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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: Staten Island. 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 $91.00. 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 generics and Tier 2 generics, you will pay no copay when using a preferred pharmacy or preferred mail-order service for a one-month, two-month, or three-month supply. If you use a standard pharmacy or standard mail-order service, Tier 1 copays start at $2 and Tier 2 copays start at $12 for a one-month supply. For higher-tier medications, cost-sharing transitions to coinsurance across all pharmacy and mail-order options. Tier 3 preferred brands require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. Choosing preferred network pharmacies and mail-order services is the most cost-effective way to fill generic prescriptions under this plan.
Additional Benefits
The Aetna Medicare Enhanced (HMO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, routine dental cleanings, and routine vision exams. Specialist visits and outpatient hospital services are also highly affordable, with copays ranging from no copay up to $45 and $395 respectively, and no coinsurance. Additionally, emergency care is covered with a $115 copay, which is waived if you are admitted, and inpatient hospital stays require a $399 copay for the first few days with no copay thereafter. For supplemental health needs, the plan covers routine hearing exams and prescription hearing aids with no coinsurance, alongside a $100 annual allowance with no copay for eyewear. Home health services are fully covered with no copay and no coinsurance, while durable medical equipment and dialysis require no copay and up to a 20% coinsurance. Skilled nursing facility stays are also covered with no copay for the first 20 days, helping you manage your recovery costs effectively.
Inpatient Hospital See details
Aetna Medicare Enhanced (HMO) partially covers inpatient hospital care with no coinsurance, requiring a $399 copay for days 1 to 6 of acute stays and days 1 to 5 of psychiatric stays, with no copay for remaining days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Enhanced (HMO) covers outpatient services with no coinsurance, featuring a $0 to $395 copay for outpatient hospital services, a $399 copay per stay for observation services, and a $45 copay for outpatient substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Aetna Medicare Enhanced (HMO) covers partial hospitalization services with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Aetna Medicare Enhanced (HMO) covers Medicare-approved ground and air ambulance services with a $260 copay and no coinsurance, subject to prior authorization. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
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 require a $40 copay with no coinsurance, and worldwide emergency services are covered up to a $250,000 limit with no coinsurance and copays ranging from $115 to $260.
Primary Care See details
Primary care benefits under the Aetna Medicare Enhanced (HMO) feature no copay and no coinsurance for primary care provider visits, while specialist visits require a copay of $0 to $45 and no coinsurance. Physical, occupational, and speech therapies carry a $35 copay with no coinsurance, and mental health services require a $45 copay with no coinsurance, though podiatry and routine chiropractic care are not covered.
Preventive Services See details
Aetna Medicare Enhanced (HMO) partially covers preventive services, with most covered benefits like annual physical exams and screenings requiring no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Several supplemental options are not covered, including in-home safety assessments, personal emergency response systems, weight management, and nutritional benefits.
Hearing Services See details
Hearing services are covered by Aetna Medicare Enhanced (HMO), which offers Medicare-covered exams for a $45 copay and no coinsurance, alongside annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $0 to $1,700, but OTC hearing aids as well as 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 deductibles and no coinsurance, featuring annual routine eye exams with no copay and Medicare-covered exams with a copay ranging from $0 to $45. Eyewear, including contact lenses and eyeglasses, also has no copay and no coinsurance, subject to a combined maximum plan benefit of $100 per year.
Dental Services See details
Aetna Medicare Enhanced (HMO) partially covers dental services, offering Medicare-covered dental services for a $45 copay and no coinsurance, and select preventive services like exams, cleanings, and X-rays with no copay and no coinsurance. However, several services are not covered, including fluoride treatments, 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 is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a 0% to 20% coinsurance and no copay.
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
Medical equipment is covered by Aetna Medicare Enhanced (HMO) with no copays, though prior authorization is required. Beneficiaries will pay no coinsurance to 20% coinsurance for durable medical equipment, medical supplies, and diabetic supplies, and a flat 20% coinsurance for prosthetics and diabetic therapeutic shoes.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Enhanced (HMO) plan, with prior authorization required for these services. Diagnostic services have no coinsurance, featuring no copay for lab services and up to a $45 copay for procedures, while radiological services require a $45 copay for X-rays and a minimum 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home health services are covered under the Aetna Medicare Enhanced (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Enhanced (HMO) with no coinsurance. Although some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require copays ranging from $15 to $20.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Enhanced (HMO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Enhanced (HMO) partially covers other services, providing a chronic illness meal benefit, annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture, over-the-counter items, and Dual Eligible SNPs are not covered.
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