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Aetna Medicare Premier (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier (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 Premier (HMO-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Premier (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Southwest Missouri. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Premier (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 Premier (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 Premier (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.00. 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 Maximum Out-Of-Pocket cost of $2900.00 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 Premier (HMO-POS) plan features an annual prescription 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. If you choose a standard pharmacy or standard mail-order service, copays range from $2 to $12 for a one-month supply. For Tier 3 preferred brand drugs, members pay a 24% coinsurance across all pharmacy and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, with specialty prescriptions limited to a one-month supply.
Additional Benefits
The Aetna Medicare Premier (HMO-POS) plan offers comprehensive medical coverage featuring no copays and no coinsurance for primary care visits, preventive services, and routine annual physicals. For hospital stays, inpatient care requires a daily copay of $290 for the first six days and no copay for days seven through 90, with no coinsurance. Emergency care is available with a $150 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also includes extensive supplemental benefits, including routine vision exams and eyewear with no copays, coinsurance, or deductibles up to a $475 annual limit. Routine dental cleanings and exams feature no copay and no coinsurance, while comprehensive dental services are covered up to a $4,000 annual maximum with coinsurance ranging from 20% to 50%. Additionally, members receive an over-the-counter item allowance of up to $75 every three months and hearing aid coverage up to $1,250 per ear annually with no copay.
Inpatient Hospital See details
Aetna Medicare Premier (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $290 daily copay for days 1 through 6 and no copay for days 7 through 90. Prior authorization is required, and some services are not covered, including upgrades, non-Medicare-covered stays, and additional psychiatric days beyond 90 days.
Outpatient Services See details
Aetna Medicare Premier (HMO-POS) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services at no copay. Outpatient hospital services require a $0 to $225 copay, observation services have a $290 copay per stay, and individual or group outpatient substance abuse sessions carry a $20 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Premier (HMO-POS) with a copay of either $55.00 or $180.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Premier (HMO-POS) covers ground ambulance services with a $350 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both of which require prior authorization. Transportation services, including trips to plan-approved or any health-related locations, are not covered.
Emergency Services See details
Aetna Medicare Premier (HMO-POS) covers emergency services with a $150 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services require a $20 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $150 to $350, up to a $250,000 maximum benefit limit.
Primary Care See details
Aetna Medicare Premier (HMO-POS) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services carry a $0 to $20 copay and no coinsurance. Telehealth benefits are available with a $0 to $20 copay and 20% coinsurance, but routine chiropractic services are not covered.
Preventive Services See details
Preventive Services under the Aetna Medicare Premier (HMO-POS) are partially covered, featuring no copay and no coinsurance for annual physicals, select screenings, and fitness benefits, while kidney education has no copay and a 20% coinsurance. Supplemental benefits include chemotherapy wigs up to $400 annually with no copay and no coinsurance. However, several services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, and counseling.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Premier (HMO-POS), featuring a $20 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are covered up to $1,250 per ear annually with no copay or coinsurance, 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 Premier (HMO-POS) with no copays, no coinsurance, and no deductibles, including one routine annual eye exam and unlimited follow-up diabetic eye exams. Eyewear, including contacts and eyeglasses, is also covered with no copay or coinsurance up to a $475 combined maximum limit every year.
Dental Services See details
Dental services are partially covered by Aetna Medicare Premier (HMO-POS), offering Medicare-covered dental for a $20 copay and no coinsurance, and preventive exams and cleanings with no copay and no coinsurance. Comprehensive services are covered up to a $4,000 annual maximum with no copay and 20% to 50% coinsurance, though fluoride, implants, maxillofacial prosthetics, orthodontics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Premier (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Premier (HMO-POS) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Aetna Medicare Premier (HMO-POS) covers medical equipment with no copay and coinsurance ranging from no coinsurance to 20% depending on the specific item. Prior authorization is required for durable medical equipment, prosthetics, and diabetic supplies, with diabetic supplies limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Premier (HMO-POS) covers diagnostic and radiological services, offering lab services and outpatient X-rays with no copay. Diagnostic procedures and tests have copays ranging from $0 to $20 with no coinsurance, while diagnostic radiological services start at a $0 copay and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Premier (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Premier (HMO-POS) does not cover cardiac rehabilitation services, as all specific rehabilitation sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD—are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Premier (HMO-POS) covers skilled nursing facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day inpatient hospital stay is not needed, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services under Aetna Medicare Premier (HMO-POS) are partially covered and include acupuncture for a $20 copay and no coinsurance for up to 12 treatments per year. Over-the-counter items up to $75 every three months, chronic illness meal benefits, and annual wellness exams are available with no copay and no coinsurance, though Dual Eligible SNPs with Highly Integrated Services are not covered.
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