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Aetna Medicare Explorer Premier (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Explorer Premier (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 Explorer Premier (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Explorer Premier (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 2025.
It's important to know that Aetna Medicare Explorer Premier (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 Explorer Premier (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 Explorer Premier (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $68.00. 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 $590.00 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 $9350.00 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 Explorer Premier (HMO-POS) plan has a $590.00 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have no copay at preferred pharmacies and preferred mail order, and a $12.00 copay at standard pharmacies and standard mail order. You may also be eligible for a reduced premium if you qualify for the low-income subsidy.
Additional Benefits
The Aetna Medicare Explorer Premier (HMO-POS) plan offers comprehensive coverage for inpatient and outpatient services, including hospital stays, emergency services, and various therapies, with varying copays depending on the service. The plan includes a range of preventive services, such as annual physical exams, health education, and fitness benefits, all with no copay. Additionally, the plan offers coverage for hearing, vision, and dental services, including exams and eyewear, along with durable medical equipment and home health services, with varying cost-sharing arrangements.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $350 for days 1-6 and no copay for days 7-90 for Inpatient Hospital-Acute, and a copay of $339 for days 1-6 and no copay for days 7-90 for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $350, Observation Services have a $350 copay, Ambulatory Surgical Center Services have no copay, and Individual and Group Sessions for Outpatient Substance Abuse each have a copay of $40. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Aetna Medicare Explorer Premier (HMO-POS) plan, with a $60 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Aetna Medicare Explorer Premier (HMO-POS) plan. Both ground and air ambulance services have a $300 copay, with no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $45 copay, and Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
The Aetna Medicare Explorer Premier (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $25 copay. The plan also covers physician specialist services with a copay between $0 and $35, and physical therapy and speech-language pathology services with a $25 copay. Mental health specialty services, psychiatric services, and opioid treatment program services are covered with a $40 copay, and additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $45. Podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services. The additional preventive services include Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies with no copay. Kidney Disease Education Services have a 20% coinsurance, and Other Preventive Services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, have no copay.
Hearing Services See details
Hearing services include hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a copay between $0 and $35, and routine eye exams and other eye exam services have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay, with a combined maximum plan benefit coverage of $150 per year.
Dental Services See details
Dental services include a $35 copay for Medicare dental services and no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Explorer Premier (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Explorer Premier (HMO-POS) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a coinsurance between 0% and 20%. Diabetic Supplies have a coinsurance between 0% and 20%, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Explorer Premier (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $35, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $295, Outpatient X-Ray Services have a $35 copay, and Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Explorer Premier (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Explorer Premier (HMO-POS) plan. However, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Explorer Premier (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Aetna Medicare Explorer Premier (HMO-POS) plan's "Other Services" benefit covers meal benefits and certain other services, but does not cover acupuncture, over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services. Meal benefits and other services have no copay.
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