A non-government entity
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 Triangle North Carolina 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) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail-order service. If you choose a standard pharmacy or standard mail-order service, copays start at $2.00 for Tier 1 and $12.00 for Tier 2 for a one-month supply. Higher-tier medications are subject to coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance. Additionally, Tier 5 specialty medications are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Signature (HMO) plan offers affordable coverage with predictable out-of-pocket costs for your essential medical needs. Members enjoy no copay and no coinsurance for primary care physician visits, routine physicals, and annual routine dental, vision, and hearing exams. For inpatient hospital care, there is no coinsurance and a daily copay of $382 for the first eight days of acute stays. This plan also includes valuable supplemental benefits such as a $125 annual eyewear allowance and up to $1,250 per ear annually for prescription hearing aids with no copay. Additionally, you receive a $30 quarterly allowance for over-the-counter health items and emergency room coverage with a $130 copay. With no coinsurance required for most outpatient, diagnostic, and home health services, this plan helps keep your healthcare expenses manageable.
Inpatient Hospital See details
Aetna Medicare Signature (HMO) inpatient hospital benefits are partially covered with no coinsurance, featuring a $382 daily copay for days 1 to 8 of acute care and a $292 daily copay for days 1 to 8 of psychiatric care, with no copays for subsequent days. Non-Medicare-covered stays, room upgrades, 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, including ambulatory surgical center and blood services which require no copay. Outpatient hospital services require a copay ranging from no copay to $382, observation services carry a $382 copay per stay, and outpatient substance abuse sessions require a $40 copay, all with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Aetna Medicare Signature (HMO) plan with a copay of $140.00 or $145.00 and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services under Aetna Medicare Signature (HMO) require prior authorization, offering ground ambulance services for a $275 copay with no coinsurance and air ambulance services for a 20% coinsurance with no copay. These costs are not waived if you are admitted to the hospital, and routine transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Signature (HMO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay with no coinsurance, and worldwide emergency services are covered up to a $250,000 maximum limit with no coinsurance and copays ranging from $130 to $275.
Primary Care See details
Aetna Medicare Signature (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $45 copay and no coinsurance. Physical, occupational, and speech therapy services require a $35 copay and no coinsurance, while telehealth services have a $0 to $50 copay and 20% coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Aetna Medicare Signature (HMO) provides partially covered preventive services with no copay and no coinsurance for annual physicals, select screenings, health education, fitness benefits, and remote access technologies, while kidney disease education has a 20% coinsurance and no copay. Sub-services that are not covered include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home/bathroom safety devices, and counseling.
Hearing Services See details
Aetna Medicare Signature (HMO) covers hearing exams with no coinsurance, requiring a $45 copay for Medicare-covered exams and no copay for annual routine exams and hearing aid fittings. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,250 annual limit per ear, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Signature (HMO) with no coinsurance, featuring a copay of up to $45 for Medicare-covered exams, no copay for annual routine exams, and no deductible. Eyewear is also covered with no copay and no coinsurance, providing up to a $125 yearly maximum benefit for contacts, frames, and lenses.
Dental Services See details
Aetna Medicare Signature (HMO) offers partial dental coverage, featuring Medicare-covered dental services for a $45 copay and no coinsurance, plus select preventive services like exams, cleanings, and x-rays with no copay or coinsurance. However, fluoride, other diagnostic or preventive dental services, and comprehensive treatments such as restorative work, endodontics, and periodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Aetna Medicare Signature (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs have a coinsurance ranging from 0% to 20%, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Aetna Medicare Signature (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Signature (HMO) with no copays for durable medical equipment, prosthetics, and diabetic therapeutic shoes, while coinsurance ranges from no coinsurance up to 20%. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Aetna Medicare Signature (HMO) with no coinsurance for diagnostic services and no copays for lab services or outpatient X-rays. Other diagnostic tests and therapeutic radiological services may require copays ranging up to $200 and coinsurance of at least 20%, with prior authorization required for some services.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Signature (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are provided by Aetna Medicare Signature (HMO) with no coinsurance. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require copays of $20, $20, $15, and $25 respectively.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Signature (HMO) with no coinsurance, requiring a daily copay of $10 for days 1 through 20 and $218 for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services under the Aetna Medicare Signature (HMO) are partially covered, offering over-the-counter (OTC) items with a $30 quarterly allowance, an annual wellness exam and screening mammography, and additional gFOBT and FIT with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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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