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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 South Carolina. 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 $56.00. 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 $500.00 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 $8200.00 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 a $500 annual prescription drug deductible. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using a preferred pharmacy or preferred mail order service for up to a three-month supply. If you choose standard pharmacies or standard mail order, Tier 1 drugs carry a copay starting at $2, while Tier 2 drugs start at a $12 copay for a one-month supply. Higher-tier prescription medications are covered under a coinsurance structure instead of flat copays. Tier 3 preferred brands require a 22% coinsurance, and Tier 4 non-preferred drugs require a 25% coinsurance across all pharmacy and mail-order options. Specialty medications in Tier 5 are available for a one-month supply with a 27% coinsurance at both preferred and standard locations.
Additional Benefits
The Aetna Medicare Enhanced (HMO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, while specialist visits range from no copay to a $20 copay. For hospital care, inpatient stays require no coinsurance but carry daily copays for the first few days, whereas home health services feature no copay and no coinsurance. Emergency care is accessible with a $115 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also provides strong coverage for routine wellness services, featuring no deductibles and no copays for annual physical exams, routine dental cleanings, and routine hearing exams. Vision and hearing benefits include allowances of up to $250 for eyewear and $1,250 per ear for prescription hearing aids with no copays. Additionally, members can receive up to $90 every three months in reimbursement for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Aetna Medicare Enhanced (HMO) covers inpatient hospital services with no coinsurance, requiring a daily copay of $395 for days 1-5 of acute stays and $260 for days 1-8 of psychiatric stays, with no copay for remaining days. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Enhanced (HMO) covers outpatient services with no coinsurance, although copays vary and prior authorization is required for most services. There is no copay for ambulatory surgical center and blood services, a $40 copay for outpatient substance abuse sessions, and copays ranging from $0 to $395 for outpatient hospital and observation services.
Partial Hospitalization See details
Aetna Medicare Enhanced (HMO) covers partial hospitalization services with a copayment of $105.00 or $110.00 and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Aetna Medicare Enhanced (HMO), as transportation to plan-approved or health-related locations is not covered. Medicare-covered ground ambulance services require a $275 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay, with prior authorization required for both.
Emergency Services See details
Aetna Medicare Enhanced (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 limit with no coinsurance and copays ranging from $115 to $275.
Primary Care See details
Primary care benefits for the Aetna Medicare Enhanced (HMO) feature no copay and no coinsurance for primary care visits, and no copay to a $20 copay with no coinsurance for specialists. Physical, occupational, and speech therapies require a $30 copay with no coinsurance, while mental health, psychiatric, and opioid treatments have a $40 copay with no coinsurance. Chiropractic and podiatry services are not covered, but telehealth is offered with no copay to a $40 copay and 20% coinsurance.
Preventive Services See details
Preventive services are covered by Aetna Medicare Enhanced (HMO) with no copay and no coinsurance for annual physical exams and standard screenings, while kidney disease education has no copay and a 20% coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, but services like 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 safety devices, counseling, personal emergency response systems, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, and re-admission prevention are not covered.
Hearing Services See details
Hearing services are covered with no deductible by Aetna Medicare Enhanced (HMO), which offers Medicare-covered exams for a $20 copay and no coinsurance, and annual routine exams with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,250 per ear annually, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Enhanced (HMO) offers comprehensive vision services with no deductibles, featuring eye exams that range from no copay to a $20 copay and no coinsurance. Eyewear, including glasses and contact lenses, is covered with no copay and no coinsurance up to a combined maximum plan benefit of $250 per year.
Dental Services See details
Dental services are partially covered by Aetna Medicare Enhanced (HMO), featuring no copay and no coinsurance for routine exams, cleanings, and X-rays, while Medicare-covered dental requires a $20 copay and no coinsurance. Comprehensive dental benefits are covered up to $2,500 annually with no copay and 20% to 50% coinsurance, though fluoride, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Enhanced (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs have no copay and a 0% to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Enhanced (HMO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Enhanced (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic equipment, with prior authorization required for most items. These covered benefits feature no copays, with coinsurance ranging from no coinsurance up to 20% depending on the service, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Enhanced (HMO), with prior authorization required for both. Diagnostic procedures and lab services feature no coinsurance, with no copay for lab services and outpatient X-rays, and copays up to $20 for other diagnostic tests. Diagnostic radiological services have a copay starting at $0, while therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by the Aetna Medicare Enhanced (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered with no coinsurance under the Aetna Medicare Enhanced (HMO) plan, though only some services are covered as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered. These unavailable services require copayments ranging from $10 to $20.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Enhanced (HMO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Enhanced (HMO) partially covers other services, offering no copay and no coinsurance for annual wellness exams, additional gFOBT and FIT, and over-the-counter (OTC) items up to $90 every three months via reimbursement. Acupuncture, meal benefits, and Dual Eligible SNPs are not covered.
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