the first five days of acute care. Emergency room visits require a $130 copay, which is waived upon hospital admission, and ground ambulance services carry a $295 copay. Ancillary benefits include routine vision and hearing exams with no copay, no coinsurance, and no deductible, plus annual allowances of $150 for eyewear and $1,250 per ear for prescription hearing aids. Dental coverage features no copay for preventive care and a 20% to 50% coinsurance for comprehensive services up to a $750 yearly limit. Lastly, durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Inpatient hospital care is covered by Aetna Medicare Elite (HMO-POS) with no coinsurance, requiring prior authorization and a daily copay of $475 for days 1 to 5 of acute stays and $465 for days 1 to 5 of psychiatric stays, followed by no copay for subsequent days. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Elite (HMO-POS) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $425, observation services have a $475 copay per stay, and outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
Aetna Medicare Elite (HMO-POS) covers partial hospitalization services with a copay of $140.00 or $145.00 and no coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under Aetna Medicare Elite (HMO-POS), with ground ambulance services requiring a $295 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Prior authorization is required for ambulance services, and while some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Aetna Medicare Elite (HMO-POS) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a $45 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 limit with no coinsurance and copays of $130 for medical care and $295 for transportation.
Primary Care See details
Aetna Medicare Elite (HMO-POS) covers primary care physician services with no copay and specialist visits with a $0 to $40 copay, both featuring no coinsurance. Chiropractic services are partially covered with a $10 copay and no coinsurance (routine and other chiropractic services are not covered), telehealth is covered with a $0 to $45 copay and 20% coinsurance, and podiatry is not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Elite (HMO-POS), featuring no copay and no coinsurance for annual physicals, health education, smoking cessation, fitness, remote access, chemotherapy-related wigs, and routine screenings, though kidney disease education requires no copay and a 20% coinsurance. Sub-services that are not covered include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional or dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Aetna Medicare Elite (HMO-POS) partially covers hearing services, offering Medicare-covered exams, one routine exam, and one fitting evaluation annually with no copay, no coinsurance, and no deductible. Prescription hearing aids are covered up to $1,250 per ear every year with no copay or coinsurance, but OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services under Aetna Medicare Elite (HMO-POS) are covered with no copay, no coinsurance, and no deductible, which includes one routine eye exam per year and unlimited follow-up diabetic eye exams. Eyewear, including contacts, eyeglasses, lenses, frames, and upgrades, is also covered with no copay or coinsurance up to a $150 combined annual maximum.
Dental Services See details
Dental services are partially covered by Aetna Medicare Elite (HMO-POS), with Medicare-covered dental requiring a $40 copay and no coinsurance, and covered preventive services having no copay and no coinsurance. Comprehensive dental services feature no copay and 20% to 50% coinsurance up to a $750 annual limit, but fluoride, implants, orthodontics, other diagnostic, other preventive, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Elite (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs require 0% to 20% coinsurance, 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, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Elite (HMO-POS) covers medical equipment with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic therapeutic shoes and inserts are covered with no copay, while diabetic supplies have a 0% to 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Elite (HMO-POS) covers diagnostic services with no coinsurance, offering lab services with no copay and diagnostic procedures with a $0 to $15 copay. Covered radiological services require prior authorization and include diagnostic radiology with copays starting at $0, outpatient X-rays with no copay and applicable coinsurance, and therapeutic radiology with a copay and a minimum 20% coinsurance.
Home Health Services See details
Aetna Medicare Elite (HMO-POS) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Elite (HMO-POS) offers no copay and no coinsurance for Cardiac Rehabilitation Services, but in practice, the benefit is not covered as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Elite (HMO-POS) covers Skilled Nursing Facility (SNF) care 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 while a prior three-day inpatient hospital stay is not required for admission, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Elite (HMO-POS), offering coverage for annual wellness exams, screening mammography, and additional gFOBT and FIT with no copay and no coinsurance. Under this plan, acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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