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Aetna Medicare Enhanced Extra (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Enhanced Extra (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 Enhanced Extra (HMO-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Enhanced Extra (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Missouri/Illinois. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Enhanced Extra (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 Enhanced Extra (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 Enhanced Extra (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $40.00. 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 $615.00 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 combined Maximum Out-Of-Pocket cost of $10100.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Enhanced Extra (HMO-POS) plan has an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order options charge copays ranging from $2 to $6 for Tier 1 drugs and $12 to $36 for Tier 2 drugs depending on the supply. For brand-name and specialty medications, costs are based on coinsurance rather than set copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance across all pharmacy types. Tier 5 specialty tier drugs also carry a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Enhanced Extra (HMO-POS) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copayments for primary care visits, home health services, and preventive care. For hospital stays, members pay no coinsurance, with inpatient care requiring a daily copay of $295 for the first six days and no copay for days seven through ninety. Outpatient procedures, emergency visits, and urgent care services are also covered with fixed copays and no coinsurance. This plan also features valuable everyday benefits, including routine vision and hearing exams with no copay, alongside a $120 quarterly allowance for over-the-counter items. Preventive dental care has no copay, while comprehensive dental services are covered up to a $4,000 annual limit with no copay and 20% to 50% coinsurance. Furthermore, diagnostic lab work and outpatient X-rays are fully covered with no copay.
Inpatient Hospital See details
Inpatient hospital services are covered by Aetna Medicare Enhanced Extra (HMO-POS) with no coinsurance and a copay of $295 per day for days 1 to 6, and no copay for days 7 to 90. The benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, though unlimited additional acute care days are covered with no copay.
Outpatient Services See details
Aetna Medicare Enhanced Extra (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services and a $295 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services require a $20 copay per session with no coinsurance.
Partial Hospitalization See details
Aetna Medicare Enhanced Extra (HMO-POS) covers partial hospitalization services with a copay of either $60.00 or $145.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Enhanced Extra (HMO-POS), with ground ambulance services requiring a $285 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Prior authorization is required for all ambulance services, and although some transportation services are covered, transportation to plan-approved or any other health-related locations is not covered.
Emergency Services See details
Aetna Medicare Enhanced Extra (HMO-POS) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services have a $20 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 maximum with no coinsurance and copays ranging from $130 to $285.
Primary Care See details
Primary Care benefits under Aetna Medicare Enhanced Extra (HMO-POS) offer primary care physician visits with no copay and no coinsurance, while specialist, therapy, and mental health services require a $0 to $20 copay and no coinsurance. Chiropractic services are not covered, and telehealth benefits are available with a $0 to $20 copay and 20% coinsurance.
Preventive Services See details
Aetna Medicare Enhanced Extra (HMO-POS) covers preventive services with no copay and no coinsurance for most benefits, including annual physical exams and fitness programs, while kidney disease education has no copay and a 20% coinsurance. This benefit is partially covered, as the plan excludes several services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, and home-based palliative care.
Hearing Services See details
Aetna Medicare Enhanced Extra (HMO-POS) covers hearing services, including Medicare-covered exams for a $20 copay and no coinsurance, and annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $1,250 annual limit per ear, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Enhanced Extra (HMO-POS) with no coinsurance or deductibles, requiring a $20 copay for Medicare-covered exams and no copay for annual routine eye exams. Eyewear, including contacts and eyeglasses, is also covered with no copay up to a $350 annual combined maximum.
Dental Services See details
Dental Services are partially covered by Aetna Medicare Enhanced Extra (HMO-POS), featuring Medicare-covered dental services for a $20 copay and no coinsurance, and preventive care with no copay and no coinsurance. Comprehensive benefits like restorative care, endodontics, and prosthodontics are covered up to a $4,000 annual maximum with no copay and 20% to 50% coinsurance, though fluoride, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Enhanced Extra (HMO-POS) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Aetna Medicare Enhanced Extra (HMO-POS) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Enhanced Extra (HMO-POS), with durable medical equipment and medical supplies requiring no copay and 0% to 20% coinsurance. Prosthetic devices feature no copay and 20% coinsurance, while diabetic therapeutic shoes or inserts require a $10 copay and no coinsurance. Prior authorization is required for these covered medical equipment benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Enhanced Extra (HMO-POS), requiring prior authorization for all services. Diagnostic procedures and lab services feature no coinsurance, with lab services, diagnostic radiology, and outpatient X-rays requiring no copay, while diagnostic procedures have a copay of up to $20 and therapeutic radiology requires a minimum 20% coinsurance.
Home Health Services See details
The Aetna Medicare Enhanced Extra (HMO-POS) plan covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Enhanced Extra (HMO-POS) covers some cardiac rehabilitation services with no copay and no coinsurance, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Enhanced Extra (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, no prior three-day inpatient hospital stay is needed, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Enhanced Extra (HMO-POS) partially covers other services with no copay and no coinsurance, providing a chronic illness meal benefit, annual wellness exams, screening mammographies, and up to $120 every three months for over-the-counter items. Acupuncture is not covered under this plan.
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