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Aetna Medicare Premier (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare 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 Premier (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Premier (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in IN Northeast. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare 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 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 Premier (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 $5000.00 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 Premier (HMO-POS) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you'll have no copay at preferred pharmacies and preferred mail order. Standard generic drugs have a 24% coinsurance. Preferred and non-preferred brand drugs have a 25% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your covered drugs.
Additional Benefits
The Aetna Medicare Premier (HMO-POS) plan offers a wide range of benefits. This plan covers inpatient hospital stays with a $325 copay for the first 7 days, and no copay for the rest. Outpatient services, including primary care, have varying copays, while many preventive services, such as an annual physical, have no copay. Additional benefits include coverage for hearing and vision services, with copays for exams and no copay for eyewear, as well as dental services with copays and coinsurance for various procedures. The plan also covers ambulance services with copays, emergency services with a $125 copay, and home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a $325 copay for days 1-7, and no copay for days 8-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $325, Observation Services with a $325 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $75 copay for both individual and group sessions, and Outpatient Blood Services with no copay. All services require prior authorization.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier (HMO-POS) plan with a $65 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Premier (HMO-POS) plan. Ground ambulance services have a $295 copay, while air ambulance services have a 20% 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 Premier (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $40 copay, and Worldwide Emergency Transportation has a $295 copay, with no coinsurance for any of these services.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services are covered with a $20 copay, but routine care is not covered. Occupational Therapy Services and Mental Health Specialty Services have a $40 copay. Other Health Care Professional services have a copay between $0 and $40. Physical Therapy and Speech-Language Pathology Services have a $40 copay. Additional Telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $75.
Preventive Services See details
The Aetna Medicare Premier (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Health education, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, wigs for hair loss related to chemotherapy, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit are covered with no copay. Kidney disease education services have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a $40 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $750 per ear annually, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Premier (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$40, and eyewear with no copay. The plan covers routine eye exams with no copay for one exam per year, and other eye exam services with no copay.
Dental Services See details
Dental services include coverage for Medicare dental services with a $40 copay, oral exams with no copay, dental x-rays and prophylaxis (cleaning) with no copay, restorative services with 20-50% coinsurance, adjunctive general services with 20-50% coinsurance, endodontics with 20% coinsurance, periodontics with 20-50% coinsurance, prosthodontics (removable) with 50% coinsurance, prosthodontics (fixed) with 50% coinsurance, and oral and maxillofacial surgery with 20-50% coinsurance. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay. 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 Premier (HMO-POS) plan. The plan requires prior authorization and has a coinsurance of 20%.
Medical Equipment See details
Under the Aetna Medicare Premier (HMO-POS) plan, Durable Medical Equipment is covered with a coinsurance between 0% and 20%, and Prosthetic Devices and Medical Supplies are covered with 20% coinsurance and 0-20% coinsurance, respectively. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Premier (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $75, Lab Services have no copay, and Diagnostic Radiological Services have a copay of at most $275. Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Premier (HMO-POS) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Premier (HMO-POS) plan. Although the plan covers Cardiac Rehabilitation Services, the specific services under this benefit are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Premier (HMO-POS) plan, but require prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, there is a $214 copay.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items, with no copay, and a maximum benefit of $60 every three months. Acupuncture, 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, 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 are not covered. Meal Benefit and Other 1 and Other 2 services are covered with no copay.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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