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Aetna Medicare Premier Preferred (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier Preferred (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 Preferred (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Premier Preferred (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Eastern/Central Missouri. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Premier Preferred (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 Preferred (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 Preferred (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 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 $3700.00 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:
Sign up for Aetna Medicare Premier Preferred (HMO-POS)
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Drug Coverage
The Aetna Medicare Premier Preferred (HMO-POS) plan has a $590 deductible for prescription drugs. Once you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you will pay no copay at a preferred pharmacy or preferred mail order. Standard generic drugs have a 24% coinsurance, and preferred and non-preferred brand drugs have a 25% coinsurance. After your total drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Premier Preferred (HMO-POS) plan offers a wide array of benefits with varying costs. It covers inpatient hospital stays with a copay, and outpatient services like hospital visits and substance abuse treatment. Primary care services, preventive services like annual exams, vision, and dental services are covered, often with no copay, and the plan also offers coverage for hearing exams and aids. This plan also includes ambulance services, emergency services, and home health services, as well as services like partial hospitalization and cardiac rehabilitation. Additionally, the plan provides coverage for medical equipment, diagnostic and radiological services, and skilled nursing facility stays with copays, along with other services such as OTC items and meal benefits.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute with a $295 copay for days 1-6, and no copay for days 7-90, and Inpatient Hospital Psychiatric with 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 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
The Aetna Medicare Premier Preferred (HMO-POS) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $275, and observation services with a $295 copay. The plan also covers ambulatory surgical center (ASC) services with no copay, outpatient substance abuse services with a $35 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier Preferred (HMO-POS) plan, and requires prior authorization. You will pay a $70 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground Ambulance Services have a $290 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, including Urgent and Worldwide Emergency Services, are covered under the Aetna Medicare Premier Preferred (HMO-POS) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $35 copay, Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $140 copay, and Worldwide Emergency Transportation has a $290 copay.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $25 copay, and Physician Specialist Services with a copay between $0 and $35. Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Opioid Treatment Program Services, and Additional Telehealth Benefits are also covered with varying copays. Physical Therapy and Speech-Language Pathology Services have a $25 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay. Other preventive services are covered, and include Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, all with no copay. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a $35 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids have a maximum plan benefit coverage of $1,500 per year. Some services are covered, while prescription hearing aids for the inner, outer, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
Vision services include eye exams and eyewear, with no copay for any of the listed services. Routine eye exams are limited to one per year, while other eye exam services are unlimited. Eyewear has a combined maximum benefit of $260 per year.
Dental Services See details
Dental services are covered, with a $1,500 annual maximum. 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 and fixed), and oral and maxillofacial surgery are covered with 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, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Premier Preferred (HMO-POS) plan, with prior authorization required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Premier Preferred (HMO-POS) plan, including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a coinsurance for Medicare-covered devices and supplies. Diabetic equipment is covered, with a coinsurance for Medicare-covered therapeutic shoes or inserts and a copay for Medicare-covered diabetes supplies.
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 $35, 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 Preferred (HMO-POS) 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 covered by the Aetna Medicare Premier Preferred (HMO-POS) plan, but the specific services of 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 are not covered. The plan has a copay, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with 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
The Aetna Medicare Premier Preferred (HMO-POS) plan covers Over-the-Counter (OTC) items with no copay, and a maximum benefit of $50 every three months. Meal benefits and other services such as annual wellness exams and screening mammography, and gFOBT, FIT are covered with no copay. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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