A non-government entity
Aetna Medicare Signature Care (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Signature Care (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 Care (HMO) in 2026, please refer to our full plan details page.
Aetna Medicare Signature Care (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Bronx, Brooklyn, NYC, Queens, Nassau, Westchester. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Aetna Medicare Signature Care (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 Care (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 Care (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:
Sign up for Aetna Medicare Signature Care (HMO)
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Drug Coverage
The Aetna Medicare Signature Care (HMO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, there is no copay when you fill your prescriptions through a preferred pharmacy or preferred mail order service. If you choose a standard pharmacy or standard mail order instead, copays start at $2.00 for Tier 1 drugs and $12.00 for Tier 2 drugs for a one-month supply. Higher-tier medications under this plan require coinsurance instead of flat copayments. You will pay a 24% coinsurance for Tier 3 preferred brand drugs at both preferred and standard pharmacies. For Tier 4 non-preferred drugs and Tier 5 specialty drugs, a 25% coinsurance applies across all pharmacy and mail order options.
Additional Benefits
The Aetna Medicare Signature Care (HMO) plan offers robust coverage with no copay or coinsurance for primary care visits, annual physicals, routine eye exams, and preventive dental services. For specialist visits and urgent care, members pay low copays ranging from $10 to $50 with no coinsurance, while emergency room visits incur a $115 copay. Inpatient hospital stays require a daily copay for the first six days, after which there is no copay, and skilled nursing facility stays are covered with no copay for the first 20 days. Diagnostic lab work, home health services, and home infusions are also available with no copay, though certain medical equipment and dialysis services require up to a 20% coinsurance. Hearing and vision benefits feature no coinsurance, providing routine exams at no copay alongside allowances for hearing aids and eyewear. Additionally, members can access over-the-counter health items with no copay up to a $15 quarterly reimbursement limit.
Inpatient Hospital See details
Aetna Medicare Signature Care (HMO) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute care, you pay a $407 daily copay for days 1 to 6 and no copay for day 7 onward, while psychiatric stays require a $346 daily copay for days 1 to 6 and no copay for days 7 to 90; upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Signature Care (HMO) covers outpatient hospital services with a $0 to $407 copay and no coinsurance, and observation services with a $407 copay per stay and no coinsurance. Ambulatory surgical center and blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $45 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Signature Care (HMO) with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Signature Care (HMO) covers ground and air ambulance services with a $285 copay and no coinsurance, with prior authorization required. For transportation, some services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Signature Care (HMO) with a $115 copay (waived if admitted within 24 hours) and no coinsurance, while urgent care has a $40 copay and no coinsurance. Worldwide emergency services are also covered up to a $250,000 limit with no coinsurance, requiring a $115 copay for emergency or urgent care and a $285 copay for emergency transportation.
Primary Care See details
Aetna Medicare Signature Care (HMO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $10 to $50 copay and no coinsurance. Therapy and mental health services require copays ranging from $35 to $45 with no coinsurance, while chiropractic services are partially covered with a $15 copay and no coinsurance (routine chiropractic is not covered) and podiatry is not covered.
Preventive Services See details
Preventive Services under the Aetna Medicare Signature Care (HMO) are partially covered, offering no copay and no coinsurance for annual physicals, health education, and various screenings, though kidney disease education requires a 20% coinsurance. Several supplemental options are not covered, including in-home safety assessments, personal emergency response systems, and nutritional benefits.
Hearing Services See details
Aetna Medicare Signature Care (HMO) covers hearing services with no deductible and no coinsurance, featuring a $50 copay for Medicare-covered exams and no copay for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with copays ranging from $0 to $1,700 for up to two aids per year, while 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 Care (HMO) with no coinsurance, featuring a $0 to $50 copay for eye exams and no copay for eyewear. This benefit includes one annual routine eye exam and follow-up diabetic eye exams at no copay, plus a $100 annual maximum allowance for contact lenses, frames, lenses, and upgrades.
Dental Services See details
Aetna Medicare Signature Care (HMO) partially covers dental services, providing Medicare-covered dental services for a $50 copay and no coinsurance, and select preventive services like exams, cleanings, and x-rays with no copay and no coinsurance. However, several sub-services are not covered, including fluoride treatments, restorative services, endodontics, periodontics, prosthodontics, implants, and oral surgery.
Home Infusion bundled Services See details
Aetna Medicare Signature Care (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Signature Care (HMO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Signature Care (HMO) with no copayments, though prior authorization is required. Depending on the item, coinsurance ranges from no coinsurance up to 20% for durable medical equipment, medical supplies, and diabetic supplies, while prosthetic devices and diabetic shoes require a flat 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under Aetna Medicare Signature Care (HMO), with prior authorization required for all services. Diagnostic services feature no coinsurance, with no copay for lab work and a $0 to $50 copay for procedures, while radiological services require a $50 copay for X-rays (with coinsurance), no copay for diagnostic radiology, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Aetna Medicare Signature Care (HMO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Signature Care (HMO) covers Cardiac Rehabilitation Services with no coinsurance, though only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Signature Care (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard 100-day limit are not covered.
Other Services See details
Aetna Medicare Signature Care (HMO) partially covers other services, offering meals for chronic illness, annual wellness exams, screening mammographies, and additional colorectal screenings with no copay and no coinsurance. Over-the-counter items are also covered with no copay and no coinsurance up to a $15 reimbursement limit every three months, while acupuncture is not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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