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Aetna Medicare Premier (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier (HMO). 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) in 2025, please refer to our full plan details page.
Aetna Medicare Premier (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Oklahoma City and Surrounding Counties. 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) 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).
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), 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 Maximum Out-Of-Pocket cost of $5900.00 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) plan has a $250 deductible for prescription drugs. After the deductible is met, 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 copay at a preferred pharmacy, while standard pharmacies charge a $12 copay. For standard generic drugs, you'll pay 25% 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 (HMO) plan offers comprehensive coverage, including inpatient hospital stays with copays ranging from $275 to $295, and no copay after the 7th day. Outpatient services have copays between $0 and $245, while emergency services and urgent care have copays of $55 to $125. The plan also includes coverage for dental, vision, and hearing services, with no copays for many routine services, and covers home health and skilled nursing facility services.
Inpatient Hospital See details
Inpatient Hospital-Acute has a copay of $295 for days 1-7, and no copay for days 8-90, with no coinsurance, while Inpatient Hospital Psychiatric has a copay of $275 for days 1-7, and no copay for days 8-90, with no coinsurance. Additional Days for Inpatient Hospital-Acute is covered with no copay or coinsurance, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay 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 $245, observation services with a $295 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services, including individual and group sessions, have a copay of $40, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier (HMO) plan, but requires prior authorization. You will pay a copay of $85 for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Premier (HMO) plan. Ground Ambulance Services have a $250 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, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Premier (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $55 copay, and Worldwide Emergency Transportation has a $250 copay; all services have no coinsurance.
Primary Care See details
Under the Aetna Medicare Premier (HMO) plan, primary care physician services have no copay, chiropractic services have a $20 copay, and occupational therapy services have a $30 copay. Physician specialist services have a copay between $0 and $30, and mental health specialty services have a $30 copay for both individual and group sessions. Physical therapy and speech-language pathology services have a $30 copay, and additional telehealth benefits have a 20% coinsurance and a copay between $0 and $55. Opioid treatment program services also have a $30 copay. Podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Premier (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Wigs for Hair Loss Related to Chemotherapy, with no copay. Kidney Disease Education Services are covered with 20% coinsurance. Other preventive services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing Services include 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 (all types) are covered with no copay, but inner ear, outer ear, and over the ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services, including eye exams and eyewear, are covered under the Aetna Medicare Premier (HMO) plan. Eye exams and eyewear have no copay. The plan covers one routine eye exam per year, and provides a combined maximum of $250 per year for eyewear.
Dental Services See details
The Aetna Medicare Premier (HMO) plan covers dental services, including oral exams with no copay, dental x-rays with no copay, and prophylaxis (cleaning) with no copay. Medicare dental services have a $30 copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are covered with coinsurance ranging from 20% to 50%. Orthodontic services are covered up to a maximum of $2500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable medical equipment has a coinsurance between 0% and 20%, and diabetic supplies have a coinsurance between 0% and 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with copays and coinsurance depending on the specific service. Diagnostic Procedures/Tests have a copay between $0 and $50, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $295, 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 (HMO) 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 (HMO) plan. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier (HMO) plan with prior authorization required. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $214.
Other Services See details
The Aetna Medicare Premier (HMO) plan's "Other Services" benefit covers over-the-counter (OTC) items with no copay, and a maximum benefit coverage amount of $45 every three months. Acupuncture, meal benefits, and several other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered.
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