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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 MI Southwest. 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 $5500.00 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. During the initial coverage phase, after you meet your deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have 24% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. If you qualify for the low-income subsidy, your Part D costs will be $0.
Additional Benefits
The Aetna Medicare Premier (HMO-POS) plan offers a range of benefits. This plan covers inpatient hospital stays with a copay for the first few days, and outpatient services with varying copays depending on the service. Emergency services have a copay, and primary care physician services have no copay. The plan also includes coverage for preventive, hearing, vision, and dental services, often with no copays for routine services. Additional benefits include home health services with no copay, along with coverage for medical equipment and home infusion services. However, certain services like cardiac rehabilitation and some other specific services are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, 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. Non-Medicare-covered stays and upgrades are not covered. Inpatient Hospital Psychiatric services are covered with a $325 copay for days 1-7, and no copay for days 8-90. Additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay ranging from $0 to $325, observation services with a $325 copay, ambulatory surgical center 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. Prior authorization is required for some services.
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 includes coverage for ground and air ambulance services, but transportation services to health-related locations are not covered. Ground ambulance services have a $265 copay, while air ambulance services have 20% coinsurance.
Emergency Services See details
Emergency Services are covered by the Aetna Medicare Premier (HMO-POS) plan with a $125 copay, and Urgently Needed Services have a $50 copay, while Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have copays of $125 and $265, respectively. Worldwide Emergency Services has a maximum plan benefit of $100,000.
Primary Care See details
Primary Care Physician Services have no copay, and Chiropractic Services have a $20 copay. Occupational Therapy Services have a $45 copay and no coinsurance, while Physician Specialist Services have a copay between $0 and $35. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $40 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $45 copay and no coinsurance. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $75.
Preventive Services See details
Preventive Services include annual physical exams with no copay, while additional preventive services may have a copay. Kidney Disease Education Services have a 20% coinsurance. Other Preventive Services include glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay.
Hearing Services See details
Hearing Services includes coverage for hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $500 per year, 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 between $0 and $35. Routine eye exams have no copay for one visit every year, and other eye exam services also have no copay. Eyewear is covered with no copay, and has a combined maximum benefit of $165 every year.
Dental Services See details
The Aetna Medicare Premier (HMO-POS) plan covers dental services, including oral exams, dental x-rays, other diagnostic services, cleanings, fluoride treatments, and other preventive services with no copay, and restorative, adjunctive general, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery services with no copay. Other dental services have a $1,600 annual maximum, and Medicare dental services require a $35 copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
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 coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Premier (HMO-POS) plan. The plan requires prior authorization and has a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetics/Medical Supplies with a coinsurance for some services, and Diabetic Equipment, including Diabetic Supplies with a coinsurance between 0% and 20% and Diabetic Therapeutic Shoes/Inserts with no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Aetna Medicare Premier (HMO-POS) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $100, while 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 by the Aetna Medicare Premier (HMO-POS) plan. While the plan generally covers this benefit, the specific cardiac rehabilitation services, intensive cardiac rehabilitation services, pulmonary rehabilitation services, and SET for PAD services 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. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered stays 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. 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.
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