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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 Southern, IN 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 $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:
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, your cost will vary depending on the drug tier and whether you use a preferred pharmacy. For example, you will have no copay for preferred generic drugs at a preferred pharmacy, and a $12 copay at a standard pharmacy. For standard generic drugs, preferred brand, and non-preferred drugs, you will pay 24% or 25% coinsurance, depending on the drug and pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Premier (HMO-POS) plan offers a range of benefits with varying costs. This plan covers inpatient hospital stays with a copay, outpatient services with copays, and offers no copay for primary care physician visits. The plan also includes coverage for emergency services, hearing and vision services, dental services, and home health services. Additional benefits include coverage for ambulance services, diagnostic and radiological services, and durable medical equipment, but some services like cardiac rehabilitation and additional home health care hours are not covered. The plan also provides an over-the-counter item benefit and a meal benefit with no copay.
Inpatient Hospital See details
Inpatient Hospital services are covered, including acute and 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, and non-Medicare covered stays and upgrades for inpatient hospital-acute are not covered. Additional days and non-Medicare-covered stays for inpatient hospital psychiatric are also not covered.
Outpatient Services See details
The Aetna Medicare Premier (HMO-POS) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $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.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier (HMO-POS) plan. You will pay a $60 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $260 copay, while air ambulance services have a 20% coinsurance; transportation services to health-related locations 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 have a $125 copay, Urgently Needed Services have a $35 copay, and Worldwide Emergency Services has a $125 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $260 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 $40 copay. The plan also covers physician specialist services with a copay between $0 and $40, and physical therapy and speech-language pathology services with a $40 copay. Mental health specialty services, psychiatric services, and opioid treatment program services are covered with a $40 copay for individual and group sessions. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $75. Podiatry services are not covered.
Preventive Services See details
Preventive Services include Medicare-covered zero dollar services, annual physical exams with no copay, additional preventive services with copays, and kidney disease education services with 20% coinsurance. Other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit have no copay. Other services like in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, and support for caregivers of enrollees are not covered.
Hearing Services See details
Hearing exams are covered with a $40 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $750 per year with no copay, but specific types of prescription hearing aids 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. Routine eye exams are covered with no copay for one visit every year, while other eye exam services are covered with no copay. Eyewear has a combined maximum of $165 per year.
Dental Services See details
Dental services are covered, including Medicare Dental Services with a $40 copay, oral exams with no copay, dental x-rays with no copay, and prophylaxis (cleaning) with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered, while restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with coinsurance ranging from 20% to 50%. Orthodontic services are covered up to a maximum of $2500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B insulin drugs with a $35 copay. Other Medicare Part B drugs and chemotherapy/radiation drugs are covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Premier (HMO-POS) plan. This plan requires prior authorization, and has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment and Prosthetics/Medical Supplies, is covered by the Aetna Medicare Premier (HMO-POS) plan. Durable Medical Equipment has a coinsurance of 0-20%, 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 $100, and Lab Services have no copay, while Diagnostic Radiological Services have a copay of at most $235. 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, though additional hours of care and personal care services are not covered. Prior 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. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by 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 for SNF 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 with no copay and a maximum benefit of $45 every three months, as well as a Meal Benefit 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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