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Aetna Medicare Enhanced (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Enhanced (HMO-POS). 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-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Enhanced (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2026 to people living in Southern Maine. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Enhanced (HMO-POS) 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-POS).
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-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $44.00. 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 $6350.00 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-POS) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay when utilizing preferred pharmacies or preferred mail-order services. If you choose standard pharmacies or standard mail-order options, Tier 1 copays range from $2 to $6, while Tier 2 copays range from $12 to $36 depending on the fill supply. For higher-tier medications, costs are structured as a percentage of the drug cost rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance regardless of the pharmacy type. While Tiers 1 through 4 allow for multi-month supplies, Tier 5 specialty medications are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Enhanced (HMO-POS) plan offers comprehensive medical coverage with predictable cost-sharing, featuring no copays for primary care visits, annual physicals, and routine vision and hearing exams. For specialized care, members pay copays up to $50 for specialists and a $130 copay for emergency room visits, which is waived if admitted. Inpatient hospital stays require a $435 daily copay for the first seven days, followed by no copay for unlimited additional days. This plan also includes strong supplemental benefits, such as a $1,000 annual maximum for preventive and comprehensive dental care with no copayments, and up to $200 yearly for eyewear. Additionally, members can take advantage of home health services with no copay, a $45 quarterly over-the-counter reimbursement, and no copays for outpatient lab services. Skilled nursing facility stays are covered with no coinsurance, requiring a low $10 daily copay for the first 20 days.
Inpatient Hospital See details
Aetna Medicare Enhanced (HMO-POS) covers inpatient acute hospital stays with no coinsurance and a $435 daily copay for days 1 through 7, followed by no copay for unlimited additional days. Inpatient psychiatric care is also covered with no coinsurance and a $334 daily copay for days 1 through 7, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Enhanced (HMO-POS) covers outpatient services with no coinsurance, featuring copays of $0 to $395 for outpatient hospital services, $360 per stay for observation services, and $50 for 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-POS) covers partial hospitalization services with a copay of either $85.00 or $145.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Enhanced (HMO-POS) covers ground ambulance services with a $320 copay and air ambulance services with a 20% coinsurance, both requiring prior authorization. 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-POS) covers emergency room visits with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, and neither service's cost-sharing counts toward the plan deductible. Worldwide emergency services are covered up to $250,000 with no coinsurance and copays of $130 for emergency or urgent care and $320 for transportation.
Primary Care See details
Aetna Medicare Enhanced (HMO-POS) provides primary care physician services with no copay and no coinsurance, while specialist visits, mental health services, and physical therapies require copays up to $50 with no coinsurance. Telehealth options are covered with a $0 to $50 copay and 20% coinsurance, though podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive Services under Aetna Medicare Enhanced (HMO-POS) are partially covered, featuring annual physical exams, health education, and select screenings with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, while several supplemental services like in-home safety assessments, medical nutrition therapy, and weight management programs are not covered.
Hearing Services See details
Hearing services are covered by Aetna Medicare Enhanced (HMO-POS), offering routine exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $50 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $0 to $1,700 and no coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Enhanced (HMO-POS) with no deductibles and no coinsurance, offering no copay for annual routine eye exams and up to a $50 copay for Medicare-covered exams. Covered eyewear, including lenses, frames, and contacts, features no copay up to a combined maximum plan benefit of $200 every year.
Dental Services See details
Dental services are partially covered by Aetna Medicare Enhanced (HMO-POS), featuring a $1,000 annual maximum for most preventive and comprehensive care with no copay and no coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered. Medicare-covered dental services are available with a $50 copay and no coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Enhanced (HMO-POS) 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 require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Aetna Medicare Enhanced (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Enhanced (HMO-POS) covers medical equipment with no copays, though coinsurance ranges from no coinsurance up to 25% depending on the specific item. Prior authorization is required for durable medical equipment, prosthetics, and diabetic supplies, which may also be subject to manufacturer limitations.
Diagnostic and Radiological Services See details
Aetna Medicare Enhanced (HMO-POS) covers diagnostic and radiological services, requiring prior authorization for all services. Outpatient diagnostic procedures and tests have no coinsurance and a copay of $0 to $45, while lab services have no copay or coinsurance. Outpatient X-rays carry a $20 copay and coinsurance, and therapeutic radiological services require a minimum 20% coinsurance and a copay.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Enhanced (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Enhanced (HMO-POS) covers some cardiac rehabilitation services with no coinsurance, but standard cardiac rehabilitation (with a $20 copay), intensive cardiac rehabilitation ($20 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Enhanced (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copayment for days 1 to 20 and a $218 daily copayment for days 21 to 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not necessary, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Enhanced (HMO-POS) offers partial coverage for other services with no copay and no coinsurance, including chronic illness meal benefits, annual wellness exams, select cancer screenings, and a $45 quarterly over-the-counter reimbursement. Acupuncture is not covered under these additional services.
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