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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 2025, 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 Northwest AR. This plan received an overall rating of 4.5 out of 5 stars in 2025.
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 $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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 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 has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay either a copay or coinsurance depending on the drug tier and where you purchase the drug. For example, preferred generic drugs have no copay at preferred pharmacies and preferred mail order, while standard generic drugs have 21% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you pay $0 for your prescriptions. Always check the plan's formulary for specific drug coverage details.
Additional Benefits
The Aetna Medicare Premier (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services, including primary care and preventive services, often have no copay. The plan also includes coverage for hearing, vision, and dental services, with specific copays and annual maximums. Additional benefits include ambulance services, emergency services, and home health services, with specific copays or coinsurance. The plan also covers prescription hearing aids, medical equipment, and diagnostic services, with varying cost-sharing. Some services, such as cardiac rehabilitation and certain specialized services, are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital benefits, including services not usually covered by Medicare plans, are covered under the Aetna Medicare Premier (HMO-POS) plan, with a copay of $380 for days 1-7 and no copay for days 8-90 for Inpatient Hospital-Acute, and a copay of $407 for days 1-5 and no copay for days 6-90 for Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered. Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services, are covered by the Aetna Medicare Premier (HMO-POS) plan. Outpatient hospital services have a copay between $0 and $380, observation services have a $380 copay, ASC services have no copay, and both individual and group outpatient substance abuse sessions have a $45 copay. Outpatient blood services have no copay.
Partial Hospitalization See details
Aetna Medicare Premier (HMO-POS) covers partial hospitalization with an $80 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Premier (HMO-POS) plan. Ground ambulance services have a $330 copay, while air ambulance services have a 20% coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgent and Worldwide Emergency Services, are covered by the Aetna Medicare Premier (HMO-POS) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Services have a $110-$330 copay depending on the service.
Primary Care See details
Primary Care Physician Services are covered with no copay, while Chiropractic Services have a $15 copay. Occupational Therapy Services, Physician Specialist Services, Individual and Group Sessions for Mental Health and Psychiatric Services, have a copay of $30. Physical Therapy and Speech-Language Pathology Services have a $30 copay. Other Health Care Professional services have a copay between $0 and $30. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $45. Opioid Treatment Program Services have a $30 copay.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services with varying copays. Kidney Disease Education Services have a 20% coinsurance, while glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit have no copay.
Hearing Services See details
Hearing Services includes coverage for hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids have a plan-specified amount of $500 per ear, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are also not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams and eyewear have no copay, and the plan covers one routine eye exam per year. Eyewear has a combined maximum benefit of $325 per year.
Dental Services See details
Dental services are covered, with a $2,700 annual maximum benefit. Medicare Dental Services have a $30 copay, and 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, Prosthodontics, fixed, and Oral and Maxillofacial Surgery have no copay. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
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 coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Premier (HMO-POS) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
The Aetna Medicare Premier (HMO-POS) plan covers medical equipment, including durable medical equipment with 20% coinsurance, and prosthetic devices and medical supplies with 20% coinsurance. Diabetic equipment is also covered, with 0-20% coinsurance for diabetic supplies and 20% coinsurance for diabetic therapeutic shoes/inserts. Durable medical equipment for use outside the home is not covered.
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 $95, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $300, Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Premier (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Premier (HMO-POS) plan. While the plan covers Cardiac Rehabilitation Services, none of the sub-services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Premier (HMO-POS) plan covers Over-the-Counter (OTC) items with no copay, up to a maximum of $75 every three months. This plan also covers meal benefits with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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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