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Aetna Medicare Gold Advantage (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Gold Advantage (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 Gold Advantage (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Gold Advantage (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Metro St Louis - Missouri/Illinois. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Gold Advantage (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 Gold Advantage (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 Gold Advantage (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 $2500.00 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 Gold Advantage (HMO-POS) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. If you qualify for the low-income subsidy (LIS), you will pay $0.00 for Part D drugs. In the initial coverage phase, after paying the $0 deductible, you will pay a copay or coinsurance for your prescriptions. For preferred generic drugs, you will pay a $5 copay at a preferred pharmacy and $12 at a standard pharmacy. For standard generic drugs, you pay 25% coinsurance regardless of the pharmacy. Once your total drug costs reach $2,000, you enter the next coverage phase.
Additional Benefits
The Aetna Medicare Gold Advantage (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, and outpatient services have copays depending on the service, while emergency services have a $140 copay. Primary care, preventive services, vision, and dental services have no copay. This plan includes coverage for hearing exams, vision services, and dental services. It also provides coverage for ambulance services, home health services, and skilled nursing facilities with some copays. Prescription hearing aids are covered, as are eyeglasses and other vision services.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a $250 copay for days 1-8 and no copay for days 9-90 for Inpatient Hospital-Acute. Inpatient Hospital Psychiatric services are also covered, with a $275 copay for days 1-8 and no copay for days 9-90, but additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $250, observation services with a $235 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay of $40 for individual sessions and $30 for group sessions, and outpatient blood services with no copay. Prior authorization is required for many of these services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Gold Advantage (HMO-POS) plan, but requires prior authorization. You will have a $75 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Gold Advantage (HMO-POS) plan. Ground ambulance services have a $280 copay, while air ambulance services have a 20% coinsurance, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage have a $140 copay, while Worldwide Emergency Transportation has a $280 copay, with no coinsurance. The copay for Emergency Services is waived if admitted to the hospital within 24 hours.
Primary Care See details
Aetna Medicare Gold Advantage (HMO-POS) covers primary care services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $20 copay. Physician specialist services have a copay between $0 and $20, and mental health specialty services and psychiatric services have copays of $40 for individual sessions and $30 for group sessions. Podiatry services and other health care professional services have a copay between $30 and $20, respectively, while physical therapy and speech-language pathology services have a $20 copay, and additional telehealth benefits have a 20% coinsurance with a copay between $0 and $40. Opioid treatment program services have a $40 copay.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services, including health education, wigs for hair loss related to chemotherapy, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, fitness benefit, and remote access technologies, all with no copay. Kidney disease education services have a 20% coinsurance, while other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, have no copay. The plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing exams are covered with a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to a maximum of $1500 per year with no copay for Prescription Hearing Aids (all types), but prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams, including routine eye exams, and other eye exam services have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay, and a combined maximum of $275.00 per year.
Dental Services See details
The Aetna Medicare Gold Advantage (HMO-POS) plan covers dental services with a $2,000 maximum benefit per year. Medicare dental services have a $25 copay, and other dental services like oral exams, dental x-rays, and cleaning have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while 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 under the Aetna Medicare Gold Advantage (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 20% coinsurance, and Prosthetics/Medical Supplies - Non-Medicare benefit with coinsurance for Medicare-covered items. Diabetic Equipment includes Diabetic Supplies with 0% to 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts with a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Gold Advantage (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $30, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $75, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Gold Advantage (HMO-POS) 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 not covered by the Aetna Medicare Gold Advantage (HMO-POS) plan. Although the plan covers Cardiac Rehabilitation Services, the specific sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Gold Advantage (HMO-POS) plan, but require prior authorization. For days 1-20, the copay is $20, and for days 21-100, the copay is $214; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Under the Aetna Medicare Gold Advantage (HMO-POS) plan, "Other Services" covers over-the-counter items and meals with no copay; however, acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, and more are not covered. Over-the-counter items have a maximum benefit coverage amount of $60 every three months.
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