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Aetna Medicare Select (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Select (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 Select (HMO-POS) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Aetna Medicare Select (HMO-POS) is a HMO-POS plan offered by Coventry Health Care of Missouri, Inc. available for the 2026 plan year 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 Select (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 Select (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 Select (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
Health deductible: information not available.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3400.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $3400.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $5450.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $5450.00 for covered services, the plan will pay 100% of 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:
Sign up for Aetna Medicare Select (HMO-POS)
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Drug Coverage
The Aetna Medicare Select (HMO-POS) plan has an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail-order service. If you use standard pharmacies or standard mail order, copays range from $2 to $6 for Tier 1 and $12 to $36 for Tier 2 depending on the supply duration. For higher-tier medications, costs are based on coinsurance rather than flat copays. You will pay 24% coinsurance for Tier 3 preferred brand drugs and 25% coinsurance for Tier 4 non-preferred drugs across all pharmacy and mail-order options. Tier 5 specialty drugs also require a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Select (HMO-POS) plan offers robust medical coverage featuring no copay for primary care doctor visits and specialist copays ranging from no copay to $25. For inpatient hospital stays, members pay a $310 daily copay for days 1 through 6 and no copay for days 7 through 90. Emergency care is available with a $150 copay, while urgent care visits require a $25 copay, both with no coinsurance. This plan also includes valuable supplemental benefits, including routine vision and hearing exams with no copay, alongside annual allowances of up to $175 for eyewear and $1,250 per ear for prescription hearing aids. Covered dental services feature no copay and 0% to 50% coinsurance up to a $2,000 annual maximum, while Medicare-covered dental services carry a $25 copay. Additionally, home health services and select preventive care are covered with no copay or coinsurance, helping you manage your healthcare costs effectively.
Inpatient Hospital See details
Aetna Medicare Select (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $310 daily copay for days 1 through 6 and no copay for days 7 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Select (HMO-POS) with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Outpatient hospital copays range from $0 to $300, observation services require a $310 copay per stay, and outpatient substance abuse sessions carry a $25 copay, with prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Select (HMO-POS) with no coinsurance, requiring prior authorization and a copay of either $55.00 or $180.00 depending on the service.
Ambulance and Transportation Services See details
Aetna Medicare Select (HMO-POS) covers ambulance services with prior authorization, requiring a $350 copay for ground ambulance services and a 20% coinsurance for air ambulance services. Some transportation services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Aetna Medicare Select (HMO-POS) covers emergency services with a $150 copay and urgently needed services with a $25 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays ranging from $150 to $350, up to a maximum benefit of $250,000.
Primary Care See details
Aetna Medicare Select (HMO-POS) covers primary care physician visits with no copay and no coinsurance, while specialist visits require a $0 to $25 copay and no coinsurance. Most other primary care services, including physical therapy, mental health, and podiatry, carry a $25 copay and no coinsurance, though chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Select (HMO-POS), generally featuring no copay and no coinsurance for annual physicals, health education, and fitness benefits, though kidney disease education carries a 20% coinsurance and no copay. The plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home/bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Select (HMO-POS), with Medicare-covered exams requiring a $25 copay and no coinsurance, while annual routine exams and hearing aid fittings have no copay, no coinsurance, and no deductible. Prescription hearing aids are covered up to $1,250 per ear yearly with no copay or coinsurance, though OTC options and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Aetna Medicare Select (HMO-POS) provides vision services with no copay and no coinsurance for eye exams, which includes one routine exam annually and unlimited follow-up diabetic eye exams. Covered eyewear, including contacts, eyeglasses, and upgrades, also features no copay or coinsurance up to a combined maximum benefit of $175 per year.
Dental Services See details
Dental services are partially covered by Aetna Medicare Select (HMO-POS), with exclusions for fluoride, implants, orthodontics, maxillofacial prosthetics, and certain diagnostic or preventive services. Medicare-covered dental services require a $25 copay and no coinsurance, while other covered dental services feature no copay and 0% to 50% coinsurance up to a $2,000 annual maximum.
Home Infusion bundled Services See details
Aetna Medicare Select (HMO-POS) covers home infusion bundled services with no copay, subject to prior authorization and step therapy. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Select (HMO-POS) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Select (HMO-POS) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copays and prior authorization required. Depending on the specific item, you will pay between no coinsurance and 20% coinsurance, with prosthetic devices and diabetic shoes or inserts requiring a flat 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Select (HMO-POS) with prior authorization required. Diagnostic procedures and tests have a $0 to $25 copay with no coinsurance, lab services and outpatient X-rays have no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Select (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Select (HMO-POS) with no coinsurance, but only some services are covered. Specifically, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered and require a $5 copay.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Select (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, and additional days beyond Medicare-covered limits are not covered.
Other Services See details
Aetna Medicare Select (HMO-POS) covers acupuncture with a $20 copay and no coinsurance for up to 12 treatments per year, alongside over-the-counter items, annual wellness exams, and select colorectal screenings with no copay and no coinsurance. Meal benefits are not covered under this plan.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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