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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 $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 $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 an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will have no copay when using a preferred pharmacy or preferred mail-order service. If you choose a standard pharmacy or standard mail-order service, Tier 1 copays range from $2 to $6 and Tier 2 copays range from $12 to $36 depending on the supply duration. Brand-name and specialty medications under this plan require coinsurance instead of copays. Tier 3 preferred brand drugs incur a 24% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance at all pharmacies and mail-order services. Tier 5 specialty drugs also carry a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Enhanced (HMO) plan offers comprehensive medical coverage with no copay for primary care visits and copays ranging from no copay to $50 for specialist appointments. For inpatient hospital stays, members pay a $395 daily copay for the first five days and no copay starting on day six, with no coinsurance required. Emergency care is available with a $115 copay, which is waived if admitted, while urgent care services require a $40 copay. This plan also features valuable ancillary benefits, including routine dental, vision, and hearing exams with no copay. Additionally, members receive coverage of up to $1,250 per ear annually for prescription hearing aids and a $175 annual limit for eyewear. Other key benefits include skilled nursing facility care with no copay for the first 20 days and a $30 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Aetna Medicare Enhanced (HMO) covers inpatient acute hospital stays with no coinsurance, requiring a $395 daily copay for days 1 to 5 and no copay for day 6 and beyond, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric stays are also covered with no coinsurance, requiring a $260 daily copay for days 1 to 8 and no copay for days 9 to 90, with prior authorization required and additional psychiatric days not covered.
Outpatient Services See details
Aetna Medicare Enhanced (HMO) covers outpatient services with no coinsurance for all benefits, though prior authorization is required for most. Under this plan, ambulatory surgical center and blood services require no copay and no coinsurance, outpatient hospital services range from no copay to a $395 copay, observation services have a $395 copay per stay, and outpatient substance abuse sessions carry a $40 copay.
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 benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by Aetna Medicare Enhanced (HMO) with prior authorization, requiring a $275 copay and no coinsurance for ground transport, and a 20% coinsurance and no copay for air transport. Transportation services to plan-approved or health-related locations are not covered.
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 with 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
Aetna Medicare Enhanced (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $50 copay and no coinsurance. Therapy, mental health, and psychiatric services require copays ranging from $30 to $40 with no coinsurance, telehealth services have a $0 to $50 copay and 20% coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Enhanced (HMO), featuring no copay and no coinsurance for annual physical exams, health education, and select screenings, while kidney disease education has a $0 copay and 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
Aetna Medicare Enhanced (HMO) covers hearing services, featuring a $50 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,250 per ear annually, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Enhanced (HMO) covers vision services with no deductibles or coinsurance, offering routine annual eye exams and follow-up diabetic exams with no copay, and Medicare-covered exams for a $0 to $50 copay. Eyewear, including contacts, lenses, and frames, is covered with no copay up to a $175 annual maximum limit.
Dental Services See details
Aetna Medicare Enhanced (HMO) dental services are partially covered, offering preventive care like cleanings, exams, and x-rays with no copay and no coinsurance, and Medicare-covered dental with a $50 copay and no coinsurance. Comprehensive services like restorative care, endodontics, and prosthodontics are available with no copay and 20% to 50% coinsurance up to a $1,000 annual limit. Fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Enhanced (HMO) covers home infusion bundled services with no copay, subject to prior authorization and step therapy. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a coinsurance of 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, medical supplies, and diabetic equipment with no copays and coinsurance ranging from no coinsurance to 20%. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Enhanced (HMO) covers diagnostic services with no coinsurance, offering no copay for lab work and a $0 to $20 copay for diagnostic procedures. Covered radiological services require prior authorization and feature no copay for outpatient X-rays, a minimum $0 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Aetna Medicare Enhanced (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Aetna Medicare Enhanced (HMO) with no coinsurance. While some services are covered, specific sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Aetna Medicare Enhanced (HMO) with no coinsurance and requires prior authorization, with no prior three-day hospital stay required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Enhanced (HMO), offering no copay and no coinsurance for annual wellness exams, screening mammographies, additional gFOBT and FIT, and up to $30 every three months in over-the-counter item reimbursements. Acupuncture and meal benefits are not covered under this plan.
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