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 Western KS: Saline 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 $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 an enhanced alternative drug benefit. Before your coverage begins, you must satisfy a deductible of $590. Once the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. In the initial coverage phase, you will pay a $0 copay for preferred generic drugs at preferred and mail-order pharmacies, and $12 at standard pharmacies. Standard generic, preferred brand, and non-preferred drugs have a 24% or 25% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Aetna Medicare Premier (HMO) plan offers comprehensive coverage with a variety of benefits. This plan includes no copay for primary care, preventive services, and many outpatient services, such as lab services. You can expect copays for services like inpatient hospital stays, specialist visits, and ambulance services, as well as coinsurance for services like dialysis and some medical equipment.
Inpatient Hospital See details
Inpatient hospital stays, including acute and psychiatric care, are covered under the Aetna Medicare Premier (HMO) plan, 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, but non-Medicare-covered stays and upgrades for inpatient hospital-acute, as well as additional days and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services, with a copay ranging from $0 to $350, and observation services with a $295 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services for both individual and group sessions have a copay of $45.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier (HMO) plan, with a $55 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) plan. Ground Ambulance Services have a $280 copay, and 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 Aetna Medicare Premier (HMO). For Emergency Services, there is a $140 copay, and for Urgently Needed Services, there is a $45 copay; both have no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $140 copay, while Worldwide Emergency Transportation has a $280 copay; all three have no coinsurance.
Primary Care See details
The Aetna Medicare Premier (HMO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, while occupational therapy services have a $40 copay. Physician specialist services, mental health specialty services, and podiatry services are covered, with copays ranging from $0 to $45. Physical therapy and speech-language pathology services have a $40 copay, and additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45.
Preventive Services See details
The Aetna Medicare Premier (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services like health education, wigs for hair loss related to chemotherapy, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, fitness benefit, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit have no copay. Kidney Disease Education Services have a 20% coinsurance. Some services are not covered, including 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, support for caregivers of enrollees, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
Hearing exams are covered with a $45 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids have a maximum plan benefit coverage of $1500 per year, and Prescription Hearing Aids (all types) have no copay. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and 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. Eyewear has a combined maximum plan benefit coverage of $125 per year.
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. The plan does not cover fluoride treatments, maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, are covered by the Aetna Medicare Premier (HMO) plan, with a $35 copay for Medicare Part B Insulin Drugs. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with a 20% coinsurance, and require prior authorization.
Medical Equipment See details
Medical Equipment is covered by Aetna Medicare Premier (HMO), including Durable Medical Equipment (DME) with 0% to 20% coinsurance, and Prosthetics/Medical Supplies with 0% to 20% coinsurance. Diabetic equipment, including diabetic supplies with 0% to 20% coinsurance, and diabetic therapeutic shoes/inserts with 20% coinsurance is also covered. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services. Diagnostic Procedures/Tests have a copay between $0 and $45, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $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 (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. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier (HMO) plan, 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 (HMO) plan covers acupuncture with a $20 copay for up to 12 treatments per year, and also covers over-the-counter items with no copay, up to a $60 benefit every three months. The plan also covers meal benefits and other services, such as annual wellness exams and screening mammography, with no copay. However, this plan does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other 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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