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Aetna Medicare Premier Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier 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 Premier Plus (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Premier Plus (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 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Premier 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 Premier 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 Premier Plus (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 a $250.00 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 $5450.00 (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 $5450.00 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 Premier Plus (HMO-POS) plan has a $250 deductible for prescription drugs. Once you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you'll pay a $10 or $12 copay, while standard generic drugs have a 25% coinsurance. Preferred brand drugs have a 26% coinsurance, and non-preferred drugs have a 30% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Premier Plus (HMO-POS) plan offers a range of benefits with varying costs. You'll have no copay for primary care visits, preventive services like annual exams, and many outpatient services, including some mental health and substance abuse treatments. The plan also covers hearing, vision, and dental services, with copays for exams and some treatments. In terms of inpatient care, you'll have a copay for hospital stays, and ambulance services. Emergency services are covered with a copay. The plan also covers home health services and offers additional perks like over-the-counter items and acupuncture.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric services, with a $295 copay for days 1-6, and no copay for days 7-90. Additional days for inpatient hospital acute are covered with no copay, while non-Medicare covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services are covered under the Aetna Medicare Premier Plus (HMO-POS) plan. Outpatient Hospital Services have a copay of $0-$225, Observation Services have a copay of $295, and Ambulatory Surgical Center (ASC) Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $20.00, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Premier Plus (HMO-POS) plan, but requires prior authorization. This benefit has a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a $350 copay, while air ambulance services have a 20% coinsurance; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Premier Plus (HMO-POS) plan. Emergency Services have a $140 copay with no coinsurance, Urgently Needed Services have a $20 copay with no coinsurance, and Worldwide Emergency Services have a copay of $140 for Worldwide Emergency and Urgent Coverage, and a $350 copay for Worldwide Emergency Transportation, with no coinsurance.
Primary Care See details
The Aetna Medicare Premier Plus (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $20 copay and no coinsurance. Physician specialist services and other health care professional services have a copay between $0 and $20. Mental health specialty services, psychiatric services, and opioid treatment program services have a $20 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $20 copay and no coinsurance. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $20. Podiatry services and routine foot care have a $20 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional services like health education, nutritional/dietary benefits, wigs for hair loss, additional sessions of smoking and tobacco cessation counseling, remote access technologies, and fitness benefits. Other preventive services such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit have no copay, while kidney disease education services have a 20% coinsurance. However, 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, and support for caregivers of enrollees are not covered.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with a $20 copay for hearing exams and no copay for routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a maximum plan benefit of $1500 per year, and 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 and eyewear have no copay, and eyewear has a combined maximum plan benefit of $300 every year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $20 copay, and other dental services with a maximum benefit of $3,500 per year. 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 are covered with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Aetna Medicare Premier Plus (HMO-POS), including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Premier Plus (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Aetna Medicare Premier Plus (HMO-POS) plan covers durable medical equipment with a coinsurance of 0% to 20% and no copay, however, durable medical equipment for use outside the home is not covered. Prosthetics/Medical Supplies are covered with no copay and coinsurance for Medicare-covered items. Diabetic equipment is covered, with coinsurance between 0% and 20% depending on the specific supply or service.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $20, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $140, 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 by the Aetna Medicare Premier 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 not covered by the Aetna Medicare Premier Plus (HMO-POS) plan. While the plan covers some cardiac rehabilitation services, none of the listed sub-services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Premier Plus (HMO-POS), but require prior authorization. For days 1-20, there is a $20 copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Premier Plus (HMO-POS) plan covers acupuncture with a $20 copay for up to 12 treatments per year, and over-the-counter items with no copay, with a maximum benefit of $60 every three months. The plan also covers meal benefits and other services such as annual wellness exams and screening mammography, with no copay. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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