A non-government entity
Aetna Medicare Signature (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Signature (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Signature (HMO) in 2026, please refer to our full plan details page.
Aetna Medicare Signature (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Capital Region and Hudson Valley Area. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Aetna Medicare Signature (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 Signature (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 Signature (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.
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 Signature (HMO) plan features a yearly drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay when using preferred pharmacies or preferred mail-order services. Standard pharmacies and standard mail-order options require a low copay, starting at $2 for Tier 1 and $12 for Tier 2 for a one-month supply. For higher-tier medications, your costs are based on a percentage of the drug cost rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance across all pharmacy and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, with specialty drugs limited to a one-month supply.
Additional Benefits
The Aetna Medicare Signature (HMO) offers comprehensive medical coverage with predictable out-of-pocket costs, including a $10 copay for primary care visits and no copay to a $50 copay for specialist visits. Emergency care is available with a $115 copay, while inpatient hospital stays require a daily copay of $407 for the first six days of acute care with no coinsurance. Outpatient services and ambulatory surgical center visits are also covered with no coinsurance and copays ranging from no copay up to $407. Beneficiaries also enjoy no copay for preventive care, annual routine vision and hearing exams, and routine dental cleanings and X-rays. Additionally, the plan covers home health services with no copay and skilled nursing facility stays with no copay for the first 20 days. Diagnostic lab services and yearly routine physicals are also fully covered with no copay or coinsurance, helping you easily manage your everyday wellness.
Inpatient Hospital See details
Aetna Medicare Signature (HMO) covers inpatient hospital services with no coinsurance, requiring a $407 daily copay for days 1 to 6 of acute stays and a $346 daily copay for days 1 to 6 of psychiatric stays, with no copays for subsequent covered days. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Signature (HMO) covers outpatient services with no coinsurance, offering ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services carry a copay ranging from $0 to $407, while outpatient substance abuse sessions require a $45 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Signature (HMO) with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by Aetna Medicare Signature (HMO) with a $300 copay and no coinsurance for both ground and air transport, subject to prior authorization. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Aetna Medicare Signature (HMO) covers emergency services with a $115 copay and no coinsurance (waived if admitted to the hospital within 24 hours), and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $115, $115, and $300 respectively, up to a $250,000 maximum plan benefit.
Primary Care See details
Aetna Medicare Signature (HMO) provides primary care physician visits for a $10 copay and specialist visits for no copay to a $50 copay, with no coinsurance required for either. Therapy services, including physical and occupational therapy, have a $35 copay and no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Signature (HMO), with most covered benefits like annual physicals and glaucoma screenings requiring no copay and no coinsurance, while kidney disease education requires no copay and a 20% coinsurance. Sub-services not covered under this plan include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
Aetna Medicare Signature (HMO) partially covers hearing services, providing routine hearing exams and fitting evaluations annually with no copay and no coinsurance, while Medicare-covered exams require a $50 copay and no coinsurance. Up to two prescription hearing aids are covered per year 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 Signature (HMO) with no coinsurance, featuring no copay for yearly routine eye exams and a copay of $0 to $50 for Medicare-covered exams. Eyewear is also covered with no copay and no coinsurance, providing a $100 annual maximum benefit for contacts, frames, lenses, and upgrades.
Dental Services See details
Aetna Medicare Signature (HMO) provides partial coverage for dental services, offering preventive care including oral exams, cleanings, and X-rays with no copay and no coinsurance. Medicare-covered dental services require a $50 copay and no coinsurance, while other services such as fluoride, restorative treatments, endodontics, periodontics, prosthodontics, implants, and oral surgery are not covered.
Home Infusion bundled Services See details
Aetna Medicare Signature (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Signature (HMO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Signature (HMO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays and coinsurance ranging from no coinsurance up to 20%. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Signature (HMO) covers diagnostic services with no coinsurance, offering lab services with no copay and diagnostic procedures with a copay of $0 to $50. Covered radiological services include outpatient X-rays for a $50 copay, diagnostic radiological services starting at no copay, and therapeutic radiological services with a 20% coinsurance.
Home Health Services See details
Aetna Medicare Signature (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Signature (HMO) with no coinsurance, though in practice some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. These non-covered rehabilitation services require copayments ranging from $15 to $20.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Aetna Medicare Signature (HMO) with no coinsurance, though prior authorization is required and additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, and a prior three-day inpatient hospital stay is not required for admission.
Other Services See details
Aetna Medicare Signature (HMO) partially covers other services, offering a chronic illness meal benefit, an annual wellness exam and screening mammography, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and dual eligible SNPs with highly integrated services are not covered under this plan.
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