A non-government entity
Aetna Medicare Signature Care (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Signature Care (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 Care (HMO) in 2026, please refer to our full plan details page.
Aetna Medicare Signature Care (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in North Carolina metro areas. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Signature Care (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 Care (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 Care (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 $6350.00 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 prescription drug coverage for the Aetna Medicare Signature Care (HMO) plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when utilizing a preferred pharmacy or preferred mail-order service for up to a three-month supply. If you choose a standard pharmacy or standard mail-order service, copays range from $2 to $6 for Tier 1 drugs and $12 to $36 for Tier 2 drugs, depending on the supply duration. For higher-tier medications, the plan transitions from flat copays to coinsurance costs. Tier 3 preferred brand drugs require a 24% coinsurance across all pharmacy and mail-order options, while Tier 4 non-preferred drugs require a 25% coinsurance. Specialty medications in Tier 5 are covered with a 25% coinsurance for a one-month supply at both preferred and standard pharmacies or mail-order services.
Additional Benefits
The Aetna Medicare Signature Care (HMO) plan offers comprehensive medical coverage with predictable cost-sharing, including no copay for primary care visits and a $10 to $55 copay for specialist care. Inpatient hospital stays require daily copays for the first eight days but feature no copay for subsequent days, while emergency room visits carry a $130 copay that is waived upon admission. Outpatient services and home health care are highly accessible, with many services requiring no copay and no coinsurance. For supplemental wellness, the plan features no copay and no coinsurance for preventive dental care, routine eye exams, and annual hearing fittings. Members receive up to $1,250 per ear annually for prescription hearing aids and a $125 annual allowance for eyewear with no copay. Additionally, the plan covers over-the-counter items with a $30 quarterly allowance, while durable medical equipment and dialysis require no copay and up to 20% coinsurance.
Inpatient Hospital See details
Aetna Medicare Signature Care (HMO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute care requires a $382 copay per day for days 1 through 8 and no copay for days 9 and beyond, while psychiatric care requires a $292 copay per day for days 1 through 8 and no copay for days 9 through 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Signature Care (HMO) covers outpatient services with no coinsurance, featuring a $0 to $382 copay for outpatient hospital services and a $382 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services require a $40 copay per session with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Signature Care (HMO) with a copay ranging from $140 to $145 and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance services under Aetna Medicare Signature Care (HMO) require prior authorization and are covered with a $275 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Signature Care (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services require a $50 copay with no coinsurance, and worldwide emergency and transportation services are covered up to a $250,000 maximum benefit with no coinsurance and copays ranging from $130 to $275.
Primary Care See details
Aetna Medicare Signature Care (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $10 to $55 copay and no coinsurance. Physical, occupational, and mental health therapies are covered with copays up to $40 and no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Signature Care (HMO), offering most covered benefits, such as annual physicals and glaucoma screenings, with no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Excluded 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
Hearing services are partially covered by Aetna Medicare Signature Care (HMO), offering Medicare-covered exams for a $55 copay and no coinsurance, plus one annual routine exam and fitting evaluation with no copay and no coinsurance. Prescription hearing aids are covered up to $1,250 per ear every year with no copay and no coinsurance, though over-the-counter (OTC), inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Signature Care (HMO) with no coinsurance, featuring annual routine eye exams with no copay and Medicare-covered exams ranging from no copay to a $55 copay. Eyewear, including contacts and eyeglasses, is also covered with no copay and no coinsurance up to a $125 annual maximum benefit.
Dental Services See details
Dental services are partially covered under the Aetna Medicare Signature Care (HMO) plan, offering no copay or coinsurance for preventive care like cleanings and exams, and a $55 copay with no coinsurance for Medicare-covered dental. Comprehensive services require no copay and a 20% to 50% coinsurance up to a $1,000 annual limit, while fluoride, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Signature Care (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Signature Care (HMO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Signature Care (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with no copays and coinsurance ranging from no coinsurance up to 20%. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Signature Care (HMO), requiring prior authorization for care. Medicare-covered diagnostic tests have a $0 to $200 copay with no coinsurance, lab services have no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by Aetna Medicare Signature Care (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Signature Care (HMO) provides Cardiac Rehabilitation Services with no coinsurance and some services are covered, though cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Aetna Medicare Signature Care (HMO) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under the Aetna Medicare Signature Care (HMO), offering no copay and no coinsurance for annual wellness exams, screening mammographies, additional gFOBT and FIT screenings, and over-the-counter (OTC) items up to $30 every three months via reimbursement. Acupuncture and meal benefits are not covered.
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