A non-government entity
Aetna Medicare Signature (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Signature (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Signature (HMO) in 2026, please refer to our full plan details page.
Aetna Medicare Signature (HMO) is a HMO 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 2026.
It's important to know that Aetna Medicare Signature (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 Signature (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 Signature (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $108.00. 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 Signature (HMO) plan features a $615 prescription drug deductible. For Tier 1 preferred generic and Tier 2 generic drugs, members pay no copay when using preferred pharmacies or preferred mail-order services. If you choose standard pharmacies or standard mail-order options, copays range from $2 to $12 for a one-month supply. Higher-tier prescription drugs transition to coinsurance costs across all pharmacy and mail-order channels. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance. This cost structure helps you estimate your out-of-pocket prescription expenses under this Medicare plan.
Additional Benefits
The Aetna Medicare Signature (HMO) plan offers robust healthcare coverage with predictable costs, featuring no coinsurance for a wide range of essential medical services. Members benefit from a low five dollar copay for primary care visits, no copay for select specialist visits, and no copay or coinsurance for annual wellness exams and preventive care. For hospital care, inpatient stays require a daily copay for the first six days before transitioning to no copay, while emergency services carry a flat one hundred fifteen dollar copay. Additional benefits under the Aetna Medicare Signature (HMO) include routine dental, vision, and hearing care, with no copay for routine exams and cleanings. Home health services are covered with no copay and no coinsurance, while skilled nursing facilities require no copay for the first twenty days. For specialized needs like durable medical equipment and dialysis, members pay no copay and a coinsurance of up to twenty percent.
Inpatient Hospital See details
Inpatient hospital services are covered by Aetna Medicare Signature (HMO) with no coinsurance, requiring a $395 daily copay for days 1 through 6 of an acute stay (with no copay for days 7 and beyond) and a $346 daily copay for days 1 through 6 of a psychiatric stay (with no copay for days 7 through 90). Prior authorization is required for both services, and upgrades, psychiatric additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Signature (HMO) covers outpatient services with no coinsurance, featuring a copay of $0 to $300 for outpatient hospital services and $395 per stay for observation services. Ambulatory surgical center and blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay.
Partial Hospitalization See details
Aetna Medicare Signature (HMO) covers partial hospitalization services with a copay of either $60.00 or $110.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Signature (HMO) covers ground and air ambulance services with a $285 copayment per service and no coinsurance, requiring prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Signature (HMO) covers emergency services with a $115 copay, which is waived if admitted within 24 hours, and no coinsurance. Urgently needed services require a $40 copay with no coinsurance, while worldwide emergency and urgent services are covered up to $250,000 with no coinsurance and copays ranging from $115 to $285.
Primary Care See details
Primary care benefits under Aetna Medicare Signature (HMO) include primary care visits for a $5 copay and specialist visits for no copay to a $40 copay, both with no coinsurance. Physical, occupational, and speech therapies require a $25 copay and no coinsurance, while telehealth is available with a no copay to $40 copay and 20% coinsurance. Podiatry is not covered, and although some chiropractic services are covered, routine and other chiropractic care are not covered.
Preventive Services See details
Aetna Medicare Signature (HMO) provides partially covered preventive services with no copay and no coinsurance for annual exams, glaucoma screenings, and select wellness programs, while kidney disease education requires no copay and 20% coinsurance. Non-covered 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 safety devices, and counseling.
Hearing Services See details
Hearing services covered by Aetna Medicare Signature (HMO) include Medicare-covered exams for a $40 copay and no coinsurance, plus annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $0 to $1,700 and no coinsurance for up to two devices per year, though 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 Signature (HMO) with no coinsurance, featuring no copay for annual routine eye exams and follow-up diabetic exams, and a $0 to $40 copay for Medicare-covered exams. Covered eyewear, including contacts and eyeglasses, has no copay and is subject to a $100 annual maximum benefit limit with no deductible.
Dental Services See details
Aetna Medicare Signature (HMO) partially covers dental services, offering Medicare-covered dental with a $40 copay and no coinsurance, and preventive services like exams, cleanings, and x-rays with no copay and no coinsurance. However, several services are not covered, including fluoride, restorative care, endodontics, periodontics, prosthodontics, implants, and oral surgery.
Home Infusion bundled Services See details
Aetna Medicare Signature (HMO) 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 no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Signature (HMO) with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
Aetna Medicare Signature (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with no copays and required prior authorization. Coinsurance ranges from no coinsurance up to 20% for DME, medical supplies, and diabetic supplies, while prosthetic devices and diabetic therapeutic shoes or inserts require a flat 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Signature (HMO) with prior authorization required. Lab services and diagnostic tests feature no coinsurance, with copays ranging from no copay to $40. Diagnostic radiological services have a minimum $0 copay with no coinsurance, therapeutic services require a copay and 20% coinsurance, and outpatient X-rays require a $40 copay and coinsurance.
Home Health Services See details
Home health services are covered by the Aetna Medicare Signature (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Aetna Medicare Signature (HMO) with no coinsurance, though some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require copayments ranging from $15 to $20.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility services are partially covered by Aetna Medicare Signature (HMO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Signature (HMO) partially covers other services, offering a meal benefit for chronic illness, an annual wellness exam and screening mammography, and additional gFOBT and FIT with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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