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Aetna Medicare Signature (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Signature (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Signature (HMO) in 2026, please refer to our full plan details page.
Aetna Medicare Signature (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in St. Joe and Surrounding Area. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Signature (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 Signature (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 Signature (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 $615.00 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 $6750.00 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 Signature (HMO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay when filling prescriptions through preferred pharmacies or preferred mail-order services. If using standard pharmacies or standard mail-order options, copays range from $2 to $6 for Tier 1 and $12 to $36 for Tier 2 depending on the supply duration. Brand-name and specialty medications are subject to coinsurance rather than flat copays under this plan. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance across all pharmacy types. Specialty drugs in Tier 5 are limited to a one-month supply, whereas other tiers offer up to a three-month supply.
Additional Benefits
The Aetna Medicare Signature (HMO) plan offers comprehensive medical coverage with no copay for primary care doctor visits and low copays ranging from $0 to $65 for specialists. Inpatient hospital stays require a $450 daily copay for the first six days with no copay for additional days, while emergency room visits carry a $130 copay that is waived upon admission. Outpatient services feature no coinsurance and flexible copays from $0 to $375, alongside home health services that require no copay. For routine and preventive care, members benefit from no copays on annual physicals, fitness programs, routine eye exams, and select dental cleanings. The plan also covers routine hearing exams with no copay and offers up to $500 annually per ear for prescription hearing aids, plus a $100 annual allowance for eyewear. While diagnostic lab work and outpatient X-rays require no copay, other services like medical equipment and dialysis require up to a 20% coinsurance.
Inpatient Hospital See details
Aetna Medicare Signature (HMO) covers inpatient acute hospital stays with no coinsurance, a $450 copay for days 1 through 6, and no copay for days 7 and beyond. Inpatient psychiatric care is also covered with no coinsurance, featuring a $390 copay for days 1 through 6 and no copay for days 7 through 90, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered and prior authorization is required.
Outpatient Services See details
Aetna Medicare Signature (HMO) covers outpatient services with no coinsurance, featuring a $0 to $375 copay for outpatient hospital services, a $450 copay per stay for observation services, and a $65 copay for outpatient substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Aetna Medicare Signature (HMO) plan, requiring a copay of either $55.00 or $145.00 and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Signature (HMO), with ground ambulance services requiring a $340 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Prior authorization is required for ambulance services, and while some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Aetna Medicare Signature (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $130 to $340, up to a maximum plan benefit of $250,000.
Primary Care See details
Aetna Medicare Signature (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits range from a $0 to $65 copay with no coinsurance. Other primary care benefits like physical therapy, occupational therapy, and mental health services require copays up to $65 with no coinsurance, though chiropractic services are only partially covered since routine chiropractic care and other chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Signature (HMO) partially covers preventive services, offering key benefits like annual exams, fitness programs, and screenings with no copay and no coinsurance, though kidney disease education requires a 20% coinsurance and no copay. Sub-services that are not covered under this plan include In-Home Safety Assessments, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefits, 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 services are covered by Aetna Medicare Signature (HMO), featuring a $65 copay for Medicare-covered exams and no copay for annual routine exams and fitting evaluations, with no coinsurance or deductibles. Prescription hearing aids are partially covered with no copay or coinsurance up to a $500 annual maximum per ear, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Signature (HMO) covers vision services with no copay and no coinsurance for eye exams and eyewear. This includes one routine eye exam per year and a combined maximum benefit of $100 annually for eyewear, such as contacts, eyeglasses, and upgrades.
Dental Services See details
Aetna Medicare Signature (HMO) partially covers dental services, offering Medicare-covered dental care for a $65.00 copay and no coinsurance, and select preventive services like exams, cleanings, and X-rays with no copay and no coinsurance. However, fluoride, restorative services, endodontics, periodontics, prosthodontics, implants, and oral surgery are not covered.
Home Infusion bundled Services See details
Aetna Medicare Signature (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Signature (HMO) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Signature (HMO) with no copays, though prior authorization is required. Depending on the specific item, you will pay between no coinsurance and 20% coinsurance for durable medical equipment, medical supplies, and diabetic supplies, or a flat 20% coinsurance for prosthetic devices and diabetic therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Signature (HMO), with prior authorization required for these services. Members pay no copay for lab services and outpatient X-rays, a $0 to $55 copay with no coinsurance for diagnostic procedures and tests, and a 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Aetna Medicare Signature (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Signature (HMO) does not cover cardiac rehabilitation services, including standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Signature (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the standard 100 days are not covered.
Other Services See details
Aetna Medicare Signature (HMO) partially covers other services, offering up to 12 acupuncture treatments per year for a $20 copay and no coinsurance, plus annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings with no copay and no coinsurance. Over-the-counter (OTC) items and meal benefits are not covered under this plan.
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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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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