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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 Wichita Kansas 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 $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:
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Drug Coverage
The Aetna Medicare Core (HMO-POS) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will have no copay at preferred pharmacies and mail order, and a $12 copay at standard pharmacies. For standard generic, preferred brand, and non-preferred drugs, you will pay 24% or 25% coinsurance. After your total drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Core (HMO-POS) plan offers a variety of benefits with varying costs. Hospital stays have a $270 copay for the first six days, and then no copay for the rest of the stay. The plan covers many services with no copay, including primary care visits, preventive services like annual physical exams, vision exams and eyewear, and many dental services. This plan also provides coverage for outpatient services, emergency care, and mental health services, with copays ranging from $20 to $270 depending on the service. Additional benefits include hearing exams and prescription hearing aids, home health services with no copay, and coverage for medical equipment and home infusion services with coinsurance requirements.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-6, the copay is $270, and for days 7-90, there is no copay. Additional Days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $250, Observation Services with a $270 copay, Ambulatory Surgical Center (ASC) Services with no copay, and Outpatient Substance Abuse Services with a $20 copay for both Individual and Group Sessions. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Core (HMO-POS) plan, with a $55 copay. Prior authorization is required for coverage.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Core (HMO-POS) plan, with prior authorization required for all ambulance services. Ground Ambulance Services have a $280 copay, and Air Ambulance Services have 20% coinsurance. 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 the Aetna Medicare Core (HMO-POS) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $20 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $140 copay, while Worldwide Emergency Transportation has a $280 copay; all of these services have no coinsurance.
Primary Care See details
Primary Care benefits include 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 copay between $0 and $20, Mental Health Specialty Services with a $20 copay for both individual and group sessions, Podiatry Services with a $20 copay, Other Health Care Professional with a copay between $0 and $20, Psychiatric Services with a $20 copay for both individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $20 copay, Additional Telehealth Benefits with a 20% coinsurance and a copay between $0 and $20, and Opioid Treatment Program Services with a $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, including Health Education, 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.
Hearing Services See details
Hearing services are covered, including hearing exams with a $20 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay for 1 visit per year, and prescription hearing aids are covered with a plan-specified amount per year.
Vision Services See details
Vision services are covered, including eye exams and eyewear. There is no copay for eye exams and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. The plan offers a combined maximum of $265.00 per year for eyewear.
Dental Services See details
Dental services include a $20 copay for Medicare dental services, while 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 have no copay. Orthodontic services are covered under diagnostic and preventive dental, with a maximum benefit of $2,500 per year. 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. Other Medicare Part B drugs have a coinsurance between 0% and 20%, and Medicare Part B Chemotherapy/Radiation Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Core (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Core (HMO-POS) plan. Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, and Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, while Medical Supplies and Diabetic Supplies have a coinsurance between 0% and 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $20, Lab Services with no copay, and Diagnostic Radiological Services with a copay up to $140. Therapeutic Radiological Services have a coinsurance of at least 20%, while 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, though 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 Core (HMO-POS) plan, but the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. The plan has a copay for some Cardiac and Pulmonary Rehabilitation Services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Core (HMO-POS), but require prior authorization. You will pay a copay of $20 for days 1-20, and a copay of $214 for days 21-100.
Other Services See details
Under the Aetna Medicare Core (HMO-POS) plan, acupuncture has a $20 copay, and you are limited to 12 treatments per year. Over-the-counter items have no copay and a maximum benefit of $60 every three months, and the plan also covers a meal benefit with no copay.
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