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Aetna Medicare SmartSaver Elite (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare SmartSaver Elite (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare SmartSaver Elite (HMO) in 2025, please refer to our full plan details page.
Aetna Medicare SmartSaver Elite (HMO) is a HMO 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 SmartSaver Elite (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 SmartSaver Elite (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 SmartSaver Elite (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. Additionally, this plan comes with a Part B Premium reduction of $102.00. You must continue to pay paying your reduced 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 $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 SmartSaver Elite (HMO) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance for your prescriptions. For preferred generic drugs, you will pay no copay at preferred and mail order pharmacies, and a $12 copay at standard pharmacies. For standard generic drugs, preferred brand drugs, and non-preferred drugs, you will pay 24% or 25% coinsurance depending on the drug and pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare SmartSaver Elite (HMO) plan offers a range of benefits. You'll have a $350 copay for inpatient hospital stays for days 1-5, and no copay for days 6-90. Outpatient services and primary care have no copay, and there are also benefits for hearing, vision, and dental services with no copays for exams and cleanings. This plan also includes coverage for emergency services, diagnostic and radiological services, and home health services, with varying copays and coinsurance amounts. It's important to note that cardiac rehabilitation, certain transportation services, and some other services like acupuncture and private duty nursing are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric, are not covered. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $350 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $0 and $450, observation services with a $450 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $50 copay for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare SmartSaver Elite (HMO) plan, but requires prior authorization. You will pay a copay of $85 for this benefit.
Ambulance and Transportation Services See details
The Aetna Medicare SmartSaver Elite (HMO) plan covers ambulance services with a $300 copay for ground ambulance services and 20% coinsurance for air ambulance services. 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 Aetna Medicare SmartSaver Elite (HMO). Emergency Services and Worldwide Emergency Coverage have a $125 copay, Worldwide Emergency Transportation has a $300 copay, and Urgently Needed Services has a $50 copay; all services have no coinsurance.
Primary Care See details
The Aetna Medicare SmartSaver Elite (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $40 copay. It also covers physician specialist services with a copay between $0 and $50, and mental health specialty, podiatry, other health care professional, psychiatric, and opioid treatment program services, each with a $50 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $40 copay, and additional telehealth benefits have a 20% coinsurance with a copay between $0 and $50.
Preventive Services See details
The Aetna Medicare SmartSaver Elite (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are covered, including Health Education, Wigs for Hair Loss Related to Chemotherapy, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Fitness Benefit, with no copay, and a 20% coinsurance for Kidney Disease Education Services. Other services such as In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and others are not covered.
Hearing Services See details
Hearing exams are covered with a $50 copay, and routine hearing exams and fitting/evaluation for hearing aids are each covered once per year with no copay. Prescription hearing aids are covered, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
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. Routine eye exams are limited to one per year.
Dental Services See details
Dental services include oral exams, dental x-rays, and prophylaxis (cleaning) with no copay. However, fluoride treatment, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare SmartSaver Elite (HMO) plan. Medicare Part B Insulin Drugs have a $35 copay, while 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 under the Aetna Medicare SmartSaver Elite (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits are covered by the Aetna Medicare SmartSaver Elite (HMO) plan. Durable Medical Equipment has no copay and a coinsurance between 0% and 20%, but Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies and Diabetic Equipment are covered with no copay, and coinsurance applies to some services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, Diagnostic Procedures/Tests, Lab Services, all radiological services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests have a copay between $0 and $50, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $350, and Outpatient X-Ray Services have no copay; Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare SmartSaver Elite (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 SmartSaver Elite (HMO) plan. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare SmartSaver Elite (HMO) plan, with a copay of $10 for days 1-20, and $214 for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are partially covered by the Aetna Medicare SmartSaver Elite (HMO) plan. Acupuncture, Over-the-Counter (OTC) Items, Meal Benefit, 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 are not covered. Other 1 and Other 2 services have no copay.
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