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Aetna Medicare Choice Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Choice Plus (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 Choice Plus (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Choice Plus (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 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Choice Plus (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 Choice Plus (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 Choice Plus (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $19.00. 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 $590.00 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 $8950.00 (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 $8950.00 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 Choice Plus (HMO-POS) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. In the initial coverage phase, you will pay either a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you will pay no copay at preferred pharmacies or mail order. For standard generic drugs, you will pay 24% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Choice Plus (HMO-POS) plan offers a wide range of benefits with varying cost-sharing. It includes coverage for inpatient hospital stays with a copay, outpatient services with copays, and emergency services. The plan also covers primary care, preventive, vision, and dental services, often with no copay, and provides coverage for hearing exams and hearing aids. This plan also covers ambulance services, home health, and skilled nursing facility stays with copays. Additionally, it offers benefits for medical equipment, diagnostic services, and home infusion. The plan includes other services like over-the-counter items and meal benefits, and has copays and coinsurance for services such as therapy, dialysis, and some medications.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $295 for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $275, and observation services with a $295 copay. Ambulatory Surgical Center (ASC) Services and outpatient blood services have no copay, and Outpatient Substance Abuse Services have a $40 copay for individual sessions and a $30 copay for group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Choice Plus (HMO-POS) plan with a $60 copay and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Choice Plus (HMO-POS), including both ground and air ambulance services. Ground ambulance services have a $285 copay, while air ambulance services have a 20% coinsurance; however, transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Choice Plus (HMO-POS) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $45 copay, Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $285 copay.
Primary Care See details
The Aetna Medicare Choice Plus (HMO-POS) plan covers Primary Care Physician Services with a $5 copay, Chiropractic Services with a $20 copay, and Occupational Therapy Services with a $35 copay. It also covers Physician Specialist Services with a copay between $0 and $45, Mental Health Specialty Services with a copay between $30 and $40, Podiatry Services with a $45 copay, and Other Health Care Professional services with a copay between $0 and $45. Additionally, the plan covers Psychiatric Services with a copay between $30 and $40, Physical Therapy and Speech-Language Pathology Services with a $35 copay, Additional Telehealth Benefits with a 20% coinsurance and a copay between $0 and $45, and Opioid Treatment Program Services with a copay of $40. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include no copay for annual physical exams, Medicare-covered preventive services, and services like glaucoma screenings, diabetes self-management training, and more. Additional preventive services may have a copay, and kidney disease education services have a 20% coinsurance. Some services like in-home safety assessments, personal emergency response systems, and others are not covered.
Hearing Services See details
Hearing exams are covered with a $45 copay, as are routine hearing exams and fitting/evaluation for hearing aids, both of which have no copay. Prescription hearing aids (all types) are covered with a maximum plan benefit of $2500 per year, and OTC hearing aids are not covered.
Vision Services See details
Vision services, including eye exams and eyewear, are covered with no copay. Eyewear has a combined maximum plan benefit coverage of $270 every year.
Dental Services See details
The Aetna Medicare Choice Plus (HMO-POS) plan covers Medicare Dental Services with a $45 copay, and also covers 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 with no copay. The plan does not cover maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Choice Plus (HMO-POS) plan and require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered under the Aetna Medicare Choice Plus (HMO-POS) plan. Durable Medical Equipment has a coinsurance between 0% and 20%, and a $0 copay; however, Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a coinsurance between 0% and 20%. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
The Aetna Medicare Choice Plus (HMO-POS) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a copay between $0 and $45, and lab services with no copay. Radiological services are also covered, including diagnostic radiological services with a copay up to $100, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Choice Plus (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 covered by the Aetna Medicare Choice Plus (HMO-POS) plan, but the specific services of 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. There is a copay for the covered services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Choice Plus (HMO-POS), 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 coverage and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and Meal Benefits, both with no copay. OTC items have a maximum benefit of $75 every three months. Acupuncture, Dual Eligible SNPs, 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, 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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