A non-government entity
Aetna Medicare North Mississippi Health (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare North Mississippi Health (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare North Mississippi Health (HMO) in 2025, please refer to our full plan details page.
Aetna Medicare North Mississippi Health (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in NMHS MS Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare North Mississippi Health (HMO) 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 North Mississippi Health (HMO).
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 North Mississippi Health (HMO), 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. Additionally, this plan comes with a Part B Premium reduction of $20.00. You must continue to pay paying your reduced 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 $6900.00 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:
Sign up for Aetna Medicare North Mississippi Health (HMO)
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Drug Coverage
The Aetna Medicare North Mississippi Health (HMO) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, there is no copay when using a preferred pharmacy or preferred mail order. The plan also offers coinsurance for standard generic drugs, preferred brand drugs, and non-preferred drugs. Once your out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare North Mississippi Health (HMO) plan offers a variety of benefits with varying costs. This plan includes coverage for inpatient and outpatient services, with copays ranging from $0 to $380. It also covers primary care, preventive services, hearing, vision, and dental services, often with no copay or a low copay. Additional benefits include ambulance, emergency, and home health services, as well as medical equipment and diagnostic services, all with specific copays or coinsurance amounts. The plan also covers skilled nursing facility stays and offers other services like over-the-counter items and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $380 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you'll pay a $407 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $380, observation services with a $380 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $30 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare North Mississippi Health (HMO) plan, but requires prior authorization. For this benefit, you will have an $80 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare North Mississippi Health (HMO) plan, with a $250 copay for ground ambulance services and 20% coinsurance for air ambulance services. 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 North Mississippi Health (HMO) plan. Emergency Services have a $110 copay with no coinsurance, Urgently Needed Services have a $45 copay with no coinsurance, and Worldwide Emergency Services have a $110 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $250 copay for Worldwide Emergency Transportation, with no coinsurance.
Primary Care See details
The Aetna Medicare North Mississippi Health (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services and physician specialist services have no copay, while chiropractic services have a $15 copay, occupational therapy services have a $25 copay, mental health specialty services, psychiatric services, and opioid treatment program services have a $30 copay, physical therapy and speech-language pathology services have a $25 copay, and other health care professional services have a copay between $0 and $35. The additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for services like an annual physical exam with no copay, and other preventive services like glaucoma screenings, diabetes self-management training, and barium enemas, all with no copay. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Hearing Services include hearing exams with a $35 copay, routine hearing exams with no copay for 1 visit per year, fitting/evaluation for hearing aids with no copay for 1 visit per year, and prescription hearing aids (all types) with no copay for 2 visits per year, up to $500 per year. Prescription hearing aids for the inner, outer, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
Vision Services include coverage for eye exams with a copay of $0-$35, routine eye exams with no copay, and other eye exam services with no copay. The plan also covers eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, all with no copay and a combined maximum of $275 per year.
Dental Services See details
Dental services are covered, with a $2,000 maximum benefit per year. Medicare dental services require prior authorization and have a $35 copay. 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 are covered with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. 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 North Mississippi Health (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Aetna Medicare North Mississippi Health (HMO) plan covers medical equipment including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable Medical Equipment has a 20% coinsurance with authorization required, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices have a coinsurance of 20% and Medical Supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $95, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $300, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare North Mississippi Health (HMO) plan with no copay and no coinsurance, however, additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare North Mississippi Health (HMO) 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 under the Aetna Medicare North Mississippi Health (HMO) 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
Other Services include coverage for Over-the-Counter items and a meal benefit with no copay, as well as coverage for annual wellness exams and screening mammograms, and gFOBT and FIT 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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