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Aetna Medicare Enhanced (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Enhanced (HMO). 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) in 2026, please refer to our full plan details page.
Aetna Medicare Enhanced (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Metro: Queens. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Aetna Medicare Enhanced (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 Enhanced (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 Enhanced (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $74.00. 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) plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay when using a preferred pharmacy or preferred mail-order service for up to a three-month supply. If you choose a standard pharmacy or standard mail order, Tier 1 copays range from $2 to $6, while Tier 2 copays range from $12 to $36 depending on the supply duration. For higher-tier medications, the plan transitions to coinsurance rather than set copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance across all pharmacy and mail-order options. Note that Tier 5 specialty medications are only available for a one-month supply.
Additional Benefits
The Aetna Medicare Enhanced (HMO) plan offers affordable healthcare coverage with no copay or coinsurance for primary care visits, routine physicals, and home health services. Specialist visits, urgent care, and emergency services are accessible with low copayments and no coinsurance. For hospital stays, members pay a daily copay for the first five days of inpatient care, after which there is no copay for up to 90 days. This plan also includes additional wellness benefits, featuring no copay or coinsurance for routine dental exams, cleanings, annual vision exams, and routine hearing tests. Covered diagnostic lab services and home infusion therapies also come with no copay, while prescription hearing aids and durable medical equipment are available with variable copays or up to 20% coinsurance. Overall, the plan minimizes out-of-pocket coinsurance costs for most routine and preventative healthcare needs.
Inpatient Hospital See details
Aetna Medicare Enhanced (HMO) provides partially covered inpatient hospital care with no coinsurance and a copay of $399 per day for days 1 through 5, and no copay for days 6 through 90. Unlimited additional days for acute stays are covered with no copay, but psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Enhanced (HMO) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and blood services. Outpatient hospital services have a copay ranging from $0 to $395, observation services require a $399 copay per stay, and outpatient substance abuse sessions have a $45 copay.
Partial Hospitalization See details
Aetna Medicare Enhanced (HMO) covers partial hospitalization services with a copay of either $105.00 or $110.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Aetna Medicare Enhanced (HMO), which covers ground and air ambulance services with a $275 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or any other health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Enhanced (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 maximum with no coinsurance and copays ranging from $115 to $275.
Primary Care See details
Primary Care benefits under the Aetna Medicare Enhanced (HMO) feature no copay and no coinsurance for primary care physician services, while specialist visits require a $0 to $45 copay and no coinsurance. Physical, occupational, mental health, and psychiatric services have copays ranging from $35 to $45 with no coinsurance, whereas telehealth requires a $0 to $45 copay and 20% coinsurance. Podiatry is not covered, and for chiropractic services, some services are covered with a $15 copay and no coinsurance, but routine chiropractic care and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Enhanced (HMO) with no copay and no coinsurance for most services, including annual physicals, while kidney disease education requires a 20% coinsurance and no copay. Uncovered sub-services include 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, nutritional/dietary benefits, home-based palliative care, in-home support services, caregiver support, enhanced disease management, telemonitoring, home and bathroom safety modifications, and counseling.
Hearing Services See details
Aetna Medicare Enhanced (HMO) covers routine hearing exams and fitting evaluations with no copay, while Medicare-covered exams require a $45 copay, both with no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $0 to $1,700 for up to two aids per year, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Aetna Medicare Enhanced (HMO) covers vision services with no coinsurance, offering routine eye exams annually with no copay and Medicare-covered exams with a $0 to $45 copay. Eyewear, including contacts and eyeglasses, is covered with no copay and no coinsurance up to a combined maximum plan benefit of $100 every year.
Dental Services See details
Dental services are partially covered under the Aetna Medicare Enhanced (HMO) plan, featuring a $45 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for exams, cleanings, and x-rays. Uncovered services include fluoride treatments, orthodontics, restorative services, endodontics, periodontics, prosthodontics, implants, and oral surgery.
Home Infusion bundled Services See details
Aetna Medicare Enhanced (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 and other Part B drugs feature no copay and 0% to 20% coinsurance.
Dialysis Services See details
Aetna Medicare Enhanced (HMO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Enhanced (HMO) covers medical equipment with no copays, though prior authorization is required. Coinsurance ranges from no coinsurance to 20% for durable medical equipment, medical supplies, and diabetic supplies, while prosthetic devices and diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Enhanced (HMO) covers diagnostic services with no coinsurance, offering no copay for lab services and a $0 to $45 copay for diagnostic procedures. Radiological services are also covered, featuring a $0 minimum copay for diagnostic radiology, a $45 copay plus coinsurance for outpatient X-rays, and a minimum 20% coinsurance along with copays for therapeutic radiology.
Home Health Services See details
Home health services are covered by Aetna Medicare Enhanced (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Enhanced (HMO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, although only some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Enhanced (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day inpatient 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 Medicare-covered period are not covered.
Other Services See details
Aetna Medicare Enhanced (HMO) provides partially covered other services, though over-the-counter (OTC) items are not covered. Covered benefits include acupuncture for a $45 copay and no coinsurance (limited to 12 treatments per year), while chronic illness meals, annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings are offered with no copay and no coinsurance.
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