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Aetna Medicare Premier Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier Plus (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 Premier Plus (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Premier Plus (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Southeastern Pennsylvania. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Premier Plus (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 Premier Plus (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 Premier Plus (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $89.00. 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 $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 Premier Plus (HMO-POS) plan has a $590 deductible for prescription drugs. Once you meet your deductible, you will pay either a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you have no copay at preferred pharmacies or preferred mail order, and a $12 copay at standard pharmacies and standard mail order. For other tiers, you will pay 24% to 25% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Premier Plus (HMO-POS) plan offers a wide range of benefits. This plan includes coverage for inpatient and outpatient hospital services, with varying copays depending on the specific service. Emergency, primary care, and preventive services generally have low or no copays, including an annual physical exam. The plan also offers additional benefits such as hearing, vision, and dental services, with copays ranging from $0 to $30 for certain services. Prescription hearing aids have a maximum benefit of $500 per year, and eyewear has a combined maximum benefit of $500 per year. The plan also covers home health services with no copay, and offers coverage for other services like OTC items, nicotine replacement therapy, and a meal benefit.
Inpatient Hospital See details
The Aetna Medicare Premier Plus (HMO-POS) plan covers Inpatient Hospital services, with a $395 copay per admission for Inpatient Hospital-Acute services, and a $350 copay for days 1-5 and no copay for days 6-90 for Inpatient Hospital Psychiatric services. Additional Days for Inpatient Hospital-Acute has no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $350, and observation services with a $350 copay. Ambulatory Surgical Center (ASC) Services have no copay, while Outpatient Substance Abuse services have a $40 copay for individual and group sessions. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier Plus (HMO-POS) plan, but prior authorization is required. The plan has a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Premier Plus (HMO-POS) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $240 copay, while air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location are covered for up to 6 one-way trips per year with no copay.
Emergency Services See details
Emergency Services are covered under the Aetna Medicare Premier Plus (HMO-POS) plan with a $110 copay and no coinsurance, while Urgently Needed Services have a $45 copay and no coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage and Worldwide Urgent Coverage, have a $110 copay and no coinsurance, while Worldwide Emergency Transportation has a $240 copay and no coinsurance, with a maximum benefit coverage of $150,000.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services are covered with a $15 copay for routine care, up to 12 visits per year. Occupational Therapy Services, Physician Specialist Services, and Other Health Care Professional services are covered with copays ranging from $0 to $30. Mental Health Specialty Services and Psychiatric Services are covered with a $40 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services are covered with a $20 copay. Additional Telehealth Benefits are covered with a 20% coinsurance and a copay between $0 and $45. Opioid Treatment Program Services are covered with a $40 copay. Podiatry Services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay. Additionally, health education, wigs for hair loss related to chemotherapy, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, remote access technologies, and fitness benefits are covered, with no copay for health education, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, remote access technologies, and fitness benefits, and a maximum benefit of $400 per year for wigs for hair loss related to chemotherapy. Kidney disease education services are covered with 20% coinsurance. Other services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
The Aetna Medicare Premier Plus (HMO-POS) plan covers hearing exams with a $30 copay, and fitting/evaluation for hearing aids and routine hearing exams with no copay. Prescription hearing aids are covered up to a maximum of $500 per year, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services include eye exams, routine eye exams, other eye exam services, and eyewear. Eye exams have a copay between $0 and $30, while routine eye exams and other eye exam services have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum plan benefit coverage of $500 per year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $30 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventative dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered, and there is a $2,500 maximum benefit per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Premier Plus (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has a coinsurance of 0% to 20%, while Diabetic Supplies have a coinsurance of 0% to 20% and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Premier Plus (HMO-POS) plan. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $250, Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Premier Plus (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 not covered under the Aetna Medicare Premier Plus (HMO-POS) plan. The plan does not cover any of the listed cardiac rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier Plus (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items with no copay, a $105 maximum benefit amount every three months, and coverage for Nicotine Replacement Therapy (NRT), Meal Benefit with no copay, and other services like annual wellness exams and screening mammography with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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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