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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 Northern 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 $95.00. 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 deductible for prescription drugs. Once you meet your deductible, you will pay either a copay or coinsurance depending on the drug tier and where you purchase your prescriptions. For preferred generic drugs, you'll pay no copay at preferred pharmacies and a $12 copay at standard pharmacies. For standard generic, preferred brand, and non-preferred drugs, you will pay 24% or 25% coinsurance depending on the drug and pharmacy.
Additional Benefits
The Aetna Medicare Explorer Premier (HMO-POS) plan offers comprehensive coverage with a focus on outpatient and preventive services. Many services have no copay, including annual physical exams, hearing exams, eyewear, dental exams, and home health services. However, some services do have associated costs, such as inpatient hospital stays, ambulance services, and specialist visits, which have copays ranging from $15 to $390. This plan also includes coverage for emergency services, vision, hearing, and dental care, with varying copays and coinsurance. Diagnostic and radiological services, as well as medical equipment, are covered with a mix of copays and coinsurance. The plan does not cover cardiac rehabilitation services, and Skilled Nursing Facility (SNF) services have a copay for days 21-100.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $390 for days 1-6 and no copay for days 7-90 for Inpatient Hospital-Acute. Inpatient Hospital Psychiatric services are also covered, with a copay of $339 for days 1-6 and no copay for days 7-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay of $0-$300, Observation Services with a copay of $390, Ambulatory Surgical Center (ASC) Services with no copay, Individual and Group Sessions for Outpatient Substance Abuse with a copay of $40, and Outpatient Blood Services with no copay. Prior authorization is required for many services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Explorer Premier (HMO-POS) plan, but requires prior authorization. You will have a $60 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Explorer Premier (HMO-POS) plan, with a $300 copay for both Ground and Air Ambulance services and no coinsurance. Transportation Services to health-related locations 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, Urgently Needed Services has a $45 copay, and Worldwide Emergency Transportation has a $300 copay; all have no coinsurance.
Primary Care See details
Primary Care services include no copay for Primary Care Physician Services, a $15 copay for Chiropractic Services (routine care not covered), a $25 copay for Occupational Therapy Services, and a copay between $0 and $35 for Physician Specialist Services. Individual and Group Sessions for Mental Health and Psychiatric Services have a $40 and $35 copay, respectively. Physical Therapy and Speech-Language Pathology Services have a $25 copay. Other Health Care Professional services have a copay between $0 and $35, and Opioid Treatment Program Services have a $40 copay. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $45.
Preventive Services See details
Preventive services include an annual physical exam with no copay. Additional preventive services include Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, all with no copay. Kidney Disease Education Services have a 20% coinsurance. 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 for one visit per year, and fitting/evaluation for hearing aids with no copay for one visit per year. Prescription hearing aids are partially covered with a maximum copay of $1700 for all types, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $35, and eyewear with no copay. Routine eye exams are covered with no copay, and other eye exam services are covered with no copay. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered with no copay. There is a combined maximum of $150 for eyewear every year.
Dental Services See details
The Aetna Medicare Explorer Premier (HMO-POS) plan covers a variety of dental services, including oral exams, dental x-rays, and other diagnostic and preventive services with no copay, and restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay. The plan has a $1,500 annual maximum for dental services, and does not cover maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Explorer Premier (HMO-POS) plan, but require prior authorization. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Explorer Premier (HMO-POS) plan, including Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, and Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered items. Diabetic Equipment is also covered, with coinsurance for Medicare-covered diabetic supplies and therapeutic shoes/inserts, and the plan requires prior authorization for this benefit.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with a copay for Medicare-covered diagnostic procedures, tests, and lab services, with a maximum copay of $35 for diagnostic procedures and no copay for lab services. Radiological services are also covered, with a copay for Medicare-covered diagnostic and therapeutic radiological services and a coinsurance of at most 20% for therapeutic radiological services, and a $35 copay for outpatient X-ray services.
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. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Explorer Premier (HMO-POS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Explorer Premier (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, but for days 21-100, the copay is $214.
Other Services See details
The Aetna Medicare Explorer Premier (HMO-POS) plan covers a meal benefit with no copay, and covers other services including annual wellness exams and screening mammography, as well as gFOBT and FIT, all with no copay. Acupuncture, over-the-counter items, Dual Eligible SNPs, EPSDT, private duty nursing services, case management, institution for mental disease services, services in an intermediate care facility, case management, tobacco cessation counseling, 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 are not covered.
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