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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 Middle Tennessee. 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 drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members pay no copay when using a preferred pharmacy or preferred mail order service. Standard pharmacies and standard mail orders charge copays starting at $2 for Tier 1 and $12 for Tier 2 drugs for a one-month supply. For higher-tier medications, costs transition to coinsurance percentages across all pharmacy and mail order channels. Tier 3 preferred brand drugs require 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry 25% coinsurance. These coinsurance rates apply consistently regardless of whether you choose a preferred or standard network provider.
Additional Benefits
The Aetna Medicare Enhanced (HMO) plan offers robust medical coverage with no copay for primary care doctor visits and a low $0 to $20 copay for specialist visits. Emergency room services carry a $130 copay, while acute inpatient hospital stays require a $395 daily copay for days 1 through 5, with no copay for subsequent days. Routine home health services and preventive care, such as annual physicals, are also covered with no copay. For extra benefits, the plan features no copay for preventive dental care, routine eye exams, and routine hearing exams. Members receive a $150 annual eyewear allowance and up to $1,250 per ear annually for prescription hearing aids with no copay or coinsurance. Additionally, the plan provides a $30 quarterly reimbursement for over-the-counter items to help lower your everyday healthcare costs.
Inpatient Hospital See details
Aetna Medicare Enhanced (HMO) covers inpatient hospital services with no coinsurance, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Acute hospital stays require a $395 daily copay for days 1 through 5 and no copay for day 6 and beyond, while psychiatric stays require a $292 daily copay for days 1 through 8 and no copay for days 9 through 90.
Outpatient Services See details
Aetna Medicare Enhanced (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $395, observation services carry a $395 copay per stay, and outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
Aetna Medicare Enhanced (HMO) covers partial hospitalization services with a copay of $140.00 or $145.00 and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Aetna Medicare Enhanced (HMO) covers ambulance services with prior authorization, requiring a $275 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. While some transportation services are covered, trips to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Enhanced (HMO) with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services have a $40 copay and no coinsurance, while 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) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $20 copay and no coinsurance. Physical, occupational, and speech therapy require a $30 copay with no coinsurance, while mental health and psychiatric services have a $40 copay and no coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Aetna Medicare Enhanced (HMO) offers partially covered preventive services with no copay and no coinsurance for annual physicals, glaucoma screenings, and fitness benefits, while kidney disease education has no copay and a 20% coinsurance. Supplemental services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Enhanced (HMO) with no deductible and no coinsurance. Medicare-covered exams require a $20 copay, while routine exams, fitting evaluations, and prescription hearing aids (up to $1,250 per ear annually) have no copay and no coinsurance; however, 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 Enhanced (HMO) with no coinsurance and no deductibles, offering eye exams for a $0 to $20 copay and annual routine exams for no copay. Covered eyewear, including contacts and eyeglasses, also has no copay and no coinsurance up to a $150 annual maximum benefit.
Dental Services See details
Aetna Medicare Enhanced (HMO) partially covers dental services, offering preventive care like cleanings, exams, and x-rays with no copay and no coinsurance, and Medicare-covered dental with a $20 copay and no coinsurance. Comprehensive services like endodontics and periodontics have no copay and 20% to 50% coinsurance, but other diagnostic services, fluoride, other preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Enhanced (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs carry a $35 copay and no coinsurance, while other Part B drugs, including chemotherapy and radiation drugs, have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Enhanced (HMO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Enhanced (HMO) covers durable medical equipment, prosthetics, and diabetic supplies with no copays and coinsurance ranging from no coinsurance to 20%. Diabetic therapeutic shoes and inserts are covered with no copay (coinsurance applies), and prior authorization is required for all medical equipment benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Enhanced (HMO) with prior authorization required. Diagnostic tests and procedures have a $0 to $20 copay with no coinsurance, lab services and outpatient X-rays have no copay, and therapeutic radiological services require a 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, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Aetna Medicare Enhanced (HMO) plan with no coinsurance. Members are responsible for a $15 copay per session for cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) services.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Aetna Medicare Enhanced (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 needed, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Enhanced (HMO) partially covers other services with no copay or coinsurance, including an annual wellness exam, additional colorectal cancer screenings, and up to $30 every three months for over-the-counter items via reimbursement. Acupuncture and meal benefits are not covered under this plan.
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