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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 St. Joe and Surrounding Area. 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 $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 $590 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies and through mail order, while standard generic drugs have 24% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, you may have reduced premiums.
Additional Benefits
The Aetna Medicare Premier (HMO) plan offers a variety of benefits with varying cost-sharing. The plan covers inpatient hospital stays with copays, and outpatient services with copays ranging from $0 to $335. Emergency services have copays, and you'll find no copays for primary care visits. This plan includes coverage for preventive, hearing, vision, and dental services, each with specific copays or allowances. It also includes benefits for home health, medical equipment, and diagnostic services, with some services subject to coinsurance. Additionally, the plan offers coverage for skilled nursing facilities and other services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $335 for days 1-6, and no copay for days 7-90 for Inpatient Hospital-Acute, and a copay of $310 for days 1-6, and no copay for days 7-90 for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute are covered with no copay, 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 are covered by the Aetna Medicare Premier (HMO) plan, including outpatient hospital services with a copay between $0 and $325, observation services with a $335 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $45 copay for both individual and group sessions, and outpatient blood services with no copay. Outpatient blood services also include an enhanced benefit where the three-pint deductible is waived.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Premier (HMO) plan with a $55 copay, and prior authorization is required. There is no coinsurance 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 $290 copay, while air ambulance services have a 20% coinsurance. Transportation services to a health-related location are not covered.
Emergency Services See details
Emergency Services, including urgently needed services and worldwide emergency services, are covered by the Aetna Medicare Premier (HMO) plan. Emergency Services have a $125 copay, urgently needed services have a $45 copay, and worldwide emergency services have a $125 copay for worldwide emergency and urgent coverage, and a $290 copay for worldwide emergency transportation; there is no coinsurance for any of these services.
Primary Care See details
The Aetna Medicare Premier (HMO) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational Therapy Services have a $40 copay, and Physician Specialist Services have a copay between $0 and $45. The plan also covers Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services with varying copays.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services with varying copays. Kidney disease education services have a 20% coinsurance. Other preventive services, such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, have no copay.
Hearing Services See details
Hearing services include hearing exams with a $45 copay, routine hearing exams with no copay for one visit per year, and fitting/evaluation for hearing aids with no copay for one visit per year. Prescription hearing aids are covered up to $1500 per year, and prescription hearing aids (all types) are covered with no copay for two visits per year. OTC hearing aids, and prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Aetna Medicare Premier (HMO) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and the plan provides a $175 allowance for eyewear every year.
Dental Services See details
The Aetna Medicare Premier (HMO) plan covers Medicare dental services with a $45 copay, oral exams and dental x-rays with no copay, and prophylaxis (cleaning) with no copay. Orthodontic services are covered up to a maximum of $3000 per year; restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with coinsurance between 20% and 50%. Fluoride treatment, 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. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Premier (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by Aetna Medicare Premier (HMO). Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a coinsurance between 0% and 20%, and no copay. Diabetic Equipment is covered with a coinsurance between 0% and 20%, 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 $45, and Lab Services with no copay. Radiological Services are covered, including Diagnostic Radiological Services with a copay up to $140, Therapeutic Radiological Services with a 20% coinsurance, and Outpatient X-Ray Services with 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. While the plan has a copay for some cardiac rehabilitation services, the specific cardiac and pulmonary rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier (HMO) plan. For days 1-20, the copay is $10, 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 (HMO) plan covers acupuncture with a $20 copay for up to 12 treatments per year, Over-the-Counter (OTC) items with no copay, up to a $45 benefit every three months, and a meal benefit with no copay. Other services covered include annual wellness exams, screening mammograms, and gFOBT/FIT, all with no copay. This plan does not cover Dual Eligible SNPs with Highly Integrated Services, 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, and 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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