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Aetna Medicare Enhanced (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Enhanced (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 Enhanced (HMO-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Enhanced (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Westchester and Rockland Counties. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Aetna Medicare Enhanced (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 Enhanced (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 Enhanced (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $69.00. 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 $615.00 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 $9250.00 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 Enhanced (HMO-POS) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay when using preferred pharmacies or preferred mail-order services for up to a three-month supply. If you choose standard pharmacies or standard mail order, copays start at $2 for Tier 1 and $12 for Tier 2 for a one-month supply. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance across all pharmacy networks. Specialty tier medications are limited to a one-month supply at this 25% coinsurance rate.
Additional Benefits
The Aetna Medicare Enhanced (HMO-POS) plan offers comprehensive medical coverage featuring no copay for primary care physician visits and low specialist copays ranging from $0 to $40. For hospital care, inpatient acute stays require a $395 daily copay for the first six days and no copay thereafter, while emergency room visits carry a $115 copay. Outpatient services and diagnostic lab tests are highly accessible, often requiring no copay and no coinsurance. This plan also provides valuable supplemental benefits, including routine vision and dental care with no copay up to specified annual limits, alongside hearing aid coverage with copays starting at $0. Skilled nursing facility stays require no copay for the first 20 days, and home health services are covered with no copay or coinsurance. Most covered services under this plan feature no coinsurance, helping to keep your healthcare costs predictable.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by Aetna Medicare Enhanced (HMO-POS) with no coinsurance, though prior authorization is required. Medicare-covered acute stays require a $395 daily copay for days 1 through 6 and no copay for additional days, while psychiatric stays require a $346 daily copay for days 1 through 6 and no copay for days 7 through 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Enhanced (HMO-POS) with no coinsurance across all benefits, including no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $395, observation services carry a $395 copay per stay, and outpatient substance abuse sessions have a $40 copay, with prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization is covered under the Aetna Medicare Enhanced (HMO-POS) plan with a copayment of $105.00 or $110.00 and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Aetna Medicare Enhanced (HMO-POS) covers ground and air ambulance services with a $275 copay and no coinsurance, though prior authorization is required. Routine transportation services to health-related locations are not covered.
Emergency Services See details
Aetna Medicare Enhanced (HMO-POS) covers emergency services with a $115 copay—waived if admitted to the hospital within 24 hours—and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance up to a $250,000 maximum limit, carrying a $115 copay for emergency or urgent care and a $275 copay for emergency transportation.
Primary Care See details
Aetna Medicare Enhanced (HMO-POS) provides primary care physician visits with no copay and no coinsurance, and specialist visits with a $0 to $40 copay and no coinsurance. Physical, occupational, mental health, and psychiatric therapies require copays of $35 to $40 with no coinsurance, while telehealth services have a $0 to $40 copay and 20% coinsurance. Chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered under Aetna Medicare Enhanced (HMO-POS), offering no copay and no coinsurance for annual physicals, health education, fitness benefits, and various screenings, while kidney disease education requires a 20% coinsurance and no copay. Although supplemental benefits like chemotherapy wigs are covered up to $400 annually with no copay, several services such as in-home safety assessments, weight management, and nutritional/dietary benefits are not covered.
Hearing Services See details
Hearing Services are partially covered by Aetna Medicare Enhanced (HMO-POS), offering Medicare-covered exams for a $40 copay and no coinsurance, alongside annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and copays ranging from $0 to $1,700, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Enhanced (HMO-POS) with no coinsurance, featuring a $0 to $40 copay for eye exams and no copay for routine annual exams. Covered eyewear, including contacts and eyeglasses, also has no copay and is subject to a $200 annual maximum benefit.
Dental Services See details
Aetna Medicare Enhanced (HMO-POS) provides partially covered dental services, featuring Medicare-covered dental care for a $40 copay and no coinsurance, and other dental services with no copay and no coinsurance up to a $750 annual limit. While many preventive and restorative treatments are included, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Enhanced (HMO-POS) covers home infusion bundled services with no copay, although prior authorization is required. Associated Medicare Part B chemotherapy and other drugs require a coinsurance ranging from no coinsurance to 20%, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Enhanced (HMO-POS) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered under the Aetna Medicare Enhanced (HMO-POS) plan with no copay, though prior authorization is required for these services. Durable medical equipment, diabetic supplies, and medical supplies require coinsurance ranging from no coinsurance up to 20%, while prosthetic devices and diabetic therapeutic shoes or inserts carry a flat 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Enhanced (HMO-POS) with prior authorization required. Lab services have no copay or coinsurance, diagnostic tests range from a $0 to $40 copay with no coinsurance, and diagnostic radiological services start at a $0 copay. Outpatient X-rays require a $40 copay, while therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Enhanced (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Enhanced (HMO-POS) features no coinsurance for cardiac rehabilitation, but only some services are covered. Specifically, cardiac rehabilitation (with a $20 copay), intensive cardiac rehabilitation (with a $20 copay), pulmonary rehabilitation (with a $15 copay), and SET for PAD services (with a $20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Enhanced (HMO-POS) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. You will pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Enhanced (HMO-POS) partially covers other services, offering a chronic illness meal benefit, an annual wellness exam and screening mammography, and additional gFOBT and FIT with no copay and no coinsurance. Under this benefit, acupuncture, over-the-counter (OTC) items, and dual-eligible SNP services are not covered.
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