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Aetna Medicare Extra Value (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Extra Value (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 Extra Value (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Extra Value (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Puget Sound Area. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Aetna Medicare Extra Value (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 Extra Value (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 Extra Value (HMO-POS), 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 $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 $6750.00 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 Extra Value (HMO-POS) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. Once you meet your deductible, you will pay a copay or coinsurance depending on the tier and pharmacy. For preferred generic drugs, you will pay no copay at preferred pharmacies and mail order, or a $12 copay at standard pharmacies. For standard generic drugs, you will pay 24% coinsurance. Preferred brand and non-preferred drugs will cost 25% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Extra Value (HMO-POS) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a copay, but many other services, such as primary care visits, preventive services, and vision services, have no copay. Additional benefits include coverage for outpatient services, hearing aids, dental services, and home infusion services. The plan also covers emergency services, ambulance services, and diagnostic services. However, some services like podiatry, maxillofacial prosthetics, and orthodontics are not covered.
Inpatient Hospital See details
The Aetna Medicare Extra Value (HMO-POS) plan covers inpatient hospital stays, with a copay of $410 for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades are not covered, and Inpatient Hospital Psychiatric benefits are covered with a $410 copay for days 1-5 and no copay for days 6-90, but Additional Days and Non-Medicare-covered Stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $320, observation services with a $410 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Extra Value (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Extra Value (HMO-POS) plan. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance. 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. Emergency Services has a $100 copay, Urgently Needed Services has a $45 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage both have a $100 copay, while Worldwide Emergency Transportation has a $250 copay; there is no coinsurance for any of these services.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services are partially covered, with a $15 copay for routine care. Occupational Therapy Services are covered with a $20 copay. Physician Specialist Services have a copay between $0 and $45. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services are covered with a $40 copay for individual or group sessions. Physical Therapy and Speech-Language Pathology Services have a $20 copay. Additional Telehealth Benefits are covered with a 20% coinsurance and a copay between $0 and $45. Other Health Care Professional services are covered with a copay between $0 and $45. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, as well as additional services like health education, wigs for hair loss, and remote access technologies, all with no copay. Other covered services include glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay, while kidney disease education services have a 20% coinsurance. Some services, such as in-home safety assessments, are not covered.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered with no copay. Prescription hearing aids are covered, with a maximum benefit of $2,000 per year, and prescription hearing aids (all types) are covered with no copay, however, inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services, including eye exams and eyewear, are covered by the Aetna Medicare Extra Value (HMO-POS) plan. Eye exams and eyewear have no copay, with an allowance of $150 per year for eyewear.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $45 copay, and other dental services with a $650 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 under the Aetna Medicare Extra Value (HMO-POS) plan. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Extra Value (HMO-POS) plan. This plan requires prior authorization and has a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment with 20% coinsurance and no copay, Prosthetics/Medical Supplies with a 20% coinsurance and no copay, and Diabetic Equipment. Diabetic Supplies have a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $10, and Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $325, while Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Extra Value (HMO-POS) 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 covered by the Aetna Medicare Extra Value (HMO-POS) plan, but no specific services are covered. The plan has a copay for these services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
The Aetna Medicare Extra Value (HMO-POS) plan covers Skilled Nursing Facility (SNF) services with prior authorization. You will have no copay for days 1-20, and a $196 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The "Other Services" benefit in the Aetna Medicare Extra Value (HMO-POS) plan does not cover acupuncture, over-the-counter items, meal benefits, or several other services. Other 1 and Other 2 are covered with no copay.
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