A non-government entity
Aetna Medicare Signature (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Signature (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Signature (HMO) in 2026, please refer to our full plan details page.
Aetna Medicare Signature (HMO) is a HMO 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 2026.
It's important to know that Aetna Medicare Signature (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 Signature (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 Signature (HMO), 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 $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 $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 Signature (HMO) plan features an annual prescription drug deductible of $615. Beneficiaries can save significantly on lower-tier drugs, as there is no copay for Tier 1 preferred generic and Tier 2 generic medications filled at preferred pharmacies or through preferred mail order. If you choose standard pharmacies or standard mail-order services, Tier 1 copays start at $2 and Tier 2 copays start at $12 for a one-month supply. For brand-name and specialty medications, the plan utilizes coinsurance 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 across all pharmacy and mail-order options. This clear pricing structure makes it easy to estimate your out-of-pocket prescription costs with the Aetna Medicare Signature (HMO) plan.
Additional Benefits
The Aetna Medicare Signature (HMO) plan offers robust medical coverage featuring no copay and no coinsurance for primary care visits, home health services, and annual preventive exams. Specialist visits range from no copay to a $65 copay, while inpatient acute hospital stays require a $550 daily copay for the first five days. Outpatient services are covered with no coinsurance, with copays ranging from no copay for ambulatory surgical center visits up to $500 for outpatient hospital services. For supplemental care, the plan provides routine hearing and vision exams with no copay, coinsurance, or deductible, alongside allowances of up to $500 per ear for prescription hearing aids and $100 for eyewear. Dental benefits include routine cleanings and exams with no copay, though Medicare-covered dental services require a $65 copay. Other essential services include a 20% coinsurance with no copay for durable medical equipment and dialysis, alongside a $130 copay for emergency room visits.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Aetna Medicare Signature (HMO) with no coinsurance, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Acute stays incur a $550 copay per day for days 1 through 5 and no copay thereafter, while psychiatric stays incur a $465 copay per day for days 1 through 5 and no copay for days 6 through 90.
Outpatient Services See details
Aetna Medicare Signature (HMO) covers outpatient services with no coinsurance, offering ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services require a copay of $0 to $500, observation services require a $550 copay per stay, and outpatient substance abuse services have a $50 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Aetna Medicare Signature (HMO) plan with a copay of $140.00 or $145.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Signature (HMO), with ground ambulance services requiring a $315.00 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Prior authorization is required for all ambulance services, and while some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Aetna Medicare Signature (HMO) covers emergency services with a $130 copay (waived if admitted to the hospital within 24 hours) and urgently needed services with a $45 copay, both with no coinsurance. Worldwide emergency and urgent services are also covered with a $130 copay, and worldwide emergency transportation has a $315 copay, with no coinsurance up to a maximum plan benefit of $250,000.
Primary Care See details
Primary care benefits for the Aetna Medicare Signature (HMO) plan feature primary care physician visits with no copay and no coinsurance, and specialist visits ranging from no copay to a $65 copay with no coinsurance. Physical, occupational, and speech therapy require a $45 copay with no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered under the Aetna Medicare Signature (HMO) plan, featuring no copay and no coinsurance for annual exams, fitness benefits, health education, remote access, and most screenings, while kidney disease education has no copay and 20% coinsurance. Uncovered sub-services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
Aetna Medicare Signature (HMO) partially covers hearing services, providing Medicare-covered exams, annual routine exams, and fitting evaluations with no copay, no coinsurance, and no deductible. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Signature (HMO) covers vision services with no copay, no coinsurance, and no deductible for both eye exams and eyewear. Covered benefits include one routine eye exam per year and a combined maximum allowance of $100 annually for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Aetna Medicare Signature (HMO) partially covers dental services, offering Medicare-covered dental care for a $65 copay and no coinsurance, and routine cleanings, exams, and x-rays with no copay and no coinsurance. However, fluoride, other diagnostic or preventive services, restorative care, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Signature (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and coinsurance ranging from 0% to 20%.
Dialysis Services See details
Aetna Medicare Signature (HMO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Signature (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, requiring prior authorization. Diabetic therapeutic shoes and inserts have no copay, while diabetic supplies from specified manufacturers require no coinsurance up to a 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Signature (HMO) covers diagnostic and radiological services with prior authorization, offering no coinsurance and a $0 to $35 copay for diagnostic tests, alongside no copay for lab services and outpatient X-rays. Diagnostic radiological services carry a $0 minimum copay, while therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by Aetna Medicare Signature (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Signature (HMO) covers cardiac rehabilitation services with no copay and no coinsurance, although only some services are covered in practice as standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Signature (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and allowing admission without a prior three-day hospital stay. Covered days require a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard 100-day limit are not covered.
Other Services See details
Aetna Medicare Signature (HMO) partially covers other services, providing coverage for annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under these additional services.
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