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Aetna Medicare Advantra (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Advantra (HMO) in 2025, please refer to our full plan details page.
Aetna Medicare Advantra (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in New Orleans, Baton Rouge and Shreveport Parishes. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Advantra (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 Advantra (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 Advantra (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. Additionally, this plan comes with a Part B Premium reduction of $10.00. You must continue to pay paying your reduced 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 $6900.00 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 Advantra (HMO) plan has a $590.00 deductible for prescription drugs. Once you meet your deductible, you will begin to pay for your prescriptions. For preferred generic drugs, you will have no copay at preferred pharmacies and preferred mail order, while standard pharmacies and standard mail order will have a $12 copay. For other tiers, you will pay coinsurance. After your total drug costs reach $2000.00, you will enter the catastrophic coverage phase where you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Aetna Medicare Advantra (HMO) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a copay for the first 10 days, and then no copay. Outpatient services have copays ranging from $0 to $195, and other services like primary care, hearing, vision, and dental have copays as well. This plan provides coverage for ambulance services, emergency services, and home health services. It also covers preventive services, hearing aids, and eyewear. Other services, like dental and medical equipment, have a coinsurance or copay.
Inpatient Hospital See details
Inpatient hospital services are covered, including acute and psychiatric care. For acute care, you'll pay a $195 copay for days 1-10, and no copay for days 11-90; for psychiatric care, you'll pay a $407 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services with a copay ranging from $0 to $195, observation services with a $195 copay, Ambulatory Surgical Center (ASC) services with no copay, outpatient substance abuse services with a $30 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Advantra (HMO) plan, but requires prior authorization. You will have an $80 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Advantra (HMO). Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance; however, 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 Aetna Medicare Advantra (HMO). Emergency Services and Worldwide Emergency Coverage have a $110 copay, Worldwide Emergency Transportation has a $250 copay, and Urgently Needed Services has a $45 copay; all services have no coinsurance.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $25 copay, Physician Specialist Services with a copay between $0 and $35, and Physical Therapy and Speech-Language Pathology Services with a $25 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $30 copay for individual and group sessions. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $45. Podiatry Services are not covered.
Preventive Services See details
Preventive services include annual physical exams with no copay, and other services like health education, wigs for hair loss, smoking cessation counseling, and fitness benefits. Some services are not covered, including in-home safety assessments, personal emergency response systems, and more. Kidney disease education services have a 20% coinsurance, and other preventive services have a copay for some services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing exams are covered with a $35 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered with a plan-specified amount of $500 per year, and prescription hearing aids (all types) are covered with no copay. Prescription hearing aids for the inner, outer, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision Services include coverage for eye exams and eyewear. Eye exams have a copay between $0 and $35, while routine eye exams and other eye exam services have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay and a combined maximum of $300 per year.
Dental Services See details
Dental services include a $35 copay for Medicare dental services, with other services such as oral exams, x-rays, and cleanings offered with no copay. This plan has a maximum benefit of $2650 per year for dental services, but does not cover maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Advantra (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Aetna Medicare Advantra (HMO) plan covers Durable Medical Equipment (DME) with a 20% coinsurance and requires authorization, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies have a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests and Lab Services, are covered with a copay of up to $95 for Diagnostic Procedures/Tests and no copay for Lab Services. Therapeutic Radiological Services are covered with a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Advantra (HMO) plan with no copay and no coinsurance; however, 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 Advantra (HMO) plan, but the specific services listed are not covered. There is a copay for some services, but no further details are provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Advantra (HMO), but require prior authorization. For days 1-20, there is no copay, while days 21-100 have a $214 copay.
Other Services See details
Other services include coverage for over-the-counter items and meal benefits with no copay, as well as other services like annual wellness exams, screening mammography, gFOBT, and FIT with no copay. 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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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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