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Aetna Medicare Assure Plus (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Assure Plus (HMO-POS D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Assure Plus (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Assure Plus (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Maine. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Assure Plus (HMO-POS D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Aetna Medicare Assure Plus (HMO-POS D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Aetna Medicare Assure Plus (HMO-POS D-SNP).
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 Assure Plus (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $33.80. 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 $590.00 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 $9350.00 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 Assure Plus (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy, your monthly Part D premium is $33.80. After meeting your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. Once you reach that amount, you will enter the next coverage phase where you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Aetna Medicare Assure Plus (HMO-POS D-SNP) plan offers coverage for a variety of services, including inpatient and outpatient care, with varying cost-sharing structures. Emergency, urgent, and preventive services often have no copay, while services like outpatient hospital, observation, and some vision and dental services may have coinsurance. The plan also includes benefits for hearing aids, home infusion, medical equipment, and home health services, as well as a monthly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $2120 per admission or stay for Inpatient Hospital-Acute and a copay of $2036 per admission or stay for Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered by this plan. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services also have a 20% coinsurance. The plan also covers individual and group sessions for outpatient substance abuse with a coinsurance between 20% and 20%.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Assure Plus (HMO-POS D-SNP) plan and requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Assure Plus (HMO-POS D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, with no copay. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Assure Plus (HMO-POS D-SNP) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
Primary Care Physician Services are covered with a 17% coinsurance, while Chiropractic Services are partially covered, with only Routine Care not covered and a 20% coinsurance for the rest. Occupational Therapy Services, Physician Specialist Services, Individual and Group Sessions for Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, and Opioid Treatment Program Services are all covered with a coinsurance ranging from 0% to 20%. Additional Telehealth Benefits are covered with no copay.
Preventive Services See details
Preventive services include annual physical exams with no copay, along with additional preventive services such as Health Education, Nutritional/Dietary Benefits, and Wigs for Hair Loss Related to Chemotherapy with no copay. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, and Barium Enemas have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a coinsurance of at most 20% for routine hearing exams, and fitting/evaluation for hearing aids has no copay. Prescription hearing aids are covered up to a maximum of $1250.00 per year, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, and neither are OTC hearing aids.
Vision Services See details
Vision Services include coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, while routine eye exams and other eye exam services have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, has a 20% coinsurance, and a combined maximum plan benefit of $445 per year.
Dental Services See details
Dental services include coverage for Medicare dental services with 20% coinsurance and other dental services with a $1,000 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Assure Plus (HMO-POS D-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance; however, Durable Medical Equipment for use outside the home is not covered. Diabetic Equipment is covered, with Diabetic Supplies having no coinsurance, and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered with no copay, and coinsurance of up to 20% for Diagnostic Procedures/Tests, Lab Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Radiological Services have no coinsurance.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Assure Plus (HMO-POS D-SNP) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Assure Plus (HMO-POS D-SNP) plan. The plan does not cover any of the sub-services including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered. You will pay the Medicare-defined cost share for tier 1, with a copay determined by the plan.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $110.00 every month. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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