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Aetna Medicare Premier (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier (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 (HMO-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Premier (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 out of 5 stars in 2026.
It's important to know that Aetna Medicare Premier (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 (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 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $104.00. 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 $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 (HMO-POS) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay when filled through a preferred pharmacy or preferred mail order service. If you use a standard pharmacy or standard mail order, copays range from $2 to $6 for Tier 1 and $12 to $36 for Tier 2 depending on the fill supply. For higher-tier medications, cost-sharing is based on coinsurance rather than copays. Tier 3 preferred brand drugs require a 24% coinsurance across all pharmacy options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, with specialty drugs restricted to a one-month fill.
Additional Benefits
The Aetna Medicare Premier (HMO-POS) plan offers robust medical coverage with no copay for primary care visits and copays ranging from no copay to $40 for specialists. Inpatient hospital stays require a daily copay of either $300 or $350 for the first few days, while emergency room visits carry a $115 copay, both with no coinsurance. Additionally, home health services and the first 20 days of skilled nursing facility care are covered with no copay or coinsurance. The plan also features generous supplemental benefits, including routine dental care up to $2,000 annually and routine vision exams with a $400 allowance for eyewear, all with no copay. Hearing aids are covered up to $500 per ear annually with no copay, and members receive a $90 quarterly reimbursement for over-the-counter items. Most diagnostic tests and medical equipment require no copay, though some specialized services and equipment may carry a coinsurance of up to 20%.
Inpatient Hospital See details
Aetna Medicare Premier (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $300 daily copay for days 1 through 7 of acute stays and a $350 daily copay for days 1 through 5 of psychiatric stays, with no copay for subsequent days. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Premier (HMO-POS) covers outpatient hospital services with no coinsurance and copays ranging from $0 to $300, plus a $300 copay per stay for observation services. Ambulatory surgical center and outpatient blood services feature no copay and no coinsurance, while outpatient substance abuse individual and group sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Aetna Medicare Premier (HMO-POS) covers partial hospitalization services with a copay of $55.00 or $110.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Premier (HMO-POS), with ground ambulance services requiring a $295 copay and air ambulance services requiring 20% coinsurance. Transportation services are partially covered, offering up to 6 one-way trips per year to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Aetna Medicare Premier (HMO-POS) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 maximum limit with no coinsurance and copays ranging from $115 to $295.
Primary Care See details
Primary care benefits under Aetna Medicare Premier (HMO-POS) are partially covered, featuring no copay and no coinsurance for primary care physician visits, though podiatry and certain chiropractic services are not covered. Most other covered services, including specialist visits, physical therapy, and mental health services, have no coinsurance and copays ranging from $0 to $40, while telehealth benefits carry a 20% coinsurance and a $0 to $40 copay.
Preventive Services See details
Preventive services under Aetna Medicare Premier (HMO-POS) are partially covered, featuring no copay and no coinsurance for annual physical exams, glaucoma screenings, and diabetes self-management training. Kidney disease education is covered with no copay and a 20% coinsurance, while wigs for chemotherapy-related hair loss are covered up to $400 annually with no copay and no coinsurance. Several supplemental options, including in-home safety assessments, personal emergency response systems, weight management, and nutritional benefits, are not covered.
Hearing Services See details
Hearing services are covered under the Aetna Medicare Premier (HMO-POS) plan, featuring a $35 copay and no coinsurance for Medicare-covered exams, alongside routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, though OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Premier (HMO-POS) covers vision services with no coinsurance, featuring a $0 to $35 copay for eye exams and no copay for routine annual exams. Covered eyewear, including contacts and eyeglasses, also has no copay and is subject to a $400 annual maximum limit.
Dental Services See details
Aetna Medicare Premier (HMO-POS) offers partially covered dental services, featuring Medicare-covered dental care for a $35 copay and no coinsurance, alongside other dental services with no copay and no coinsurance up to a $2,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Premier (HMO-POS) covers home infusion bundled services with no copay, although prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs carry a coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Aetna Medicare Premier (HMO-POS) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Aetna Medicare Premier (HMO-POS) covers medical equipment with no copays for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Coinsurance ranges from no coinsurance up to 20% depending on the item, with prosthetic devices requiring a flat 20% coinsurance, and prior authorization is required.
Diagnostic and Radiological Services See details
Aetna Medicare Premier (HMO-POS) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic tests, lab services, and procedures have no copay and no coinsurance, while radiological services require a $20 copay for outpatient X-rays, a minimum 20% coinsurance for therapeutic radiology, and copays starting at $0 for diagnostic radiology.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Premier (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Premier (HMO-POS) covers some cardiac rehabilitation services with no copay and no coinsurance, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Premier (HMO-POS) covers skilled nursing facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered under Aetna Medicare Premier (HMO-POS) with no copay and no coinsurance, though acupuncture is not covered. Covered benefits include chronic illness meal services, annual wellness exams, screening mammographies, additional gFOBT and FIT screenings, and up to $90 every three months in reimbursement for over-the-counter items.
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