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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 Central. 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.

Overview IconKey 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 $4900.00 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:

Regular visits to your primary care doctor are covered and will have a copay of $0.00 and coinsurance of 0% (no coinsurance).

Specialist Visits:

Visits to specialists are covered and will have a copay of $35.00 and coinsurance of 0% (no coinsurance). Specialist visits may require a referral from your primary care doctor or prior authorization.

Emergency Room:

Trips to the Emergency Room are covered, and will have a copay of $125.00 and coinsurance of 0% (no coinsurance). Coverage may vary for in-network and out-of-network hospitals.

Urgent Care:

Trips to Urgent Care arecovered and will have a copay of $40.00 and coinsurance of 0% (no coinsurance). Coverage may vary for in-network and out-of-network hospitals.

Sign up for Aetna Medicare Premier (HMO-POS)

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Drug Coverage IconDrug Coverage

The Aetna Medicare Premier (HMO-POS) plan has an enhanced alternative drug benefit. The plan has a $590 deductible. After the deductible is met, you will pay a copay or coinsurance for your prescriptions. For example, preferred generic drugs have no copay at preferred pharmacies and preferred mail order, while standard generic drugs have a 24% coinsurance.

Additional Benefits IconAdditional Benefits

The Aetna Medicare Premier (HMO-POS) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. Emergency, primary care, preventive, hearing, vision, and dental services are also included, with some services having no copay. The plan provides coverage for home health, skilled nursing, and medical equipment, while also covering other services like over-the-counter items and meal benefits.

Inpatient Hospital See details

Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $325 for days 1-6, and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered, while 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 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 $325 copay, and ambulatory surgical center services have no copay. Individual and group sessions for outpatient substance abuse have a copay of $75, and outpatient blood services have no copay.

Partial Hospitalization See details

Partial Hospitalization is covered by the Aetna Medicare Premier (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $85.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered by Aetna Medicare Premier (HMO-POS), with prior authorization required for all ambulance services. Ground ambulance services have a $275 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 by the Aetna Medicare Premier (HMO-POS) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a $40 copay, and Worldwide Emergency Services have a copay of $125 for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $275 copay for Worldwide Emergency Transportation.

Primary Care See details

The Aetna Medicare Premier (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $35 copay. The plan covers physician specialist services with a $35 copay, and physical therapy and speech-language pathology services with a $35 copay. Mental health specialty services, psychiatric services, and opioid treatment program services are covered with a $40 copay for both individual and group sessions. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $75. However, podiatry services are not covered.

Preventive Services See details

Preventive services are covered. Annual physical exams have no copay. Kidney disease education services have a 20% coinsurance. Other preventive services including glaucoma screenings, 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, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a $35 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $750 per ear every year, with no copay for all types, except for Inner Ear, Outer Ear, and Over the Ear hearing aids, which are not covered. OTC hearing aids are not covered.

Vision Services See details

Vision services are covered, including eye exams and eyewear. Eye exams have a copay of $0-$35, and routine eye exams are limited to one per year with no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay, and has a combined maximum benefit of $205 per year.

Dental Services See details

Dental services are covered, with a $35 copay for Medicare dental services, and no copay for oral exams, dental x-rays, and prophylaxis (cleaning). The plan does not cover fluoride treatment, maxillofacial prosthetics, implant services, or orthodontics. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with 20% to 50% coinsurance, depending on the service.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered by Aetna Medicare Premier (HMO-POS) and 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 under the Aetna Medicare Premier (HMO-POS) plan and require prior authorization. You will pay 20% coinsurance for these services.

Medical Equipment See details

Medical Equipment benefits are covered under the Aetna Medicare Premier (HMO-POS) plan. Durable Medical Equipment has a coinsurance between 0% and 20%, but does not have a copay, 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%, with no copay. Diabetic Supplies have a coinsurance between 0% and 20%, while Diabetic Therapeutic Shoes/Inserts have no copay.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are covered under the Aetna Medicare Premier (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $60, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $225, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $10 copay.

Home Health Services See details

Home Health Services are covered by the Aetna Medicare 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 not covered under the Aetna Medicare Premier (HMO-POS) plan. Although generally covered, the plan does not cover any specific services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.

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 no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.

Other Services See details

The Aetna Medicare Premier (HMO-POS) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay. However, acupuncture, 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 are not covered. Other services such as annual wellness exams, screening mammography, gFOBT and FIT, are covered with no copay.

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