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Aetna Medicare Prime Value (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Prime Value (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 Prime Value (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Prime Value (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Counties: BR, HT, MR, MN, MO, PS, SM, SX, UN, WR. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Prime Value (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 Prime Value (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 Prime Value (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 Prime Value (HMO-POS) plan has a $590.00 deductible for prescription drugs. After the deductible, you'll pay either a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies and preferred mail order pharmacies, while standard generic drugs have 24% coinsurance. The plan offers an enhanced alternative drug benefit. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Prime Value (HMO-POS) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays that vary by service. Primary care visits have no copay, and many preventive services are covered with no copay. The plan provides coverage for hearing, vision, and dental services, with some services having no copay. Diagnostic, radiological, and home health services are covered, with varying copays and coinsurance amounts depending on the service. Additionally, the plan covers emergency services, ambulance, and skilled nursing facilities, with copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $345 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will pay a $339 copay for days 1-6, and no copay for days 7-90. Additional days and upgrades for Inpatient Hospital-Acute are not covered, and Non-Medicare-covered Stay for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes 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 $325, observation services have a $345 copay, ambulatory surgical center services have no copay, and outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse each have a $40 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Prime Value (HMO-POS) plan. This benefit has a $60 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Prime Value (HMO-POS) plan. Ground and Air Ambulance Services have a $300 copay, and there is 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 under the Aetna Medicare Prime Value (HMO-POS) plan. 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 services have no coinsurance.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $25 copay, Physician Specialist Services with a $0-$30 copay, Mental Health and Psychiatric Specialty Services with a $40 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $30 copay, and Other Health Care Professional services with a $0-$30 copay. Additional Telehealth Benefits have a 20% coinsurance and a $0-$45 copay, while Opioid Treatment Program Services have a $40 copay. Podiatry Services are not covered.
Preventive Services See details
Preventive services include no copay for annual physical exams, health education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. Wigs for hair loss related to chemotherapy are covered with no copay and a maximum plan benefit coverage amount of $400. Kidney disease education services have a 20% coinsurance.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $30 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription Hearing Aids (all types) have a copay up to $1,700, while Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Prime Value (HMO-POS) plan covers vision services, including eye exams with a copay between $0 and $30, and eyewear with a $0 copay and a combined maximum benefit of $150 per year. Routine eye exams, other eye exam services, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are all covered with no copay.
Dental Services See details
Dental services include coverage for Medicare dental services with a $30 copay, and other dental services. 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 have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Prime Value (HMO-POS) plan. 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 Prime Value (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the Aetna Medicare Prime Value (HMO-POS) plan. Durable Medical Equipment (DME) is covered with a coinsurance between 0% and 20%, and there is no copay. Prosthetics/Medical Supplies, including Medicare-covered Prosthetic Devices and Medical Supplies, have a coinsurance. Diabetic Equipment, including Diabetic Supplies with a coinsurance between 0% and 20% and Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance, is covered, and some services require prior authorization.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Prime Value (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $30, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $225, and Outpatient X-Ray Services have a $30 copay. Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Prime Value (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 Prime Value (HMO-POS) plan, but the plan does not cover any of the sub-services. There is a copay for the services, but the amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Prime Value (HMO-POS) plan, with prior authorization required. There is no copay for days 1-20, and a $214 copay for days 21-100; additional days beyond Medicare and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Prime Value (HMO-POS) plan 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. The plan covers meal benefits with no copay, and other services including annual wellness exams, screening mammography, gFOBT, and FIT with no copay.
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