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Aetna Medicare Core (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Core (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 Core (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Core (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Kansas City Metro Area. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Core (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 Core (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 Core (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 $3400.00 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 Core (HMO-POS) plan has a $590 deductible for prescription drugs. In the initial coverage phase, you will pay either a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies and preferred mail order, while standard generic drugs have 24% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. If you qualify for the low-income subsidy, you pay no cost for Part D.
Additional Benefits
The Aetna Medicare Core (HMO-POS) plan offers a wide range of benefits with varying costs. You'll find that many services have no copay, including primary care visits, preventive services like annual physical exams, and vision services such as eye exams and eyewear. The plan also covers inpatient hospital stays with a $290 copay for the first six days, and no copay for days 7-90. The plan includes coverage for outpatient services, with copays that range from $0 to $290 depending on the service. Other key benefits include hearing services, with a $20 copay for hearing exams and no copay for routine exams, and dental services, with a $20 copay for Medicare dental services, as well as home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered, but require prior authorization. For inpatient hospital-acute, you pay a $290 copay for days 1-6 and no copay for days 7-90, and for inpatient hospital psychiatric, you also pay a $290 copay for days 1-6 and no copay for days 7-90. Additional days and upgrades for inpatient hospital-acute are covered, while non-Medicare-covered stays for both inpatient hospital-acute and psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services and observation services, with copays ranging from $0 to $250 and $290, respectively. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Individual and Group Sessions for Outpatient Substance Abuse have a copay of $20.
Partial Hospitalization See details
Aetna Medicare Core (HMO-POS) covers partial hospitalization with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Core (HMO-POS), with prior authorization required for all ambulance services. Ground ambulance services have a $265 copay, and air ambulance services have a 20% coinsurance, while 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. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Urgently Needed Services has a $20 copay, and Worldwide Emergency Transportation has a $265 copay; all of these services have no coinsurance.
Primary Care See details
The Aetna Medicare Core (HMO-POS) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $20 copay, Physician Specialist Services with a $0-$20 copay, and Physical Therapy and Speech-Language Pathology Services with a $20 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $20 copay for individual and group sessions, while Additional Telehealth Benefits have a 20% coinsurance and a $0-$20 copay; Routine Chiropractic Care is not covered.
Preventive Services See details
The Aetna Medicare Core (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, all with no copay. The plan also covers Kidney Disease Education Services with 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams with a $20 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids have a maximum plan benefit coverage of $1500 per year with no copay for Prescription Hearing Aids (all types), but some services, like prescription hearing aids for the inner, outer, and over the ear, and OTC hearing aids, are not covered.
Vision Services See details
The Aetna Medicare Core (HMO-POS) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and eyewear has a combined maximum plan benefit of $300 every year.
Dental Services See details
Dental Services are covered, with a $20 copay for Medicare Dental Services, which require prior authorization. Other services, including oral exams, dental x-rays, and other diagnostic and preventive services, have no copay. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Core (HMO-POS) plan, but prior authorization is required. The plan covers Medicare Part B insulin drugs with a $35 copay; 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 by the Aetna Medicare Core (HMO-POS) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance of 0-20%, while the plan does not cover DME for use outside the home. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 0-20% coinsurance. Diabetic Supplies have a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $20, and lab services with no copay. Diagnostic Radiological Services have a copay up to $140, while Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Core (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 not covered under the Aetna Medicare Core (HMO-POS) 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 Core (HMO-POS) plan, but require 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
Aetna Medicare Core (HMO-POS) covers acupuncture with a $20 copay, up to 12 treatments per year, and also covers over-the-counter (OTC) items with no copay, up to $50 every three months, including Nicotine Replacement Therapy (NRT) and Naloxone. The plan also offers a meal benefit with no copay, and other services like annual wellness exams and screening mammography with no copay. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and several other services are not covered.
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