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Aetna Medicare Enhanced (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Enhanced (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Enhanced (HMO) in 2026, please refer to our full plan details page.
Aetna Medicare Enhanced (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2026 to people living in Greensboro, Winston-Salem NC and Surrounding Area. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Enhanced (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 Enhanced (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 Enhanced (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $63.00. 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 $5900.00 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 Enhanced (HMO) plan features an annual prescription 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, generic drug copays range from $2 to $12 for a one-month supply. For brand-name and specialty medications, costs transition to coinsurance. Tier 3 preferred brand drugs require a 24% coinsurance across all pharmacy and mail order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, with specialty drugs limited to a one-month supply.
Additional Benefits
The Aetna Medicare Enhanced (HMO) plan offers robust coverage with predictable out-of-pocket costs, featuring no copay for primary care doctor visits and a low copay of up to $10 for specialists. For more intensive care, inpatient hospital stays require a $395 daily copay for the first five days, while emergency room visits carry a $130 copay that is waived if you are admitted. Outpatient hospital services and surgeries are also covered with no coinsurance and copays ranging from no copay up to $395. This plan also provides excellent supplemental benefits, including no copays for preventive dental, routine vision, and annual hearing exams. You will benefit from valuable allowances, such as up to $1,750 yearly for comprehensive dental care, $175 annually for eyewear, and $1,250 per ear each year for prescription hearing aids. Additionally, members receive a $30 over-the-counter item allowance every three months and home health services with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital care is covered by Aetna Medicare Enhanced (HMO) with no coinsurance and prior authorization required. Acute stays require a $395 daily copay for days 1 to 5 (with no copay for additional days) and psychiatric stays require a $292 daily copay for days 1 to 8 (with no copay for days 9 to 90), though upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Enhanced (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services which also require no copay. Outpatient hospital services carry a copay of $0 to $395, observation services require a $395 copay per stay, and outpatient substance abuse sessions have a $40 copay, all with no coinsurance and some requiring prior authorization.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the Aetna Medicare Enhanced (HMO) plan with a copay of $140.00 or $145.00 and no coinsurance. Prior authorization is required to access these services.
Ambulance and Transportation Services See details
Aetna Medicare Enhanced (HMO) covers ground ambulance services with a $275 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both of which require prior authorization. Routine transportation services to plan-approved or health-related locations are not covered by this plan.
Emergency Services See details
Aetna Medicare Enhanced (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $20 copay and no coinsurance, and worldwide emergency services are covered up to $250,000 with no coinsurance and copays ranging from $130 to $275.
Primary Care See details
Aetna Medicare Enhanced (HMO) covers primary care physician visits with no copay and no coinsurance, and specialist visits with a $0 to $10 copay and no coinsurance. Therapy services require a $20 copay and no coinsurance, while mental health, psychiatric, and telehealth services are covered with copays up to $40 and up to 20% coinsurance, though podiatry and routine chiropractic care are not covered.
Preventive Services See details
Preventive Services under the Aetna Medicare Enhanced (HMO) are partially covered, featuring no copay and no coinsurance for annual physicals, health education, and select screenings, while kidney disease education requires a 20% coinsurance and no copay. Several supplemental preventive services are not covered, including in-home safety assessments, personal emergency response systems, and nutritional therapy.
Hearing Services See details
Hearing services are covered by Aetna Medicare Enhanced (HMO), featuring a $10 copay for Medicare-covered exams and no copay or coinsurance for annual routine exams and fittings. Prescription hearing aids are partially covered up to $1,250 per ear yearly with no copay or coinsurance, though OTC hearing aids and inner, outer, or over-the-ear prescription devices are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Enhanced (HMO) with no deductibles and no coinsurance, featuring routine and follow-up diabetic eye exams with no copay and Medicare-covered exams with a copay of up to $10. Covered eyewear, including eyeglasses and contact lenses, has no copay and is subject to a combined maximum plan allowance of $175 per year.
Dental Services See details
Aetna Medicare Enhanced (HMO) offers partially covered dental services, with no copay and no coinsurance for preventive care, and a $10 copay and no coinsurance for Medicare-covered dental. Comprehensive services are covered up to a $1,750 annual limit with no copay and 20% to 50% coinsurance, but fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Enhanced (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy may be required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs have a coinsurance of 0% to 20%, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Enhanced (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Aetna Medicare Enhanced (HMO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays and coinsurance ranging from no coinsurance to 20%. Diabetic therapeutic shoes and inserts have no copay, while prosthetic devices require 20% coinsurance, and prior authorization is required for these services.
Diagnostic and Radiological Services See details
Aetna Medicare Enhanced (HMO) covers diagnostic and radiological services, requiring prior authorization for all services. Lab services feature no copay and no coinsurance, diagnostic tests range from a $0 to $20 copay with no coinsurance, and therapeutic radiological services require a copay and at least 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Enhanced (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered under the Aetna Medicare Enhanced (HMO) plan with no coinsurance, though standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Enhanced (HMO) covers Skilled Nursing Facility (SNF) services 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, and while a three-day hospital stay prior to admission is not needed, additional days beyond the standard 100 days are not covered.
Other Services See details
Aetna Medicare Enhanced (HMO) partially covers other services with no copay and no coinsurance, which includes over-the-counter (OTC) items up to $30 every three months, annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings. Acupuncture and meal benefits are not covered under this plan.
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