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Aetna Medicare Enhanced (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Enhanced (HMO-POS). 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-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Enhanced (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Southern New Jersey. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Enhanced (HMO-POS) 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-POS).
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-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $83.00. 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 $9250.00 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-POS) 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 standard pharmacies or mail order, copays start at $2 for Tier 1 and $12 for Tier 2 for a one-month supply. For higher-tier prescriptions, cost-sharing changes from copays to coinsurance. Tier 3 preferred brand drugs require 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require 25% coinsurance across all pharmacy types.
Additional Benefits
The Aetna Medicare Enhanced (HMO-POS) plan offers robust coverage for core medical needs, featuring no copay and no coinsurance for primary care visits, while specialist visits range from no copay up to a $35 copay. For hospital services, inpatient stays require a $350 daily copay for the first six days with no copay thereafter, and outpatient hospital services carry a copay ranging from no copay to $350. Emergency care is available with a $115 copay, which is waived upon admission, while urgent care visits require a $40 copay, both with no coinsurance. Routine dental, vision, and hearing services are highly accessible, featuring no copay for routine exams and up to $1,000 in annual dental coverage with no coinsurance. Prescription hearing aids are partially covered with copays ranging from no copay up to $1,700, while Medicare-covered dental services require a $35 copay. Additionally, skilled nursing facility stays have no copay for the first 20 days, and home health services are fully covered with no copay and no coinsurance.
Inpatient Hospital See details
Aetna Medicare Enhanced (HMO-POS) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute care, there is a $350 daily copay for days 1 through 6 and no copay for days 7 and beyond, while psychiatric care requires a $346 daily copay for days 1 through 6 and no copay for days 7 through 90. 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-POS) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay ranging from $0 to $350, while individual and group substance abuse therapy sessions have a $35 copay.
Partial Hospitalization See details
Aetna Medicare Enhanced (HMO-POS) covers partial hospitalization services with a copay of either $60.00 or $110.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Enhanced (HMO-POS) covers ground and air ambulance services with a $285 copay and no coinsurance, though prior authorization is required. Routine transportation services, including trips to plan-approved or any other health-related locations, are not covered.
Emergency Services See details
Aetna Medicare Enhanced (HMO-POS) 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 have a $40 copay and no coinsurance, while worldwide emergency care is covered up to $250,000 with no coinsurance and copays ranging from $115 to $285.
Primary Care See details
Aetna Medicare Enhanced (HMO-POS) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $35 copay and no coinsurance. Physical, occupational, and speech therapy services require a $25 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Enhanced (HMO-POS), offering an annual physical, health education, fitness benefits, and select screenings for no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Uncovered services 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 and bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are covered by Aetna Medicare Enhanced (HMO-POS), including Medicare-covered exams for a $35 copay and routine exams or hearing aid fittings with no copay, all with no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $0 to $1,700, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Enhanced (HMO-POS) 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 $0 to $35. Covered eyewear also has no copay and includes a combined maximum benefit of $100 every year for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Aetna Medicare Enhanced (HMO-POS) provides partially covered dental services, featuring Medicare-covered dental with a $35 copay and no coinsurance, and other dental services with no copay and no coinsurance up to a $1,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Aetna Medicare Enhanced (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Aetna Medicare Enhanced (HMO-POS) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
Medical Equipment is covered under the Aetna Medicare Enhanced (HMO-POS) plan with no copay and coinsurance ranging from no coinsurance up to 20% depending on the item. Prior authorization is required for all covered durable medical equipment, prosthetics, medical supplies, and diabetic services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Enhanced (HMO-POS) with prior authorization required. Diagnostic services carry no coinsurance, featuring lab services with no copay and diagnostic tests with a $0 to $35 copay, while radiological services require a $35 copay for X-rays and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Enhanced (HMO-POS) 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-POS) plan, though only some services are covered as standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Enhanced (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance and allows admission without a prior three-day inpatient hospital stay, subject to prior authorization. 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
Aetna Medicare Enhanced (HMO-POS) provides partial coverage for other services, featuring a chronic illness meal benefit, annual wellness exams, screening mammography, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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