A non-government entity
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 Topeka and surrounding areas. 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 $590.00 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 $4150.00 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 $590.00 deductible for prescription drugs. After meeting the deductible, you will pay a copay or coinsurance depending on the drug tier and where you get your prescription. For preferred generic drugs, you will pay no copay if you use a preferred pharmacy or preferred mail order. Standard generic drugs have a 24% coinsurance. Brand name and non-preferred drugs have a 25% coinsurance.
Additional Benefits
The Aetna Medicare Premier (HMO) plan offers comprehensive coverage for various healthcare services. You can expect no copay for primary care physician visits, and many preventive services, including an annual physical exam. The plan also includes coverage for inpatient and outpatient services, emergency services, hearing, vision, and dental services. Copays and coinsurance amounts vary depending on the specific service, such as a $335 copay for inpatient hospital stays (days 1-6) and a $140 copay for emergency services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $335 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you will pay a $310 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 Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Aetna Medicare Premier (HMO) plan. Outpatient Hospital Services have a copay between $0 and $325, Observation Services have a copay of $335, and Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse Services have a copay of $35 for both individual and group sessions, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier (HMO) plan with a $55 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Premier (HMO) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $295 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 (HMO) plan. Emergency Services have a $140 copay and no coinsurance, while Urgently Needed Services have a $35 copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $140 copay, and Worldwide Emergency Transportation has a $295 copay; all have no coinsurance.
Primary Care See details
Under the Aetna Medicare Premier (HMO) plan, primary care physician services are covered with no copay, while chiropractic services have a $20 copay for routine care. Occupational therapy services have a $35 copay, and physical therapy and speech-language pathology services have a $35 copay. Physician specialist services have a copay between $0 and $35. Mental health specialty services, psychiatric services, and opioid treatment program services have a minimum copay of $35 and a maximum copay of $35 for individual and group sessions. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $35.
Preventive Services See details
The Aetna Medicare Premier (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are covered, and some services have a $0 copay, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered by the Aetna Medicare Premier (HMO) plan. Routine hearing exams and fitting/evaluation for hearing aids have no copay, while hearing exams have a $35 copay. Prescription hearing aids (all types) are covered, but 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, including eye exams and eyewear, are covered under the Aetna Medicare Premier (HMO) plan. Eye exams and eyewear have no copay. Eyewear has a combined maximum benefit of $200 per year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $35 copay, oral exams with no copay, dental x-rays with no copay, prophylaxis (cleaning) with no copay, restorative services with 20-50% coinsurance, adjunctive general services with 20-50% coinsurance, endodontics with 20% coinsurance, periodontics with 20-50% coinsurance, prosthodontics removable with 50% coinsurance, and prosthodontics fixed with 50% coinsurance. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered, and there is a $3,000 maximum plan benefit for orthodontic services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including insulin, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Insulin has 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 with a coinsurance of 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), is covered under the Aetna Medicare Premier (HMO) plan, with a coinsurance between 0% and 20% and no copay, although durable medical equipment for use outside the home is not covered. Prosthetics, medical supplies, and diabetic equipment are also covered, with varying coinsurance amounts and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $35, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $140, Therapeutic Radiological Services with a coinsurance of at least 20%, and Outpatient X-Ray Services with no copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Premier (HMO) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Premier (HMO) plan, but the plan does not cover any of the specific services. The plan has a copay for some Cardiac Rehabilitation Services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
The Aetna Medicare Premier (HMO) plan covers Skilled Nursing Facility (SNF) services, but requires prior authorization. For days 1-20, the copay is $20, and for days 21-100, the copay is $214; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Under the Aetna Medicare Premier (HMO) plan, acupuncture has a $20 copay per visit and is limited to 12 treatments per year, while over-the-counter items and meal benefits have no copay. This plan also covers annual wellness exams, screening mammography, and gFOBT/FIT with no copay, but does not cover 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, or Self-Directed Personal Assistance Services.
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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.
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